Given the hematologic and metabolic alterations induced by cortisol excess, the HALP score may provide an integrative reflection of the magnitude and duration of glucocorticoid exposure by assessing its effects on hemoglobin (via erythropoiesis stimulation), albumin (via increased catabolism), lymphocytes (via apoptosis and redistribution), and platelets (via enhanced production), thereby serving as a composite marker of both endocrine activity (degree of hypercortisolism) and systemic burden (immunometabolic consequences) in patients with Cushing’s syndrome. This evidence concerns the gene ALB and Cushing syndrome due to macronodular adrenal hyperplasia.