Efficacy of Adjuvant Mitotane Treatment (ADIUVO)

Inclusion Criteria: * Histologically confirmed diagnosis of ACC according to Weiss system by a national reference pathologist who has to be nominated before study initiation. * Low-intermediate risk of relapse defined as: * Stage I-III (according to ENSAT classification 2008; see Appendix 2) * Microscopically complete resection, defined as no evidence of microscopic residual disease based on surgical reports, histopathology and post-operative imaging. Detailed pathological and surgical reports prepared according to guidelines detailed in appendix x and y should be available for assessment. * Ki 67 \< 10% * Post-operative imaging (thoracic and whole abdominal CT with contrast medium or MRI) demonstrating no evidence of disease within 4 weeks from randomization * Age \> 18 years * ECOG performance status 0-2 (Appendix 3) * Adequate bone marrow reserve (neutrophils \> 1000/mm3 and platelets \> 80000/ mm3) * Ability to comply with the protocol procedures (including geographic accessibility) * Written informed consent Exclusion Criteria: * Time between primary surgery and randomization \> 3 months. * Repeat surgery for recurrence of disease * Presence of autonomous adrenocortical hormone secretion despite the absence of disease detectable with imaging techniques * History of prior malignancy, except for cured non-melanoma skin cancer, cured in situ cervical carcinoma, or other treated malignancies with no evidence of disease for at least three years * Renal insufficiency…