POMC and Infertility: The pathogenesis of TARTs is not fully understood, but they are believed to be derived from ectopic adrenal cells that descend with the testes during embryological development and grow under the influence of high concentrations of adrenocorticotropic hormone (ACTH), which is usually seen in cases of poor control of the disease.[7,8] Growth of TARTs may cause infertility by compression of the normal testicular tissue and the seminiferous tubules, which leads to obstruction of semen outflow.