In this study we investigated the involvement of the ARMC5 in three groups of patients, to look for pathogenic allelic variants: (1) patients with bilateral adrenal incidentalomas (with possible/autonomous cortisol secretion); (2) patients with unilateral adrenal incidentaloma (with possible/autonomous cortisol secretion); and (3) patients with overt Cushing's syndrome ACTH pituitary independent associated with bilateral adrenal nodules. Here, ARMC5 is linked to Cushing syndrome due to macronodular adrenal hyperplasia.