Espiard et al. demonstrated that patients with ARMC5-driven PBMAH presented more frequently with overt Cushing syndrome, higher midnight plasma cortisol, urinary free cortisol, and cortisol after dexamethasone suppression test than those with ARMC5-wild-type disease (54). Here, ARMC5 is linked to Cushing syndrome due to macronodular adrenal hyperplasia.