CYP11B1 and Cushing syndrome due to macronodular adrenal hyperplasia: It is reported that 10–20% of patients with APA also have subclinical Cushing’s syndrome [33–35], and a relatively high percentage of APAs comprise cells that are double-positive for CYP11B1 and CYP17, which are key enzymes in cortisol biosynthesis [21, 23, 36].