Recent studies on the 8-mg HDDST demonstrated sensitivity and specificity rates between 79% and 80% and between 77% and 78%, respectively, in differentiating CD from EAS [29, 30], a diagnostic performance similar to the pretest probability of CD [31] which accounts for 80% to 90% of ACTH-dependent CS [32]. This evidence concerns the gene POMC and Cowden syndrome 1.