IGF1 and Cushing syndrome due to macronodular adrenal hyperplasia: 1Consider additional testing based on clinical concern for paraneoplastic syndromes: Carcinoid syndrome (24‐hour urine 5‐HIAA), acromegaly (serum IGF‐1), Cushing's Syndrome (salivary cortisol, 24‐hour urine cortisol, dexamethasone suppression test); 2 SSA‐ somatostatin analog; 3 PRRT‐ peptide receptor radionuclide therapy.