Primary adrenal insufficiency should be suspected in HD (1) if the peak serum cortisol is <15 ug/dL in the ACTH stimulation test (according to Ohashi et al. [97]) or under 18 ug/dL (according to Sakao et al. [98]) or (2) if basal plasma ACTH are high without increased serum cortisol in the ACTH stimulation test [97]. Here, POMC is linked to primary adrenal insufficiency.