During Lenvatinib treatment, 24 of 31 patients (77.4%) had an insufficient response (peak cortisol <18.1 mcg/dL or 500 nmol/L) to ACTH stimulation (Table 2, Figure 1), supporting the diagnosis of adrenal insufficiency, according to current Endocrine Society Clinical Practice Guideline (11). This evidence concerns the gene POMC and Adrenal insufficiency.