Pathogenesis of hypertension in Cushing's syndrome has remained controversial. A 56-year-old Japanese man with Cushing's syndrome due to adrenal carcinoma has been followed up for more than 6 years. During the followup period, left adrenalectomy and hemi-hepatectomy due to metastatic lesion were performed. Blood pressure, serum cortisol, and urinary excretion of 17-OHCS, as well as other routine biochemicals, have been measured periodically. These data revealed that there is a marked correlation between the levels of blood pressure and serum cortisol or urinary excretion of 17-OHCS. This finding suggests that cortisol production by tumor is a determinant factor in hypertension in Cushing's syndrome.