Over the past few decades, PBMAH has transitioned from a rare subtype of adrenal Cushing syndrome to a heterogeneous, and genetically and biologically diverse entity. Once defined primarily by its morphological and hormonal features, PBMAH is now recognized as a spectrum of disorders arising from multiple, and sometimes coexisting, pathogenic mechanisms, including aberrant expression of G protein-coupled receptors, intra-adrenal ACTH production, and clonal genetic alterations consistent with
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