For the IHC staining of ACTH, although only eight patients (8/15) showed positive expression of ACTH and one patient did not have available information about ACTH staining after the first surgery, positive IHC staining for ACTH was found in all 16 patients at the time of diagnosis of Cushing's syndrome, which supported the diagnosis of SCA. The gene discussed is POMC; the disease is Cushing syndrome due to macronodular adrenal hyperplasia.