Unusual presentations of Carney Complex in patient with a novel PRKAR1A mutation

Neuro Endocrinol Lett. 2017 Aug;38(4):248-254.

Abstract

Carney Complex (CNC) is a multiple neoplasia syndrome characterized by skin tumors and pigmented lesions, myxomas, and various endocrine tumors. The aim of this case report was to describe a case of CNC with a novel PRKAR1A mutation. A man aged 46 years with a medical history of surgery for cardiac myxomas at the age of 39 was admitted to our hospital because of four newly-developed heart masses. The histologic examination confirmed cardiac myxomas. He had many presentations of CNC such as growth hormone (GH) and prolactin (PRL)-secreting mixed pituitary adenoma, benign thyroid nodule, large-cell calcifying Sertoli cell tumor (LCCST), and superficial angiomyxoma. A bilateral adrenalectomy was performed because the laboratory findings suggested primary pigmented nodular adrenocortical disease (PPNAD). The pathologic examination revealed a focal unilateral PPNAD, unilateral nonpigmented adrenocortical nodule, and bilateral adrenal medullary hyperplasia. Two years after the second cardiac operation, an interatrial septum-derived tumor was detected. An atrial myxoma was confirmed with histologic studies. Based on these findings, the patient was confirmed to have CNC. A novel insertion mutation in the type 1A regulatory subunit of the cAMP-dependent protein kinase A gene (PRKAR1A) in exon 2 was detected in our patient through genetic analysis. The presence of multiple myxomas and endocrine abnormalities should be an indication to physicians to further investigate for CNC. Herein, we described a case of CNC with a novel mutation in exon 2 of the PRKAR1A gene with typical and atypical clinical features.

Publication types

  • Case Reports

MeSH terms

  • Carney Complex / diagnosis*
  • Carney Complex / genetics
  • Carney Complex / pathology
  • Cyclic AMP-Dependent Protein Kinase RIalpha Subunit / genetics*
  • Heart Neoplasms / genetics*
  • Heart Neoplasms / pathology
  • Heart Neoplasms / surgery
  • Humans
  • Male
  • Middle Aged
  • Mutation*
  • Myxoma / genetics*
  • Myxoma / pathology
  • Myxoma / surgery

Substances

  • Cyclic AMP-Dependent Protein Kinase RIalpha Subunit
  • PRKAR1A protein, human