Less often, patients can present with benign multinodular hyperplastic lesions including primary pigmented nodular adrenocortical disease (PPNAD), non-pigmented isolated micronodular adrenal disease (iMAD), and corticotropin (ACTH)-independent macronodular adrenal hyperplasia (AIMH) (3). Here, POMC is linked to primary pigmented nodular adrenocortical disease.