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I thank Pintilie et al for the interesting case and discussion. Acute hypercortisolism due to malignancy is often refractory to medical therapy, and where therapy directed against the primary malignancy is not possible, early bilateral laparoscopic adrenalectomy may be the treatment of choice, especially given the high risk of sepsis due to immunosuppression. An excellent discussion is presented by Davenport et al in Clinical Endocrinology 2014: 81; 498-502.