POMC and Hypertension: Indeed, in a context of clinical manifestations suggestive of hypercortisolism (abdominal striae, dorsal fat pad, worsening hypertension) and persistently elevated ACTH levels, the diagnosis of overt CD was based on the loss of a normal cortisol circadian rhythm and a two-fold increase in UFC at the beginning of pregnancy, at a time when UFC is not yet significantly increased (7).