A, Mifepristone (RU-486) can act as a glucocorticoid receptor (GR) antagonist; when mifepristone binds to the GR, it prevents the release of the GR from the associated heat shock protein (Hsp) and prevents the translocation of the RU-486/GR complex to the nucleus. B, In primary pigmented nodular adrenocortical disease cells, mifepristone probably acts as an agonist or antagonist, depending on the protein kinase A (PKA) status. Through a GR-PKA interaction, the constitutively active PKA in these cells may potentiate the agonist activity of mifepristone. The complex RU-486/GR translocates to the nucleus, where it recruits nuclear coactivator TIF2 and nuclear receptor corepressor (NCoR) and regulates gene expression.