POMC and Cushing syndrome due to macronodular adrenal hyperplasia: The urine steroid metabolome of patients with overt Cushing syndrome is characterized by excessive excretion of glucocorticoid and mineralocorticoid precursor metabolites, although androgen metabolites tend to be suppressed (148, 149) in adrenal Cushing but increased in ACTH-dependent Cushing syndrome (150, 151) [Fig. 8A and 8B (1, 148–155)].