Mitotane as an adjuvant therapy for ACC patients, it is metabolites can inhibit several enzymes in the adrenocortical steroidogenesis pathway, mainly at the level of the cholesterol side-chain cleavage enzymes CYP11A1 and CYP11B1.[27,28] CYP11B1 is reliable biomarkers for the histopathological subtyping of functional benign adrenocortical tumors (ACT) and may offer some value in the histopathological diagnosis of malignant ACT.[29] Compared with normal tissue, this gene is low expressed in ACC. The gene discussed is CYP11A1; the disease is adrenal cortex carcinoma.