In cases with Cushing syndrome, ectopic ACTH syndrome was defined as ACTH dependent when the plasma ACTH level was >15 pg/ml (reference range: 10–50 pg/ml) and ACTH independent when the plasma ACTH level was <5 pg/ml based on a previous report (23). Here, POMC is linked to Cushing syndrome due to macronodular adrenal hyperplasia.