Adrenal cortex autotransplantation with ACTH stimulation may be an alternative therapy for patients with bilateral adrenalectomy to avoid adrenal crisis, but its underlying mechanism has not been elucidated. Previously, we detected Dhh upregulation in rat adrenocortical autografts after transplantation. Here, we investigated potential regulators such as Gata4, Gata6, Sry and Sox9 which affect Dhh transcription in adrenocortical autografts with or without ACTH stimulation. In ACTHstimulated autografts, Gata4 and Gata6 were downregulated compared to control autografts. This response was linked to rDhh repression. A reporter assay using the upstream region of rDhh and a GATA binding motif revealed that rDhh promoters were significantly upregulated by co-transfection with Gata4 or Gata6 or both. Sry and Sox9 expression in autografts with or without ACTH stimulation were verified by PCR and RNAscope analyses. The ovarian differentiation factors Foxl2 and Rspo1 were also upregulated in the autografts. Gata4 and Gata6 were found to be significant factors in the regulation of rDhh expression and could be associated with adrenocortical autograft maintenance. Gonadal primordia with bipotential testicular and ovarian functions may also be present in these autografts.Pheochromocytomas arise from the adrenal medulla and are catecholamine-producing tumours. Hereditary pheochromocytoma can be treated with bilateral adrenalectomy and lifelong glucocorticoid replacement therapy 1 . Autotransplantation and allotransplantation of the adrenal cortex are potential alternatives that allow bilateral adrenalectomy patients to avoid adrenal crises 1,2 . However, adrenal autotransplantation has not been established in humans and its success rate is only 20-35% 3,4 . Possible reasons for this poor performance include ACTH suppression by negative feedback from excessive postoperative glucocorticoid replacement therapy. This response causes autograft regression. According to previous reports, adrenal autotransplantation has been highly successful in the management of Cushing's disease (ACTH hypersecretion from the pars distalis) 5-7 . Four patients who underwent bilateral adrenalectomy and ACTH replacement were able to withdraw from glucocorticoid replacement immediately after adrenal autotransplantation 8 . Dexamethasone-induced adrenal atrophy in mice was restored with daily ACTH stimulation 9 . ACTH stimulation after autotransplantation preserves autografts and may involve an unidentified pathway which promotes adrenal cortical regeneration and recovers endocrine function.In the search for factors affecting post-transplant adrenocortical autograft remodelling and regeneration, we found that Dhh was upregulated and Shh was downregulated in the regeneration step of rat adrenocortical autograft 8 . The HH signalling pathway may participate in adrenocortical autograft regeneration as well as adrenal cortex development. The regulation of Dhh transcription during gonadal development involves transcription factors such as Wt1, Gata4, Gata6, Sox9...