Acquired IAD is associated with multiple factors, among which autoimmunity is the most well-recognized, supported by 4 key lines of evidence: Most patients with acquired IAD have comorbid autoimmune diseases, most commonly hypothyroidism and Hashimoto thyroiditis, and may also present with type 1 diabetes or Crohn disease.[17] IAD can manifest as a paraneoplastic syndrome, where ectopic expression of pituitary antigens in tumors disrupts ACTH-related immune tolerance. Here, POMC is linked to Hashimoto thyroiditis.