POMC and adenoma: In the report from the Mayo clinic, including 10 patients with ACTH-independent CS and bilateral adrenal masses [10], an adrenal vein to peripheral vein gradient greater than 6.5 was considered to be consistent with a cortisol-secreting adenoma and a cortisol lateralization ratio (side-to-side adrenal vein cortisol ratio) ≥2.3 consistent with unilateral dominant disease [10].