Low early morning serum cortisol is abnormal and the concomitant presence of a high-serum ACTH is suggestive of primary adrenal insufficiency, while low-serum ACTH is suggestive of secondary adrenal insufficiency.[11] The diagnosis of primary adrenal insufficiency can made when secondary adrenal insufficiency is excluded according to clinical features, biochemical evidence, and medical imaging of the case. Here, POMC is linked to primary adrenal insufficiency.