POMC and neoplasm: While spontaneous tumor regression cannot be ruled out (although extremely rare) (43), the changes in ACTH and cortisol levels that occurred in these patients during relacorilant treatment, characterized by early increases followed by reductions later during treatment, are consistent with the hypothesized inhibition of ACTH by endogenous somatostatin due to upregulation of SSTR2, as also seen in Patient 1.