Her biochemical workup (summarized in Table 1) demonstrated elevated serial late-night salivary cortisol, increased 8am serum cortisol and 24-hour urine free cortisol (UFC) and failed cortisol suppression after 1 mg dexamethasone with increased plasma ACTH consistent with ACTH-dependent Cushing syndrome. The gene discussed is POMC; the disease is Cushing syndrome due to macronodular adrenal hyperplasia.