**8. Clinical Surveillance in Patients with PRKAR1A-Associated Thyroid Tumors**

Human studies in CNC underly the importance of investigating thyroid nodules in these patients. Multiple thyroid nodules are present in up to 75% of patients with CNC on thyroid ultrasound; the majority of them are non-functioning follicular adenomas [164]. However, thyroid carcinomas are common as well. Early detection is vital and CNC patients should be followed with long-term clinical and/or ultrasound surveillance with biopsy of suspicious nodules, for early detection of carcinomas [164].

Because CNC is inherited in an autosomal dominant manner, each child of an affected individual has a 50% chance of inheriting the pathogenic variant. Most of the affected patients (approximately 70%) have an affected parent. In the case that the pathogenic variant is known in a family, prenatal testing may be recommended [164].
