A diagnosis of PAI depends on low serum cortisol and high plasma adrenocorticotropic hormone (ACTH) as well as clinical findings, such as hyperpigmentation of the skin, hypoglycemia, salt wasting, hypotension, and other non-specific symptoms such as fatigue, weight loss, failure to thrive, depression, and convulsions (2,3). This evidence concerns the gene POMC and Failure to thrive.