Below is an instruction from Human. Write a response.
    ### Instruction:
    What are the genetic changes related to primary macronodular adrenal hyperplasia ?
    ### Response:
    In about half of individuals with PMAH, the condition is caused by mutations in the ARMC5 gene. This gene provides instructions for making a protein that is thought to act as a tumor suppressor, which means that it helps to prevent cells from growing and dividing too rapidly or in an uncontrolled way.
    