• • hyperpigmentation of the skin and mucous membranes, a consequence of the ACTH-MSH cross reactivity, which occurs in high levels of ACTH (in Cushing’s disease and non Cushing’s syndrome) or in the secretion of ectopic ACTH (also Nelson syndrome) [1]. This evidence concerns the gene POMC and Cushing syndrome due to macronodular adrenal hyperplasia.