The constellation of adrenal, gonadal and thyroid disease is described in one other non-autoimmune-inherited form of adrenal insufficiency secondary to mutations in nicotinamide nucleotide transhydrogenase (NNT), involved in energy transfer in the mitochondrial respiratory chain (44), although there have now also been reports of hypothyroidism adding to the phenotype of adrenal and gonadal insufficiency in MIRAGE syndrome secondary to gain of function mutations in SAMD9 (45). Here, NNT is linked to MIRAGE syndrome.