Endogenous Cushing's syndrome is a relatively rare disease. Most cases being ACTH-dependent, ACTH-independent Cushing's syndrome (AICS) is an even rarer condition [15%-20%]. In more than 95% cases the cause of AICS is unilateral adrenal enlargement caused by adenoma or carcinoma. Bilateral adrenal disease is caused by primary pigmented nodular adrenal dysplasia (PPNAD) and ACTH-independent macro nodular hyperplasia (AIMAH). Only few case reports of the latter condition exist in the radiology literature, PPNAD being the commoner of two as the cause for AICS.