POMC and hypopituitarism: The usual sequential pattern of hormonal failure is loss of secretion of GH followed by gonadotropins, TSH, and ACTH; this order is mainly seen in patients with tumors and after radiation therapy, while hypopituitarism due to other etiologies may present with a different sequence of deficiency, for example, ACTH deficiency may be the first manifestation in hypophysitis (1,22,30).