The documentation of an increased incidence of metastatic disease (70% vs 51.2%, p = 0.04) and disease specific death (6 of 25, 17.1% vs 6 of 127, 4.7%) among patients with known TERT alterations in combined institutional/ TCGA cases of adrenocortical carcinomas suggests that these alterations may have significant impact on prognostication. Here, TERT is linked to metastatic neoplasm.