Interestingly, similar inconsistency was also apparent in a recent Italian national cohort study where among 134 operated ACC patients selected just for surveillance 44.4% had Ki67 > 10%.26 On the positive side, only two of our patients who were started on mitotane were at low/intermediate risk of recurrence after surgery and might have been overtreated.9 Furthermore, most of our patients started with mitotane within the ideal 6 weeks after surgery. This evidence concerns the gene MKI67 and adrenal cortex carcinoma.