Hypercortisolemia resultant from an aberrant HPA axis can be mild, which leads to challenges with appropriately diagnosing the patient. As in most cases of subtle disease, definition of ‘subclinical’ Cushing’s syndrome (SCS), or endogenous hypercortisolemia, is somewhat ambiguous, controversial, and ill-defined. The term, almost invariably related to adrenocortical tumors, is used to describe mild hypercortisolism in the absence of the cardinal features such as violaceous striae and proximal myopathy that are commonly observed in overt Cushing’s syndrome.