Ectopic ACTH production is a common cause of Cushing's syndrome. In most patients, the neoplasm is obvious and is readily identified as the source of ACTH. However, in some patients, the neoplasm is not obvious and differentiating the tumor from a pituitary source is difficult. Current data demonstrate that virtually all normal tissues produce small amounts of a biologically inactive precursor ACTH molecule, probably proopiomelanocortin (POMC). All cancers produce this same substance in increased quantities. Selected cancers, correlated with histologic type, convert POMC to biologically active ACTH to produce the so-called ectopic ACTH syndrome. In this context, ectopic ACTH production is not ectopic.