KEGG   PATHWAY: lav04934
lav04934                    Pathway                                

Cushing syndrome - Loxodonta africana (African savanna elephant)
Cushing syndrome (CS) is a rare disorder resulting from prolonged exposure to excess glucocorticoids via exogenous and endogenous sources. The typical clinical features of CS are related to hypercortisolism and include accumulation of central fat, moon facies, neuromuscular weakness, osteoporosis or bone fractures, metabolic complications, and mood changes. Traditionally, endogenous CS is classified as adrenocorticotropic hormone (ACTH)-dependent (about 80%) or ACTH- independent (about 20%). Among ACTH-dependent forms, pituitary corticotroph adenoma (Cushing's disease) is most common. Most pituitary tumors are sporadic, resulting from monoclonal expansion of a single mutated cell. Recently recurrent activating somatic driver mutations in the ubiquitin-specific protease 8 gene (USP8) were identified in almost half of corticotroph adenoma. Germline mutations in MEN1 (encoding menin), AIP (encoding aryl-hydrocarbon receptor-interacting protein), PRKAR1A (encoding cAMP-dependent protein kinase type I alpha regulatory subunit) and CDKN1B (encoding cyclin-dependent kinase inhibitor 1B; also known as p27 Kip1) have been identified in familial forms of pituitary adenomas. However, the frequency of familial pituitary adenomas is less than 5% in patients with pituitary adenomas. Among ACTH-independent CS, adrenal adenoma is most common. Rare adrenal causes of CS include primary bilateral macronodular adrenal hyperplasia (BMAH) or primary pigmented nodular adrenocortical disease (PPNAD).
Human Diseases; Endocrine and metabolic disease
Pathway map
lav04934  Cushing syndrome

Loxodonta africana (African savanna elephant) [GN:lav]
100673077  CRH; LOW QUALITY PROTEIN: corticoliberin [KO:K05256]
100659551  CRHR1; corticotropin-releasing factor receptor 1 isoform X3 [KO:K04578]
100672505  CRHR2; corticotropin-releasing factor receptor 2 [KO:K04579]
100655206  guanine nucleotide-binding protein G(s) subunit alpha isoform X1 [KO:K04632]
100669226  neuroendocrine secretory protein 55-like [KO:K04632]
100671072  ADCY1; adenylate cyclase type 1 [KO:K08041] [EC:]
100673570  ADCY2; LOW QUALITY PROTEIN: adenylate cyclase type 2 [KO:K08042] [EC:]
100674724  ADCY3; adenylate cyclase type 3 [KO:K08043] [EC:]
100675525  ADCY4; adenylate cyclase type 4 [KO:K08044] [EC:]
100670244  ADCY5; LOW QUALITY PROTEIN: adenylate cyclase type 5 [KO:K08045] [EC:]
100653532  ADCY6; adenylate cyclase type 6 isoform X1 [KO:K08046] [EC:]
100653771  ADCY7; adenylate cyclase type 7 isoform X1 [KO:K08047] [EC:]
100661616  ADCY8; adenylate cyclase type 8 [KO:K08048] [EC:]
100663448  ADCY9; LOW QUALITY PROTEIN: adenylate cyclase type 9 [KO:K08049] [EC:]
100656966  PRKACB; cAMP-dependent protein kinase catalytic subunit beta isoform X1 [KO:K04345] [EC:]
100674245  PRKACA; cAMP-dependent protein kinase catalytic subunit alpha [KO:K04345] [EC:]
100675162  CREB1; cyclic AMP-responsive element-binding protein 1 isoform X1 [KO:K05870]
100657989  ATF2; cyclic AMP-dependent transcription factor ATF-2 isoform X1 [KO:K04450]
100662521  ATF4; cyclic AMP-dependent transcription factor ATF-4 isoform X2 [KO:K04374]
100653565  CREB3L1; cyclic AMP-responsive element-binding protein 3-like protein 1 [KO:K09048]
100673694  CREB3L4; cyclic AMP-responsive element-binding protein 3-like protein 4 [KO:K09048]
100666211  CREB3L2; cyclic AMP-responsive element-binding protein 3-like protein 2 [KO:K09048]
100670574  CREB3L3; cyclic AMP-responsive element-binding protein 3-like protein 3 [KO:K09048]
100677344  CREB3; cyclic AMP-responsive element-binding protein 3 isoform X1 [KO:K09048]
100675079  CREB5; cyclic AMP-responsive element-binding protein 5 isoform X1 [KO:K09047]
100666885  ATF6B; cyclic AMP-dependent transcription factor ATF-6 beta isoform X2 [KO:K09049]
100666867  MEN1; menin isoform X2 [KO:K14970]
100665231  ASH2L; set1/Ash2 histone methyltransferase complex subunit ASH2 isoform X2 [KO:K14964]
100659816  RBBP5; retinoblastoma-binding protein 5 isoform X2 [KO:K14961]
100671380  WDR5B; WD repeat-containing protein 5B [KO:K14963]
100673925  WDR5; WD repeat-containing protein 5 [KO:K14963]
100653681  KMT2A; LOW QUALITY PROTEIN: histone-lysine N-methyltransferase 2A [KO:K09186] [EC:]
100670013  KMT2D; LOW QUALITY PROTEIN: histone-lysine N-methyltransferase 2D [KO:K09187] [EC:]
100669475  CDKN2C; cyclin-dependent kinase 4 inhibitor C [KO:K06622]
100664726  CDKN2B; cyclin-dependent kinase 4 inhibitor B [KO:K04685]
104845647  cyclin-dependent kinase inhibitor 2A-like [KO:K06621]
104847103  CDK4; cyclin-dependent kinase 4 [KO:K02089] [EC:]
100655429  CDK6; cyclin-dependent kinase 6 isoform X1 [KO:K02091] [EC:]
100669703  CCND1; G1/S-specific cyclin-D1 [KO:K04503]
100673196  RB1; retinoblastoma-associated protein [KO:K06618]
100664468  E2F1; LOW QUALITY PROTEIN: transcription factor E2F1 [KO:K17454]
100665816  E2F2; transcription factor E2F2 isoform X1 [KO:K09389]
100656140  E2F3; transcription factor E2F3 isoform X1 [KO:K06620]
100667822  RASD1; dexamethasone-induced Ras-related protein 1 [KO:K07843]
100666344  GNAI1; guanine nucleotide-binding protein G(i) subunit alpha-1 [KO:K04630]
100670234  GNAI2; guanine nucleotide-binding protein G(i) subunit alpha-2 [KO:K04630]
100667957  GNAI3; LOW QUALITY PROTEIN: guanine nucleotide-binding protein G(k) subunit alpha [KO:K04630]
104847035  aryl hydrocarbon receptor-like [KO:K09093]
100664247  AHR; aryl hydrocarbon receptor [KO:K09093]
100677666  AIPL1; aryl-hydrocarbon-interacting protein-like 1 [KO:K17767]
100672942  AIP; AH receptor-interacting protein isoform X1 [KO:K17767]
100673667  ARNT; aryl hydrocarbon receptor nuclear translocator isoform X6 [KO:K09097]
100674125  CDKN1B; cyclin-dependent kinase inhibitor 1B [KO:K06624]
100668134  CDK2; cyclin-dependent kinase 2 isoform X2 [KO:K02206] [EC:]
100668342  CCNE2; G1/S-specific cyclin-E2 isoform X1 [KO:K06626]
100659451  CCNE1; G1/S-specific cyclin-E1 isoform X1 [KO:K06626]
100671706  CDKN1A; cyclin-dependent kinase inhibitor 1 [KO:K06625]
100659992  CACNA1D; LOW QUALITY PROTEIN: voltage-dependent L-type calcium channel subunit alpha-1D [KO:K04851]
100674649  CACNA1F; LOW QUALITY PROTEIN: voltage-dependent L-type calcium channel subunit alpha-1F [KO:K04853]
100673089  CACNA1S; LOW QUALITY PROTEIN: voltage-dependent L-type calcium channel subunit alpha-1S [KO:K04857]
104846071  CAMK2A; calcium/calmodulin-dependent protein kinase type II subunit alpha [KO:K04515] [EC:]
100653927  CAMK2G; calcium/calmodulin-dependent protein kinase type II subunit gamma isoform X1 [KO:K04515] [EC:]
100663321  CAMK2D; calcium/calmodulin-dependent protein kinase type II subunit delta isoform X2 [KO:K04515] [EC:]
100658516  CAMK2B; calcium/calmodulin-dependent protein kinase type II subunit beta [KO:K04515] [EC:]
100676220  RAP1A; ras-related protein Rap-1A [KO:K04353]
100665185  RAP1B; ras-related protein Rap-1b [KO:K07836]
100664119  BRAF; serine/threonine-protein kinase B-raf [KO:K04365] [EC:]
100667623  MAP2K1; dual specificity mitogen-activated protein kinase kinase 1 [KO:K04368] [EC:]
100657587  MAP2K2; dual specificity mitogen-activated protein kinase kinase 2 [KO:K04369] [EC:]
100658240  MAPK3; mitogen-activated protein kinase 3 [KO:K04371] [EC:]
100665157  MAPK1; mitogen-activated protein kinase 1 [KO:K04371] [EC:]
100654848  NR4A1; nuclear receptor subfamily 4 group A member 1 [KO:K04465]
100659125  EGFR; epidermal growth factor receptor isoform X1 [KO:K04361] [EC:]
100668297  USP8; LOW QUALITY PROTEIN: ubiquitin carboxyl-terminal hydrolase 8 [KO:K11839] [EC:]
100669102  POMC; LOW QUALITY PROTEIN: pro-opiomelanocortin [KO:K05228]
100667193  MC2R; adrenocorticotropic hormone receptor [KO:K04200]
100669277  MRAP; melanocortin-2 receptor accessory protein [KO:K22398]
100670699  PDE8B; high affinity cAMP-specific and IBMX-insensitive 3',5'-cyclic phosphodiesterase 8B [KO:K18437] [EC:]
100658501  PDE8A; high affinity cAMP-specific and IBMX-insensitive 3',5'-cyclic phosphodiesterase 8A isoform X3 [KO:K18437] [EC:]
100676113  PDE11A; dual 3',5'-cyclic-AMP and -GMP phosphodiesterase 11A [KO:K13298] [EC:]
100667099  NR5A1; steroidogenic factor 1 isoform X1 [KO:K08560]
100662543  SP1; transcription factor Sp1 [KO:K04684]
100658312  PBX1; pre-B-cell leukemia transcription factor 1 isoform X1 [KO:K09355]
100654178  cytochrome P450 11B2, mitochondrial-like [KO:K00497] [EC:]
100660963  steroid 17-alpha-hydroxylase/17,20 lyase [KO:K00512] [EC:]
100664947  STAR; steroidogenic acute regulatory protein, mitochondrial [KO:K16931]
100668092  NCEH1; neutral cholesterol ester hydrolase 1 isoform X1 [KO:K14349] [EC:3.1.1.-]
100663645  ARMC5; LOW QUALITY PROTEIN: armadillo repeat-containing protein 5 [KO:K22499]
100670141  AGT; LOW QUALITY PROTEIN: angiotensinogen [KO:K09821]
100659079  AGTR1; type-1 angiotensin II receptor [KO:K04166]
100656672  GNAQ; guanine nucleotide-binding protein G(q) subunit alpha isoform X1 [KO:K04634]
100675896  guanine nucleotide-binding protein subunit alpha-11 [KO:K04635]
100670617  PLCB4; 1-phosphatidylinositol 4,5-bisphosphate phosphodiesterase beta-4 isoform X3 [KO:K05858] [EC:]
100672435  PLCB1; LOW QUALITY PROTEIN: 1-phosphatidylinositol 4,5-bisphosphate phosphodiesterase beta-1 [KO:K05858] [EC:]
100668575  PLCB2; LOW QUALITY PROTEIN: 1-phosphatidylinositol 4,5-bisphosphate phosphodiesterase beta-2 [KO:K05858] [EC:]
100663829  PLCB3; 1-phosphatidylinositol 4,5-bisphosphate phosphodiesterase beta-3 isoform X1 [KO:K05858] [EC:]
100665028  ITPR1; LOW QUALITY PROTEIN: inositol 1,4,5-trisphosphate receptor type 1 [KO:K04958]
100667845  ITPR2; inositol 1,4,5-trisphosphate receptor type 2 [KO:K04959]
100659666  ITPR3; LOW QUALITY PROTEIN: inositol 1,4,5-trisphosphate receptor type 3 [KO:K04960]
100654542  KCNK2; potassium channel subfamily K member 2 isoform X1 [KO:K04913]
100666554  CACNA1G; voltage-dependent T-type calcium channel subunit alpha-1G isoform X1 [KO:K04854]
100675598  CACNA1H; LOW QUALITY PROTEIN: voltage-dependent T-type calcium channel subunit alpha-1H [KO:K04855]
100660332  CACNA1I; LOW QUALITY PROTEIN: voltage-dependent T-type calcium channel subunit alpha-1I [KO:K04856]
100669326  ORAI1; calcium release-activated calcium channel protein 1 [KO:K16056]
100667029  KCNA4; potassium voltage-gated channel subfamily A member 4 [KO:K04877]
100672525  KCNK3; potassium channel subfamily K member 3 [KO:K04914]
100669109  LDLR; low-density lipoprotein receptor isoform X2 [KO:K12473]
100660517  SCARB1; scavenger receptor class B member 1 [KO:K13885]
100665050  cholesterol side-chain cleavage enzyme, mitochondrial [KO:K00498] [EC:]
100659049  HSD3B2; LOW QUALITY PROTEIN: 3 beta-hydroxysteroid dehydrogenase/Delta 5-->4-isomerase type 2 [KO:K00070] [EC:]
100658069  LOW QUALITY PROTEIN: steroid 21-hydroxylase [KO:K00513] [EC:]
100667785  FH; fumarate hydratase, mitochondrial isoform X1 [KO:K01679] [EC:]
100653551  WNT2B; protein Wnt-2b [KO:K00182]
100657046  WNT2; protein Wnt-2 [KO:K00182]
100663058  WNT3; proto-oncogene Wnt-3 [KO:K00312]
100662337  WNT3A; protein Wnt-3a [KO:K00312]
100664388  WNT4; LOW QUALITY PROTEIN: protein Wnt-4 [KO:K00408]
100664544  WNT5B; protein Wnt-5b isoform X2 [KO:K00444]
100658849  WNT5A; protein Wnt-5a isoform X1 [KO:K00444]
100675069  WNT6; protein Wnt-6 [KO:K00445]
100675463  WNT7A; protein Wnt-7a [KO:K00572]
100660629  WNT7B; protein Wnt-7b [KO:K00572]
100665788  WNT8B; protein Wnt-8b [KO:K00714]
100668409  WNT8A; protein Wnt-8a [KO:K00714]
100658979  WNT9B; protein Wnt-9b [KO:K01064]
100662057  WNT9A; protein Wnt-9a [KO:K01064]
100674782  WNT10A; protein Wnt-10a [KO:K01357]
100655805  WNT10B; protein Wnt-10b [KO:K01357]
100656630  WNT11; protein Wnt-11 [KO:K01384]
100659037  WNT16; protein Wnt-16 [KO:K01558]
100657335  FZD1; frizzled-1 [KO:K02432]
100658936  FZD7; frizzled-7 [KO:K02432]
100654997  FZD2; frizzled-2 [KO:K02235]
100666465  FZD3; frizzled-3 [KO:K02329]
100675317  FZD4; frizzled-4 [KO:K02354]
100674586  FZD5; frizzled-5 [KO:K02375]
100666499  FZD8; LOW QUALITY PROTEIN: frizzled-8 [KO:K02375]
100677440  FZD6; frizzled-6 [KO:K02376]
100660631  FZD10; frizzled-10 [KO:K02842]
100673586  DVL3; segment polarity protein dishevelled homolog DVL-3 isoform X1 [KO:K02353]
100657749  DVL2; segment polarity protein dishevelled homolog DVL-2 isoform X1 [KO:K02353]
100657649  DVL1; segment polarity protein dishevelled homolog DVL-1 isoform X1 [KO:K02353]
100675105  GSK3B; glycogen synthase kinase-3 beta isoform X2 [KO:K03083] [EC:]
100655765  AXIN1; axin-1 [KO:K02157]
100663921  AXIN2; axin-2 [KO:K04385]
100670988  CTNNB1; LOW QUALITY PROTEIN: catenin beta-1 [KO:K02105]
100659017  APC; adenomatous polyposis coli protein isoform X2 [KO:K02085]
100663559  TCF7; transcription factor 7 isoform X3 [KO:K02620]
100656106  TCF7L2; transcription factor 7-like 2 isoform X22 [KO:K04491]
100658960  LEF1; lymphoid enhancer-binding factor 1 isoform X2 [KO:K04492]
C00020  AMP
C00076  Calcium cation
C00187  Cholesterol
C00238  Potassium cation
C00410  Progesterone
C00575  3',5'-Cyclic AMP
C00735  Cortisol
C01176  17alpha-Hydroxyprogesterone
C01245  D-myo-Inositol 1,4,5-trisphosphate
C01953  Pregnenolone
C05138  17alpha-Hydroxypregnenolone
C05488  11-Deoxycortisol
C07557  2,3,7,8-Tetrachlorodibenzodioxin
Lacroix A, Feelders RA, Stratakis CA, Nieman LK
Cushing's syndrome.
Lancet 386:913-27 (2015)
Xiong Q, Ge W
Gene mutations in Cushing's disease.
Biomed Rep 5:277-282 (2016)
Fukuoka H, Takahashi Y
The role of genetic and epigenetic changes in pituitary tumorigenesis.
Neurol Med Chir (Tokyo) 54 Suppl 3:943-57 (2014)
Quereda V, Malumbres M
Cell cycle control of pituitary development and disease.
J Mol Endocrinol 42:75-86 (2009)
Caimari F, Korbonits M
Novel Genetic Causes of Pituitary Adenomas.
Clin Cancer Res 22:5030-5042 (2016)
Lecoq AL, Kamenicky P, Guiochon-Mantel A, Chanson P
Genetic mutations in sporadic pituitary adenomas--what to screen for?
Nat Rev Endocrinol 11:43-54 (2015)
Hannah-Shmouni F, Faucz FR, Stratakis CA
Alterations of Phosphodiesterases in Adrenocortical Tumors.
Front Endocrinol (Lausanne) 7:111 (2016)
Melmed S
Pathogenesis of pituitary tumors.
Nat Rev Endocrinol 7:257-66 (2011)
Daly AF, Tichomirowa MA, Beckers A
Genetic, molecular and clinical features of familial isolated pituitary adenomas.
Horm Res 71 Suppl 2:116-22 (2009)
Albani A, Theodoropoulou M, Reincke M
Genetics of Cushing's disease.
Clin Endocrinol (Oxf) 88:3-12 (2018)
Duan K, Hernandez KG, Mete O
Clinicopathological correlates of adrenal Cushing's syndrome.
Postgrad Med J 91:331-42 (2015)
Drougat L, Espiard S, Bertherat J
Genetics of primary bilateral macronodular adrenal hyperplasia: a model for early diagnosis of Cushing's syndrome?
Eur J Endocrinol 173:M121-31 (2015)
Stratakis CA, Boikos SA
Genetics of adrenal tumors associated with Cushing's syndrome: a new classification for bilateral adrenocortical hyperplasias.
Nat Clin Pract Endocrinol Metab 3:748-57 (2007)
Refojo D, Holsboer F
CRH signaling. Molecular specificity for drug targeting in the CNS.
Ann N Y Acad Sci 1179:106-19 (2009)
Kovalovsky D, Refojo D, Liberman AC, Hochbaum D, Pereda MP, Coso OA, Stalla GK, Holsboer F, Arzt E
Activation and induction of NUR77/NURR1 in corticotrophs by CRH/cAMP: involvement of calcium, protein kinase A, and MAPK pathways.
Mol Endocrinol 16:1638-51 (2002)
Lacroix A, Baldacchino V, Bourdeau I, Hamet P, Tremblay J
Cushing's syndrome variants secondary to aberrant hormone receptors.
Trends Endocrinol Metab 15:375-82 (2004)
Reincke M, Sbiera S, Hayakawa A, Theodoropoulou M, Osswald A, Beuschlein F, Meitinger T, Mizuno-Yamasaki E, Kawaguchi K, Saeki Y, Tanaka K, Wieland T, Graf E, Saeger W, Ronchi CL, Allolio B, Buchfelder M, Strom TM, Fassnacht M, Komada M
Mutations in the deubiquitinase gene USP8 cause Cushing's disease.
Nat Genet 47:31-8 (2015)
Kaiser UB
Cushing's disease: towards precision medicine.
Cell Res 25:649-50 (2015)
Uzilov AV, Cheesman KC, Fink MY, Newman LC, Pandya C, Lalazar Y, Hefti M, Fowkes M, Deikus G, Lau CY, Moe AS, Kinoshita Y, Kasai Y, Zweig M, Gupta A, Starcevic D, Mahajan M, Schadt EE, Post KD, Donovan MJ, Sebra R, Chen R, Geer EB
Identification of a novel RASD1 somatic mutation in a USP8-mutated corticotroph adenoma.
Cold Spring Harb Mol Case Stud 3:a001602 (2017)
Huang C, Shi Y, Zhao Y
USP8 mutation in Cushing's disease.
Oncotarget 6:18240-1 (2015)
Theodoropoulou M, Reincke M, Fassnacht M, Komada M
Decoding the genetic basis of Cushing's disease: USP8 in the spotlight.
Eur J Endocrinol 173:M73-83 (2015)
Yu L, Zhang J, Guo X, Chen X, He Z, He Q
ARMC5 mutations in familial and sporadic primary bilateral macronodular adrenal hyperplasia.
PLoS One 13:e0191602 (2018)
Wu X, Hua X
Menin, histone h3 methyltransferases, and regulation of cell proliferation: current knowledge and perspective.
Curr Mol Med 8:805-15 (2008)
Ozfirat Z, Korbonits M
AIP gene and familial isolated pituitary adenomas.
Mol Cell Endocrinol 326:71-9 (2010)
lav00020  Citrate cycle (TCA cycle)
lav00140  Steroid hormone biosynthesis
lav04020  Calcium signaling pathway
lav04024  cAMP signaling pathway
lav04110  Cell cycle
lav04310  Wnt signaling pathway
lav04927  Cortisol synthesis and secretion
lav04960  Aldosterone-regulated sodium reabsorption
KO pathway

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