Low ACTH in the presence of a failure to pass the ACTH1-24 stimulation test is indicative of secondary adrenal insufficiency, which supports the diagnosis of OAI due to a central cause; however, opioid receptors are abundant on the adrenal glands as well (22) and the presence of a combined primary (which will cause high ACTH level) and secondary (causing low ACTH level) adrenal insufficiency resulting in low-normal ACTH level had never been studied. This evidence concerns the gene POMC and Adrenal insufficiency.