POMC and Cushing syndrome: However, at least in one of these cases, the causative adrenal macronodule was already present at the time of the initial diagnosis of Cushing’s syndrome (8); in the other case, the adrenal mass was detected 10 months after pituitary surgery (making an ACTH-driven nodular autonomy instead of the consecutive occurrence of two independent Cushing subtypes very likely) (9).