POMC and adrenal gland hyperfunction: ACTH <10 pg/mL or ng/L indicates ACTH-independent hypercortisolism (suggesting adrenal CS), though the level can be 10–20 pg/mL in patients with adrenal CS.40 Elevated dehydroepiandrosterone sulfate (DHEA-S) associated with low ACTH should raise suspicion of adrenal carcinoma.