The CS patients with co-infections had higher levels of ACTH (671.5 ± 398.2 <i>vs</i> 245.5 ± 217.1 pg/ml, <i>P</i> = 0.047), and 38.9% (7/18) patients survived through the antibiotic therapy and the treatment of CS. Here, POMC is linked to Cowden syndrome 1.