Primary pigmented nodular adrenocortical disease (PPNAD) is a rare genetic disorder where small, darkly pigmented nodules form in the adrenal glands and produce excess cortisol. This leads to ACTH-independent Cushing’s syndrome, with symptoms like weight gain, high blood pressure, and growth delays. It often appears in childhood or adolescence and may be part of Carney complex. Diagnosis involves hormone tests, imaging, and genetic studies. Treatment usually requires surgical removal of the adrenal glands.