Laboratory tests confirmed ACTH-dependent hypercortisolemia with a high plasma ACTH level, high plasma cortisol levels with loss of diurnal rhythm, elevated 24-hour urinary free cortisol excretion, high plasma dehydroepiandrosterone sulfate (DHEA-S) and testosterone levels, and significantly elevated levels of serum metanephrines (Table 1). This evidence concerns the gene POMC and adrenal gland hyperfunction.