TRH and Hypoglycemia: Some evidence suggests that ES itself may be the result of long-standing hypothalamic dysfunction rather than pituitary pathology per se8 as demonstrated by a blunted ACTH-cortisol response to hypoglycemia in the background of an exaggerated ACTH response to corticotropin-releasing hormone administration as well as a delayed thyroid-stimulating hormone response to thyrotropin-releasing hormone stimulation.8