Uchida et al. reported a case of an ACC presenting with mild primary aldosteronism and subclinical Cushing’s syndrome, in which CYP11B1, CYP11B2 and 3-β-hydroxysteroid dehydrogenase were poorly expressed as detected by immunohistochemistry and varied across different areas of the tumor. The gene discussed is CYP11B1; the disease is Cushing syndrome due to macronodular adrenal hyperplasia.