Abstract
Carney complex (CNC) is a rare autosomal dominantly inherited syndrome with near-to-complete penetrance characterized by multiple endocrine and nonendocrine neoplasia. Morbidities are mainly associated with cardiac myxoma and hormonal overactivity.
Although genetically heterogeneous, most CNC cases are a consequence of germline inactivating mutations in the gene encoding the cAMP-dependent protein kinase A type I-alpha regulatory subunit (PRKAR1A).
Here, we present the case of a patient with Cushing’s syndrome due to primary pigmented nodular adrenocortical disease (PPNAD) and an asymptomatic IGF-1 and GH excess, with a positive family history for adrenal cortisol-secreting adenoma. DNA mutation analysis revealed a heterozygous splice site mutation in PRKAR1A with possible deleterious effects on protein function.
After medical treatment with steroidogenesis inhibitors, left monolateral laparoscopic adrenalectomy was performed, achieving a recovery of cortisol-related signs and symptoms. After substitutive glucocorticoid discontinuation, the pituitary-adrenal function was consistent with autonomous cortisol secretion without overt hypercortisolism. Treatment with somatostatin analogues was efficacious in normalizing IGF-1 levels.
References
Bertherat J. Carney complex (CNC). Orphanet J Rare Dis. 2006;1:21. https://doi.org/10.1186/1750-1172-1-21.
Bertherat J, Horvath A, Groussin L, Grabar S, Boikos S, Cazabat L, Libe R, René-Corail F, Stergiopoulos S, Bourdeau I, Bei T, Clauser E, Calender A, Kirschner LS, Bertagna X, Carney JA, Stratakis CA. Mutations in regulatory subunit type 1A of cyclic adenosine 5′-monophosphate-dependent protein kinase (PRKAR1A): phenotype analysis in 353 patients and 80 different genotypes. J Clin Endocrinol Metab. 2009;94:2085–91. https://doi.org/10.1210/jc.2008-2333.
Correa R, Salpea P, Stratakis CA. Carney complex: an update. Eur J Endocrinol. 2015;173:M85–97. https://doi.org/10.1530/EJE-15-0209. BioScientifica Ltd.
Espiard S, Vantyghem M-C, Assié G, Cardot-Bauters C, Raverot G, Brucker-Davis F, Archambeaud-Mouveroux F, Lefebvre H, Nunes M-L, Tabarin A, Lienhardt A, Chabre O, Houang M, Bottineau M, Stroër S, Groussin L, Guignat L, Cabanes L, Feydy A, Bonnet F, North MO, Dupin N, Grabar S, Duboc D, Bertherat J. Frequency and incidence of Carney complex manifestations: a prospective multicenter study with a three-year follow-up. J Clin Endocrinol Metab. 2020;105:1–11. https://doi.org/10.1210/clinem/dgaa002.
Fu J, Lai F, Chen Y, Wan X, Wei G, Li Y, Xiao H, Cao X. A novel splice site mutation of the PRKAR1A gene, C.440+5 G>C, in a Chinese family with Carney complex. J Endocrinol Investig. 2018;41:909–17. https://doi.org/10.1007/s40618-017-0817-5.
Stratakis CA, Raygada M. [Updated 2018 Aug 16]. Carney complex. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle: University of Washington; 2003; 1993–2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1286/.
Weinhäusel A, Haas OA, Segovia G, Lind P, Behmel A. Identification of a novel PRKARIA mutation predisposing for Carney complex disease. Int J Disabil Hum Dev. 2002;3:33–6. https://doi.org/10.1515/IJDHD.2002.3.1.33.
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Ceccato, F., Occhi, G. (2021). Carney Complex in Clinical Practice. In: Colao, A., Jaffrain-Rea, ML., Beckers, A. (eds) Polyendocrine Disorders and Endocrine Neoplastic Syndromes. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-73082-0_18-1
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DOI: https://doi.org/10.1007/978-3-319-73082-0_18-1
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