These included genetic causes in 5 patients: 1 patient with adrenal hypoplasia due to a defect in NR0B1, 2 patients with ACTH resistance due to a defect in MRAP, 1 patient with triple A syndrome due to a defect in AAAS, and 1 patient with Mulibrey nanism due to a defect in TRIM37. In addition, 1 patient had been diagnosed with adrenal aplasia during fetal ultrasound. The gene discussed is POMC; the disease is Triple A syndrome.