According to current clinical practice guidelines, all patients with ACC and a high risk of recurrence after surgery (ENSAT stage III, R1 resection or Ki67 >10%) should receive adjuvant treatment with mitotane.3 Recently published results of the ADIUVO trial did not support adjuvant treatment with mitotane in patients with low-intermediate risk of recurrence (ENSAT stage I-III, R0 resection and Ki67 ≤ 10%).9 Only one phase III clinical trial (FIRM-ACT) was conducted in patients with ACC. Here, MKI67 is linked to adrenal cortex carcinoma.