Although all of them presented with hypercortisolism at initial presentation and died due to ACC (OS 7, 36, and 12 months, respectively), they presented with variable expression of ATRX (score 2, 0, and 0, respectively) and variable expression of ZNRF3 (score 3, 2, and 5, respectively). The gene discussed is ATRX; the disease is adrenal cortex carcinoma.