POMC and Cushing syndrome due to macronodular adrenal hyperplasia: Cushing disease (CD) caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the most common etiology of endogenous Cushing syndrome [1]; persistently elevated ACTH levels lead to excessive cortisol secretion which is associated with increased morbidity and mortality compared to the general population [2].