Primary bilateral macronodular adrenal hyperplasia (PBMAH) is an uncommon cause of Cushing syndrome (CS), accounting for <2% of CS cases.[1–3] In PBMAH, enlarged adrenal nodules secrete cortisol independently of corticotropin (ACTH), causing mild to overt CS. Here, POMC is linked to Cushing syndrome due to macronodular adrenal hyperplasia.