POMC and Cushing syndrome due to macronodular adrenal hyperplasia: Laboratory investigation revealed augmented late-night salivary cortisol, demonstrating loss of cortisol circadian rhythm; low-dose overnight dexamethasone suppression test indicated failure in suppressing the hypothalamic-pituitary-adrenal axis (HPA); 24-hour urinary free cortisol excretion value indicated elevated levels of circulating free cortisol; plasmatic ACTH was measured twice, with values of 42.8 pg/mL and 37.6 pg/mL, confirming ACTH-dependent Cushing syndrome (Table 1).