POMC and Cushing syndrome due to macronodular adrenal hyperplasia: A post-surgical follow-up showed a persistent remission of Cushing's syndrome.<h4>Conclusions</h4>The present report describes a case of severe hypercortisolism due to EAS not detected by functional imaging methods, in which the localization of ACTH ectopic origin was puzzled by a concomitant metastatic rectal carcinoma.