In another study, PDE11A was sequenced in 150 patients with CNC that harbored germline PRKAR1A variants; interestingly, germline variants in PDE11A were significantly more frequent in CNC patients with PPNAD and/or testicular large-cell calcifying Sertoli cell tumors (LCCSCT) than in patients without PPNAD and/or LCCSCT. This evidence concerns the gene PDE11A and primary pigmented nodular adrenocortical disease.