POMC and adrenal gland hyperfunction: Biochemical examination revealed severely high levels of catecholamines (AD 13,071 pg/mL (< 100); NAD 8987 pg/mL (100 ~ 450); DA 190 mg/mL (< 20)) as well as extremely high ACTH (1402 pg/mL (7.2 ~ 63.3)) and cortisol (78.4 μg/dL (7.07 ~ 19.6)), with a high ACTH/cortisol ratio (17.9 × 10− 4), suggesting ACTH-driven hypercortisolemia (Table. 1).