POMC and Cowden syndrome 1: Our workup revealed serum cortisol of 21.5 μg/dL after overnight dexamethasone suppression test (DST) (normal < 1.8 μg/dL), elevated 24-hour urinary free cortisol (UFC) (728.9 μg/day; normal 36.0–137.0 μg/day), and suppressed morning plasma ACTH (< 1.0 pg/mL; normal < 63.3 pg/mL), findings consistent with ACTH-independent CS.