A 55-year-old female was involved in a motor vehicle accident, at which time she underwent an abdominal CT scan that was negative for any injury. However, a 1.7-cm right adrenal nodule was incidentally noted. The patient complains of difficulty losing weight but denies any recent weight gain, abnormal hair growth, or muscle weakness. She has a long-standing history of diabetes and hypertension. She denies headache, palpitations, and flushing. A physical exam is significant for central obesity, but she does not have supraclavicular fat accumulation or purple striae. Workup for the adrenal mass revealed an elevated 24-hour urine cortisol level (170 mcg/dL; normal <45 mcg/dL). This was followed by a low-dose dexamethasone suppression test, which resulted in a lack of cortisol suppression (AM cortisol 14.2 mcg/dL, normal <2 mcg/dL). Further biochemical workup, including catecholamines and metanephrines as well as plasma aldosterone and renin levels, was normal.