POMC and Adrenal insufficiency: Primary adrenal insufficiency was confirmed by decreased serum cortisol levels (73 nmol/L at 9 am, reference range 135–540 nmol/L), increased plasma adrenocorticotropic hormone (ACTH) levels (89 pmol/L, reference range 1.6–14 pmol/L), and a positive (that is, no steroid response) ACTH stimulation test.