Because rapid and aggressive onset of symptoms, the severity of the hypercortisolism (both clinically and biochemically), the high levels of ACTH, and the lack of suppression of cortisol at afternoon of day 1 during dexamethasone 7 mg infusion test (Table 2), the IPSS was not considered necessary in this case, as pituitary corticotroph adenoma was very unlikely. Here, POMC is linked to adrenal gland hyperfunction.