Primary bilateral macronodular adrenal hyperplasia (PBMAH)52 patients carrying ARMC5 mutations over-accumulate RPB1 in adrenal glands and other organs.50 Similarly, Armc5 KO mice show elevated RPB1 levels across the animal and in cultured embryonic fibroblasts,50 suggesting a pervasive, conserved role for ARMC5 in controlling RNA Pol II abundance. Here, POLR2A is linked to congenital adrenal hyperplasia.