The diagnosis of EAS can be made by identifying the ACTH-producing source through surgical documentation of the lesion with a positive immunohistochemistry for ACTH, clinical and laboratory remission of Cushing’s syndrome after excision of the suspected lesion, or the absence of a center to peripheral ACTH gradient in a reliable BIPSS (not suggestive of a false negative result). This evidence concerns the gene POMC and Cushing syndrome due to macronodular adrenal hyperplasia.