Sterol-O-acyl transferase 1 (SOAT1), also known as acyl-coenzyme A: cholesterol acyltransferase 1 (ACAT1), is involved in cholesterol processing in the adrenal cortex.76 In preclinical studies, mitotane has been shown to inhibit SOAT1, leading to accumulation of toxic lipids and subsequent apoptosis of ACC cells.77 As a result, SOAT1 was initially investigated as a prognostic marker in ACC but showed mixed results.77, -79 More recently, Smith et al80 studied the adrenal-specific SOAT1 inhibitor nevanimibe in a phase I trial of 63 patients with progressive metastatic ACC. The gene discussed is ACAT1; the disease is adrenal cortex carcinoma.