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). Here, POMC is linked to chronic primary adrenal insufficiency.