Subscribe to RSS
DOI: 10.1055/a-0753-4943
Carney Complex
Publication History
received 17 May 2018
revised 06 September 2018
accepted 02 October 2018
Publication Date:
14 November 2018 (online)
Abstract
Carney complex is a rare, autosomal dominant, multiple endocrine neoplasia and lentiginosis syndrome, caused in most patients by defects in the PRKAR1A gene, which encodes the regulatory subunit type 1α of protein kinase A. Inactivating defects of PRKAR1A lead to aberrant cyclic-AMP-protein kinase A signaling. Patients may develop multiple skin abnormalities and a variety of endocrine and non-endocrine tumors. Endocrine manifestations include primary pigmented nodular adrenocortical disease, that may cause Cushing syndrome, growth-hormone secreting pituitary adenoma or pituitary somatotropic hyperplasia which can result in acromegaly, as well as gonadal and thyroid tumors. Non-endocrine tumors associated with Carney complex include myxomas of the heart, breast, and other sites, psamommatous melanotic schwannomas, breast ductal adenomas, osteochondromyxomas, and a predisposition to a number of malignancies from adrenal to pancreatic and liver cancer.
-
References
- 1 Stratakis CA, Kirschner LS, Carney JA. Clinical and molecular features of the carney complex: diagnostic criteria and recommendations for patient evaluation. J Clin Endocrinol Metab 2001; 86: 4041-4046 doi:10.1210/jcem.86.9.7903
- 2 Kirschner LS, Carney JA, Pack SD. et al. Mutations of the gene encoding the protein kinase A type I-alpha regulatory subunit in patients with the carney complex. Nat Genet 2000; 26: 89-92 doi:10.1038/79238
- 3 Bertherat J, Horvath A, Groussin L. et al. 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: 2085-2091 doi:10.1210/jc.2008-2333
- 4 Cazabat L, Ragazzon B, Groussin L. et al. PRKAR1A mutations in primary pigmented nodular adrenocortical disease. Pituitary 2006; 9: 211-219 doi:10.1007/s11102-006-0266-1
- 5 Stratakis CA, Carney JA, Lin JP. et al. Carney complex, a familial multiple neoplasia and lentiginosis syndrome. Analysis of 11 kindreds and linkage to the short arm of chromosome 2. J Clin Invest 1996; 97: 699-705 doi:10.1172/JCI118467
- 6 Matyakhina L, Pack S, Kirschner LS. et al. Chromosome 2 (2p16) abnormalities in carney complex tumours. J Med Genet 2003; 40: 268-277
- 7 Forlino A, Vetro A, Garavelli L. et al. PRKACB and Carney complex. N Engl J Med 2014; 370: 1065-1067 doi:10.1056/NEJMc1309730
- 8 Carney JA, Gordon H, Carpenter PC. et al. The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine (Baltimore) 1985; 64: 270-283
- 9 Bain J. Carney’s complex. Mayo Clin Proc 1986; 61: 508
- 10 Atherton DJ, Pitcher DW, Wells RS. et al. A syndrome of various cutaneous pigmented lesions, myxoid neurofibromata and atrial myxoma: the NAME syndrome. Br J Dermatol 1980; 103: 421-429
- 11 Rhodes AR, Silverman RA, Harrist TJ. et al. Mucocutaneous lentigines, cardiomucocutaneous myxomas, and multiple blue nevi: the “LAMB” syndrome. J Am Acad Dermatol 1984; 10: 72-82
- 12 Espiard S, Bertherat J. Carney complex. Front Horm Res 2013; 41: 50-62 doi:10.1159/000345669
- 13 Taylor SS, Ilouz R, Zhang P. et al. Assembly of allosteric macromolecular switches: lessons from PKA. Nat Rev Mol Cell Biol 2012; 13: 646-658 doi:10.1038/nrm3432
- 14 Amieux PS, McKnight GS. The essential role of RI alpha in the maintenance of regulated PKA activity. Ann NY Acad Sci 2002; 968: 75-95
- 15 Horvath A, Bossis I, Giatzakis C. et al. Large deletions of the PRKAR1A gene in carney complex. Clin Cancer Res 2008; 14: 388-395 doi:10.1158/1078-0432.CCR-07-1155
- 16 Salpea P, Horvath A, London E. et al. Deletions of the PRKAR1A locus at 17q24.2-q24.3 in carney complex: genotype-phenotype correlations and implications for genetic testing. J Clin Endocrinol Metab 2014; 99: E183-E188 doi:10.1210/jc.2013-3159
- 17 Groussin L, Horvath A, Jullian E. et al. A PRKAR1A mutation associated with primary pigmented nodular adrenocortical disease in 12 kindreds. J Clin Endocrinol Metab 2006; 91: 1943-1949 doi:10.1210/jc.2005-2708
- 18 Bonnet-Serrano F, Bertherat J. Genetics of tumors of the adrenal cortex. Endocr Relat Cancer 2018; 25: R131-R152 doi:10.1530/ERC-17-0361
- 19 Patronas Y, Horvath A, Greene E. et al. In vitro studies of novel PRKAR1A mutants that extend the predicted RIalpha protein sequence into the 3'-untranslated open reading frame: proteasomal degradation leads to rIalpha haploinsufficiency and carney complex. J Clin Endocrinol Metab 2012; 97: E496-E502 doi:10.1210/jc.2011-2220:
- 20 Tsilou ET, Chan CC, Sandrini F. et al. Eyelid myxoma in carney complex without PRKAR1A allelic loss. Am J Med Genet A 2004; 130A: 395-397 doi:10.1002/ajmg.a.30279
- 21 Robinson-White A, Hundley TR, Shiferaw M. et al. Protein kinase-A activity in PRKAR1A-mutant cells, and regulation of mitogen-activated protein kinases ERK1/2. Hum Mol Genet 2003; 12: 1475-1484
- 22 Stratakis CA, Salpea P, Raygada M. Carney Complex. In: Adam MP, Ardinger HH, Pagon RA. et al. (eds.) GeneReviews((R)). 1993. Seattle (WA):
- 23 Shenoy BV, Carpenter PC, Carney JA. Bilateral primary pigmented nodular adrenocortical disease. Rare cause of the Cushing syndrome. Am J Surg Pathol 1984; 8: 335-344
- 24 Libe R, Horvath A, Vezzosi D. et al. Frequent phosphodiesterase 11A gene (PDE11A) defects in patients with carney complex (CNC) caused by PRKAR1A mutations: PDE11A may contribute to adrenal and testicular tumors in CNC as a modifier of the phenotype. J Clin Endocrinol Metab 2011; 96: E208-E214 doi:10.1210/jc.2010-1704
- 25 Stratakis CA, Sarlis N, Kirschner LS. et al. Paradoxical response to dexamethasone in the diagnosis of primary pigmented nodular adrenocortical disease. Ann Intern Med 1999; 131: 585-591
- 26 Bourdeau I, Lacroix A, Schurch W. et al. Primary pigmented nodular adrenocortical disease: paradoxical responses of cortisol secretion to dexamethasone occur in vitro and are associated with increased expression of the glucocorticoid receptor. J Clin Endocrinol Metab 2003; 88: 3931-3937 doi:10.1210/jc.2002-022001
- 27 Louiset E, Stratakis CA, Perraudin V. et al. The paradoxical increase in cortisol secretion induced by dexamethasone in primary pigmented nodular adrenocortical disease involves a glucocorticoid receptor-mediated effect of dexamethasone on protein kinase A catalytic subunits. J Clin Endocrinol Metab 2009; 94: 2406-2413 doi:10.1210/jc.2009-0031
- 28 Courcoutsakis NA, Tatsi C, Patronas NJ. et al. The complex of myxomas, spotty skin pigmentation and endocrine overactivity (carney complex): imaging findings with clinical and pathological correlation. Insights Imaging 2013; 4: 119-133 doi:10.1007/s13244-012-0208-6
- 29 Cignarelli M, Picca G, Campo M. et al. A six month mitotane course induced sustained correction of hypercortisolism in a young woman with PPNAD and carney complex. J Endocrinol Invest 2005; 28: 54-60
- 30 Lowe KM, Young Jr. WF, Lyssikatos C. et al. Cushing syndrome in carney complex: clinical, pathologic, and molecular genetic findings in the 17 affected mayo clinic patients. Am J Surg Pathol 2017; 41: 171-181 doi:10.1097/PAS.0000000000000748
- 31 Bertherat J. Adrenocortical cancer in carney complex: a paradigm of endocrine tumor progression or an association of genetic predisposing factors?. J Clin Endocrinol Metab 2012; 97: 387-390 doi:10.1210/jc.2011-3327
- 32 Bertherat J, Groussin L, Sandrini F. et al. Molecular and functional analysis of PRKAR1A and its locus (17q22-24) in sporadic adrenocortical tumors: 17q losses, somatic mutations, and protein kinase A expression and activity. Cancer Res 2003; 63: 5308-5319
- 33 Watson JC, Stratakis CA, Bryant-Greenwood PK. et al. Neurosurgical implications of carney complex. J Neurosurg 2000; 92: 413-418 doi:10.3171/jns.2000.92.3.0413
- 34 Raff SB, Carney JA, Krugman D. et al. Prolactin secretion abnormalities in patients with the “syndrome of spotty skin pigmentation, myxomas, endocrine overactivity and schwannomas” (carney complex). J Pediatr Endocrinol Metab 2000; 13: 373-379
- 35 Pack SD, Kirschner LS, Pak E. et al. Genetic and histologic studies of somatomammotropic pituitary tumors in patients with the “complex of spotty skin pigmentation, myxomas, endocrine overactivity and schwannomas” (carney complex). J Clin Endocrinol Metab 2000; 85: 3860-3865 doi:10.1210/jcem.85.10.6875
- 36 Kirschner LS. PRKAR1A and the evolution of pituitary tumors. Mol Cell Endocrinol 2010; 326: 3-7 doi:10.1016/j.mce.2010.04.027
- 37 Armstrong DK, Irvine AD, Handley JM. et al. Carney complex: report of a kindred with predominantly cutaneous manifestations. Br J Dermatol 1997; 136: 578-582
- 38 Hernandez-Ramirez LC, Tatsi C, Lodish MB. et al. Corticotropinoma as a component of carney complex. J Endocr Soc 2017; 1: 918-925 doi:10.1210/js.2017-00231
- 39 Kiefer FW, Winhofer Y, Iacovazzo D. et al. PRKAR1A mutation causing pituitary-dependent cushing disease in a patient with carney complex. Eur J Endocrinol 2017; 177: K7-K12 doi:10.1530/EJE-17-0227
- 40 Okamoto A, Wajima D, Tei R. et al. A case of a pituitary adenoma diagnosed as carney complex syndrome in an older female patient. No Shinkei Geka 2017; 45: 225-231 doi:10.11477/mf.1436203483
- 41 Lonser RR, Mehta GU, Kindzelski BA. et al. Surgical management of carney complex-associated pituitary pathology. Neurosurgery 2017; 80: 780-786 doi:10.1227/NEU.0000000000001384
- 42 Stratakis CA, Courcoutsakis NA, Abati A. et al. Thyroid gland abnormalities in patients with the syndrome of spotty skin pigmentation, myxomas, endocrine overactivity, and schwannomas (carney complex). J Clin Endocrinol Metab 1997; 82: 2037-2043 doi:10.1210/jcem.82.7.4079
- 43 Carney JA, Lyssikatos C, Seethala RR. et al. The spectrum of thyroid gland pathology in carney complex: The importance of follicular carcinoma. Am J Surg Pathol 2018; 42: 587-594 doi:10.1097/PAS.0000000000000975
- 44 Sandrini F, Matyakhina L, Sarlis NJ. et al. Regulatory subunit type I-alpha of protein kinase A (PRKAR1A): a tumor-suppressor gene for sporadic thyroid cancer. Genes Chromosomes Cancer 2002; 35: 182-192 doi:10.1002/gcc.10112
- 45 Burton KA, McDermott DA, Wilkes D. et al. Haploinsufficiency at the protein kinase A RI alpha gene locus leads to fertility defects in male mice and men. Mol Endocrinol 2006; 20: 2504-2513 doi:10.1210/me.2006-0060
- 46 Stratakis CA, Papageorgiou T, Premkumar A. et al. Ovarian lesions in carney complex: clinical genetics and possible predisposition to malignancy. J Clin Endocrinol Metab 2000; 85: 4359-4366 doi:10.1210/jcem.85.11.6921
- 47 Mateus C, Palangie A, Franck N. et al. Heterogeneity of skin manifestations in patients with carney complex. J Am Acad Dermatol 2008; 59: 801-810 doi:10.1016/j.jaad.2008.07.032
- 48 Horvath A, Stratakis CA. Carney complex and lentiginosis. Pigment Cell Melanoma Res 2009; 22: 580-587 doi:10.1111/j.1755-148×.2009.00613.x
- 49 Stratakis CA. Genetics of Peutz-Jeghers syndrome, Carney complex and other familial lentiginoses. Horm Res 2000; 54: 334-343 doi:10.1159/000053283
- 50 Vandersteen A, Turnbull J, Jan W. et al. Cutaneous signs are important in the diagnosis of the rare neoplasia syndrome Carney complex. Eur J Pediatr 2009; 168: 1401-1404 doi:10.1007/s00431-009-0935-y
- 51 Carney JA, Stratakis CA. Epithelioid blue nevus and psammomatous melanotic schwannoma: the unusual pigmented skin tumors of the Carney complex. Semin Diagn Pathol 1998; 15: 216-224
- 52 Carney JA, Ferreiro JA. The epithelioid blue nevus. A multicentric familial tumor with important associations, including cardiac myxoma and psammomatous melanotic schwannoma. Am J Surg Pathol 1996; 20: 259-272
- 53 Carney JA, Headington JT, Su WP. Cutaneous myxomas. A major component of the complex of myxomas, spotty pigmentation, and endocrine overactivity. Arch Dermatol 1986; 122: 790-798
- 54 Kennedy RH, Waller RR, Carney JA. Ocular pigmented spots and eyelid myxomas. Am J Ophthalmol 1987; 104: 533-538
- 55 Hachisuka J, Ichikawa M, Moroi Y. et al. A case of carney complex. Int J Dermatol 2006; 45: 1406-1407 doi:10.1111/j.1365-4632.2006.02889.x
- 56 Serio A, Favalli V, Giuliani L. et al. Cardio-Oncology: The carney complex Type I. J Am Coll Cardiol 2016; 68: 1921-1923 doi:10.1016/j.jacc.2016.07.764
- 57 He J, Sun M, Li E. et al. Recurrent somatic mutations of PRKAR1A in isolated cardiac myxoma. Oncotarget 2017; 8: 103968-103974 doi:10.18632/oncotarget.21916
- 58 Boikos SA, Stratakis CA. Carney complex: the first 20 years. Curr Opin Oncol 2007; 19: 24-29 doi:10.1097/CCO.0b013e32801195eb
- 59 Bandettini WP, Karageorgiadis AS, Sinaii N. et al. Growth hormone and risk for cardiac tumors in carney complex. Endocr Relat Cancer 2016; 23: 739-746 doi:10.1530/ERC-16-0246
- 60 Carney JA, Boccon-Gibod L, Jarka DE. et al. Osteochondromyxoma of bone: a congenital tumor associated with lentigines and other unusual disorders. Am J Surg Pathol 2001; 25: 164-176
- 61 Carney JA. Psammomatous melanotic schwannoma. A distinctive, heritable tumor with special associations, including cardiac myxoma and the Cushing syndrome. Am J Surg Pathol 1990; 14: 206-222
- 62 Rodriguez FJ, Stratakis CA, Evans DG. Genetic predisposition to peripheral nerve neoplasia: diagnostic criteria and pathogenesis of neurofibromatoses, Carney complex, and related syndromes. Acta Neuropathol 2012; 123: 349-367 doi:10.1007/s00401-011-0935-7
- 63 Shields LB, Glassman SD, Raque GH. et al. Malignant psammomatous melanotic schwannoma of the spine: A component of carney complex. Surg Neurol Int 2011; 2: 136 doi:10.4103/2152-7806.85609
- 64 Gonzalez-Cantu YM, Rodriguez-Padilla C, Tena-Suck ML. et al. Synchronous fibrolamellar hepatocellular carcinoma and auricular myxoma. Case Rep Pathol 2015; 2015: 241708 doi:10.1155/2015/241708
- 65 Graham RP, Lackner C, Terracciano L. et al. Fibrolamellar carcinoma in the Carney complex: PRKAR1A loss instead of the classic DNAJB1-PRKACA fusion. Hepatology 2017;
- 66 Ye H, Wang X, Constans MM. et al. The regulatory 1alpha subunit of protein kinase A modulates renal cystogenesis. Am J Physiol Renal Physiol 2017; 313: F677-F686 doi:10.1152/ajprenal.00119.2017
- 67 Stratakis CA. Carney complex: A familial lentiginosis predisposing to a variety of tumors. Rev Endocr Metab Disord 2016; 17: 367-371 doi:10.1007/s11154-016-9400-1