POMC and hyperandrogenism: Cortisol deficiency in patients with PACI typically results in a compensatory increase in pituitary adrenocorticotropic hormone (ACTH) secretion (14); patients with PACI due to autoimmune adrenalitis often also have hypoaldosteronism, hypoandrogenism (particularly in female patients), or hyperandrogenism (particularly in patients with select steroidogenesis enzyme mutations) (19).