PDE11A and Carney complex: Inactivating PDE11A variants induce alterations in cAMP pathway increasing the levels of this cyclic nucleotide, which may promote TGCT development similarly to what has been observed in non-germ cell-derived testicular tumours, such as in Leydig cell hyperplasia, McCune-Albright syndrome and Carney complex-associated Sertoli cell tumours [20, 21].