Yokohama et al. also evaluated the adrenal axis in patients with renal cell carcinoma with adrenal involvement who underwent adrenalectomy and likewise found a significant elevation in ACTH post-operatively; they did not find any differences in cortisol levels post-operatively, but did note differences in cortisol kinetics after ACTH stimulation between patients who underwent adrenal intervention and those who did not [4]. This evidence concerns the gene POMC and hereditary clear cell renal cell carcinoma.