In rare cases, ONB secretes antidiuretic hormone (ADH) and causes syndrome of inappropriate ADH secretion, or produces ectopic adrenocorticotropic hormone and leads to Cushing’s syndrome.6 In a large series including 38 cases of ONB, Rakes et al.7 reported that 53% of patients had orbital or ocular symptoms and that the most common symptoms were periorbital pain and lacrimation. This evidence concerns the gene POMC and Cushing syndrome due to macronodular adrenal hyperplasia.