POMC and Adrenal insufficiency: In our present work, adrenal insufficiency was found in 13.6% (43/316) of patients at baseline; 70.3% (222/316) had elevated ACTH with normal cortisol levels in the morning; 70.3% of patients had elevated ACTH with normal cortisol levels, but it was hard to decide whether it was pulsatile secretion or partial adrenal deficiency.