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. This evidence concerns the gene POMC and Insulin resistance.