Seven patients received <sup>177</sup>Lu-PSMA therapy, but therapeutic outcomes were limited.<h4>Conclusion</h4>High [<sup>68</sup>Ga]Ga-PSMA-11 uptake in recurred or metastatic ACC was associated with location of metastases, longer tumor diameter, high tumor % growth rate, and a longer duration from diagnosis. The gene discussed is FOLH1; the disease is adrenal cortex carcinoma.