As a limitation, we did not perform an adrenocorticotropic hormone stimulation test in our cases for confirmation of AI, however, according to the guideline released by “Endocrine Society Clinical Practice Guideline “If a corticotropin stimulation test is not feasible, using morning cortisol < 5 μg/dL in combination with high ACTH ( i.e. > twofold upper limit of the reference range) is suggestive of adrenal insufficiency [44]. This evidence concerns the gene POMC and Adrenal insufficiency.