We thank Müller and David for their thoughtful comment on our editorial on the “citrate challenge” [1, 2]. We fully agree with their central point that citrate accumulation (CA) still lacks a universally accepted and clinically meaningful definition, and that harmonized criteria remain needed. However, we believe their interpretation partly differs from the intent of our proposal. The citrate challenge was not conceived as a score designed to predict CA from a single baseline variable.

Claude Bernard (1813 - 1878) French physiologist [more author details] Showing quotations 1 to 3 of 3 total Man can learn nothing unless he proceeds from the known to the unknown. Mediocre men often have the most acquired knowledge. We can learn nothing except by going from the known to the unknown.

Bilateral Macronodular Adrenocortical Disease (BMAD) is characterized by bilateral benign macronodules and, frequently, autonomous cortisol secretion. Germline molecular alterations of tumor suppressor genes are identified in around 30% of cases, the most frequent being ARMC5.