Endogenous hypercortisolemia results from a variety of diseases and disorders, including cortisol-producing adenoma (CPA), adrenal carcinoma, primary pigmented nodular adrenocortical disease (PPNAD), bilateral adrenal hyperplasia (BAH), adrenocorticotropic hormone (ACTH)-independent macronodular adrenocortical hyperplasia (AIMAH), excess ACTH produced by the pituitary (Cushing’s disease) or by ectopic tumors producing ACTH (ectopic Cushing’s syndrome)2. Here, POMC is linked to Cushing syndrome due to macronodular adrenal hyperplasia.