Possible triggers are thought to be caused by local viral infections with increased tropism to adrenocortical cells, such as herpes simplex virus 1, cytomegalovirus and adenovirus, as well as interferon alfa treatments and the relatively new checkpoint inhibitors targeting CTLA-4, programmed cell death protein 1 (PD-1), and PD-1 ligand (PD-L1), used in melanoma and lung cancer treatment (48). The gene discussed is PDCD1; the disease is lung cancer.