In 1977, Hogan et al[4] reported a case of PA accompanied by subclinical Cushing syndrome (SCS) for the first time, and subsequent studies found this condition was not uncommon.[5–7] According to the literature concerning immunohistochemistry based on CYP11B1 and CYP11B2 staining, PA accompanied by SCS may occur in various forms, with A/CPA being the most common. The gene discussed is CYP11B1; the disease is Cushing syndrome due to macronodular adrenal hyperplasia.