POMC and infection: CIRCI is more commonly observed in critically ill patients with prolonged intensive care unit stays due to severe infections, organ failure, or sustained systemic inflammation.[16] It is diagnosed based on a delta cortisol (response to adrenocorticotropic hormone [ACTH] stimulation) of ≤9 μg/dL or a random cortisol level <10 μg/dL, reflecting an inadequate adrenal response relative to critical illness.