POMC and Salla disease: In addition, SD also relates to various HPA axis dysregulations (e.g., flattened CORT rhythm amplitude, blunted CORT awakening response (CAR), increased but also decreased diurnal CORT levels, higher CRH levels) and altered endocrine stress reactivity (e.g., attenuated pituitary ACTH reactivity, increased adrenocortical ACTH sensitivity) (257, 263–269), as well as to altered autonomic regulation with increased sympatho-adrenal and reduced vagal activity and blunted cardiovascular autonomic rhythmicity and autonomic reactivity (257, 270–273).