STAR and adrenal cortex neoplasm: Adrenal steroidogenesis involves a series of enzymatic reactions that convert cholesterol into biologically active steroid hormones in response to angiotensin II, adrenocorticotropic hormone (ACTH), and other peptide hormones.[22] Previous clinical and molecular research has highlighted the involvement of steroidogenic pathway enzymes, including STAR, CYP11A1, CYP17A1, CYP21A2, CYP17B1, CYP17B2, AKR1B1, and HSD3B2,[23, 24] as well as the melanocortin receptor 2 (MC2R, the ACTH receptor),[25] in the pathogenesis of functional adrenocortical tumors.