LCNEC can cause paraneoplastic syndromes too: in two different case reports from 2020 and from 2022, the authors reported two patients with all the typical signs of Cushing Syndrome, such as hypertension, hyperglycemia, central obesity, hyperpigmented skin, moon face, elevated serum cortisol, and adrenocorticotropin (ACTH); further investigation revealed in both patients a LCNEC with ectopic production of ACTH [3,33]. Here, POMC is linked to Cushing syndrome due to macronodular adrenal hyperplasia.