POMC and hypogonadotropic hypogonadism: He appeared fatigued, although the remainder of the physical examination was unremarkable. Low cortisol and adrenocorticotropic hormone (ACTH) and an inadequate cosyntropin response suggest secondary adrenal insufficiency. The patient also reported symptoms of low libido and erectile dysfunction over the past two years, including a lack of morning erections, no sexual intercourse, and absence of ejaculation for two years with low LH, FSH, and testosterone, suggesting hypogonadotropic hypogonadism.