These ACTH-independent causes include the following: unilateral adrenal cortical tumors, which may be adenomas or carcinomas; and bilateral adrenal abnormalities, which may be due to primary pigmented nodular adrenal disease associated with the Carney complex (CNC), McCune-Albright syndrome (MAS), or macronodular disease related to aberrations of the cAMP signaling pathway and ectopic expression of G-protein coupled receptors (2). This evidence concerns the gene POMC and adrenal cortex carcinoma.