ACACA and neoplasm: In addition, although our study and most other steroid metabolomics studies support the fact that the majority of ACCs present an altered steroidogenesis with low levels of key steroidogenic enzymes, we must point out that other studies reported a great variation in the ACC steroidogenic activity and suggested that this may be dependent on tumor size, with a trend for small tumors to have higher CYP11B1 activities [18].