POMC and skin atrophy: Diagnosed SH by the absence of signs and/or symptoms of cortisol excess (i.e. striae rubrae,moon facies, buffalo hump, and skin atrophy) and by the presence (in at least two out of three different estimations)of cortisol levels after 1 mg overnight dexamethasonesuppression (1 mg-DST)>5.0 μg/dl (138 nmol/l) or in the presence of greater than or equal to two out of the following alterations: 1 mg-DsT >3.0 μg/d (83nmol/1),adrenocorticotropic hormone (ACTH) levels <10 pg/ml(2.2 pmol/l),24h urinary free cortisol (UFC) levels>70 μg/24 h (193 nmol/24 h).