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Protocol Details

Definition of the Genotype and Clinical Phenotype of Primary Pigmented Nodular Adrenocortical Disease (PPNAD), Carney Complex, Peutz-Jeghers Syndrome and Related Conditions

This study is NOT currently recruiting participants.

Summary | Eligibility | Citations | Contacts




Sponsoring Institute

National Institute of Child Health and Human Development (NICHD)

Recruitment Detail

Type: Completed Study; data analyses ongoing
Gender: Male & Female
Min Age: 3 Years
Max Age: 70 Years

Referral Letter Required


Population Exclusion(s)



Cushing's Syndrome;
Pituitary Adenoma;
Carney Complex;
Natural History

Recruitment Keyword(s)



Cushing's Syndrome;
Pituitary Adenoma;
Carney Complex;
Primary Pigmented Nodular Adrenocortical Disease;
Peutz-Jeghers Syndrome

Investigational Drug(s)


Investigational Device(s)



Drug: oCRH

Supporting Site

National Institute of Child Health and Human Development

Lentiginosis refers to groups of diseases marked by the presence of pigmented spots on the skin. These conditions are most commonly associated with multiple tumors and changes in hormone producing glands. The cause of these diseases is unknown, but researchers suggest there may be a level of inheritance involved in their development. Meaning to say that some of these diseases may "run in the family" and be passed down form generation to generation.

Primary pigmented nodular adrenocortical disease (PPNAD) is a pituitary-independent, primary adrenal form of hypercortisolism characterized by;

1. Resistance to suppression by the drug dexamethasone

2. The body is unable to secrete cortisol in a normal rhythm

3. Distinct microscopic changes of both adrenal glands

PPNAD can be associated with tumors (myxomas) of the skin, heart, breast, tumors (swannomas) of the nerve sheaths, pigmented spots (nevi and lentigines) of the skin, growth hormone (GH) producing tumors of the pituitary gland, and tumors of the testicles, ovaries, and thyroid gland. In the presence of these associations the condition is referred to as the Carney Complex. Presently there are no tests for screening of PPNAD and the Carney Complex. In addition, it is unknown how these conditions are genetically transferred from generation to generation.

This study proposes to use standard methods of clinical testing for endocrine and nonendocrine diseases and genetic testing in order to;

1. Define the genetic basis for PPNAD and/or the Carney Complex.

2. Determine the molecular changes associated with the development of the tumors.

3. Identify carriers of the disease.

4. Determine the prognosis for carriers and affected individuals.

5. Provide sufficient data for genetic counseling of families with PPNAD and/or Carney Complex.<TAB>

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1. All patients with PPNAD and/or Carney Complex by history and their siblings, children and parents. Additional relatives and their families that are suspected to have the same disorder on clinical grounds will be recruited:

(a) PPNAD patients will be included if their diagnosis is fully documented. First-degree relatives of patients with the disease will be accepted also for evaluation, or if already conclusively evaluated elsewhere, for DNA linkage analysis only.

(b) Patients with suspected Carney complex will be accepted for evaluation and/or DNA analysis for linkage, if they have at least two of the following:

1. cardiac myxoma

2. cutaneous myxoma

3. breast myxoma

4. oral myxoma

5. myxoma of the external ear

6. spotty mucocutaneous pigmentation (lentigines)

7. testicular tumor

8. pituitary growth hormone secreting adenoma

9. nerve tumor, such as psammomatous melanotic schwannoma

10. first-, second-, or third-degree relatives with Carney complex

(c) Patients with one of the familial lentiginosis syndromes: Peutz-Jeghers and LEOPARD syndrome, other forms of familial lentiginosis.


(a) For DNA analysis and linkage study:

1. Unwillingness to participate.

(b) For clinical evaluation and DNA analysis/linkage study:

1. Patients with major illnesses, such as severe renal failure, restrictive or obstructive lung disease, cardiac disease, anemia and/or terminal cancer that will not be able to undergo appropriate testing or the stress of hospitalization. Also, patients with Carney complex and a known heart tumor (heart myxoma) will not be able to enter the clinical part of the study until after surgical treatment of their tumor. These patients, however, will be asked to participate in the DNA analysis study.

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Lodish MB, Yuan B, Levy I, Braunstein GD, Lyssikatos C, Salpea P, Szarek E, Karageorgiadis AS, Belyavskaya E, Raygada M, Faucz FR, Izzat L, Brain C, Gardner J, Quezado M, Carney JA, Lupski JR, Stratakis CA. Germline PRKACA amplification causes variable phenotypes that may depend on the extent of the genomic defect: molecular mechanisms and clinical presentations. Eur J Endocrinol. 2015 Jun;172(6):803-11. doi: 10.1530/EJE-14-1154. PMID: 25924874; PMCID: PMC4428149.

The complex of myxomas, spotty pigmentation, and endocrine overactivity

Familial Cushing's syndrome due to primary pigmented nodular adrenocortical disease: reinvestigation 50 years later

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Principal Investigator

Referral Contact

For more information:

Christina Tatsi, M.D.
National Institute of Child Health and Human Development (NICHD)
NIHBC 10 - CRC BG RM 1-3150
(301) 451-7170

Crystal D. Kamilaris, M.D.
National Institute of Child Health and Human Development (NICHD)
National Institutes of Health
Building 10
Room 5-2571
10 Center Drive
Bethesda, Maryland 20892
(301) 496-8368

Office of Patient Recruitment
National Institutes of Health Clinical Center (CC)
Building 61, 10 Cloister Court
Bethesda, Maryland 20892
Toll Free: 1-800-411-1222
Local Phone: 301-451-4383
TTY: TTY Users Dial 7-1-1

Clinical Trials Number:


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