A case report showed that a patient with subclinical CS and ACTH-independent macronodular adrenal hyperplasia (AIMAH) underwent AVS and the result indicated no lateralization using criteria stated by Young et al. A left adrenalectomy was performed, and the patient improved clinically after the surgery (the left mass was larger than the right mass) (16). Here, POMC is linked to Cushing syndrome due to macronodular adrenal hyperplasia.