POMC and Cushing syndrome due to macronodular adrenal hyperplasia: Subclinical Cushing syndrome, which particularly causes increased insulin resistance, type 2 diabetes mellitus, obesity, and osteoporosis, is the most frequently encountered hormonal dysfunction in adrenal incidentalomas.8 This is a term used to describe that cortisol production is insufficient to cause clinically recognizable syndrome and to suppress the release of corticotropin releasing hormone and ACTH.