The discovery of PDE11A variants in patients with Carney complex (63) and genomic duplication of the locus of PRKACB (encoding the catalytic C-beta subunit of PKA) in a patient with Carney complex but without evidence of Cushing syndrome support the existence of versatile genomic alterations causing PKA dysregulation (101). This evidence concerns the gene PDE11A and Cushing syndrome due to macronodular adrenal hyperplasia.