When it is confirmed that endogenous Cushing’s Syndrome is present, serumlevels of an adrenocorticotropic hormone (ACTH) indicate the etiology: <10 pg/mLdemonstrate an independent cause, between 10 and 29 pg/mL is considered to besuspicious, while levels >30 pg/mL and especially >50 pg/mL suggest ACTHdependent causes. 7 Here, POMC is linked to Cushing syndrome due to macronodular adrenal hyperplasia.