AVP and Cushing syndrome due to macronodular adrenal hyperplasia: 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.