POMC and primary pigmented nodular adrenocortical disease: 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.