She stopped AK, and 1 month later, her am cortisol level rose to 9.1 μg/dL (reference range, 8.0-25.0 μg/dL) and ACTH level rose to 68 pg/mL (reference value < 46 pg/mL).<h4>Discussion</h4>Supplements containing hidden glucocorticoids and causing Cushing syndrome have been reported in rare cases and can pose a diagnostic challenge for providers.<h4>Conclusion</h4>Exogenous glucocorticoid use because of unregulated herbal supplements should be considered when Cushing syndrome is suspected. This evidence concerns the gene POMC and Cushing syndrome due to macronodular adrenal hyperplasia.