POMC and Prader-Willi syndrome: The following clinical findings seem to suggest that HPA axis impairment (HPAI) may indeed be a part of the clinical picture of PWS: (i) the presence of a hypothalamic dysfunction with multiple hormone deficiencies (2), consistent with pituitary hypoplasia in brain imaging (7, 8), (ii) the autopsy findings of hypoplastic adrenal glands in PWS patients dying suddenly, and (iii) reports of sudden death cases with a documented poor cortisol response after an ACTH test (9, 10).