Comprehensive genomic studies of ACC have revealed recurrent mutations in critical pathways, including Wnt/β-catenin (ZNRF3, CTNNB1), p53-driven apoptosis and cell cycle regulation (CDKN2A, CDK4, RB1, TP53), chromatin remodeling and telomere stabilization (MEN1, DAXX, TERT, TERF2, ATRX), cAMP-PKA signaling (PRKAR1A), and the IGF2/IGF1R axis, all of which contribute to dysregulated cell proliferation, impaired apoptosis, and an unfavorable prognosis (9). The gene discussed is IGF1R; the disease is adrenal cortex carcinoma.