POMC and adrenal gland hyperfunction: Given that the onset of PBMAH is often after 40 years of age and that a high proportion of PBMAH patients exhibited subclinical hypercortisolism or only mildly suppressed ACTH levels, as indicated in our study and in several previous studies [2, 16, 19, 21, 23], the family histories of so-called sporadic PBMAH patients may be unknown.