The dominant role of ACTH in the regulation of adrenal androgens readily explains the differences in concentrations of androgen precursors as androstenedione (A4), dehydroepiandrostendione (DHEA) (13) and dehydroepiandrosterone-sulphate (DHEAS) in different subtypes of CS with the highest concentrations of adrenal androgens in CS due to ectopic ACTH production and low-to-suppressed adrenal androgens in CS due to an adrenal adenoma (10, 14). The gene discussed is POMC; the disease is Cowden syndrome 1.