MCID: ACT092
MIFTS: 53

Acth-Independent Macronodular Adrenal Hyperplasia

Categories: Genetic diseases, Rare diseases, Endocrine diseases

Aliases & Classifications for Acth-Independent Macronodular Adrenal Hyperplasia

MalaCards integrated aliases for Acth-Independent Macronodular Adrenal Hyperplasia:

Name: Acth-Independent Macronodular Adrenal Hyperplasia 57 53 13 73
Adrenocorticotropic Hormone-Independent Macronodular Adrenal Hyperplasia 57 53 75
Corticotropin-Independent Macronodular Adrenal Hyperplasia 57 53 75
Acth-Independent Macronodular Adrenocortical Hyperplasia 57 53 75
Aimah1 57 75
Hyperplasia, Adrenal, Acth-Independent, Macronodular, Type 1 40
Acth-Independent Macronodular Adrenal Hyperplasia 2 73
Acth-Independent Macronodular Adrenal Hyperplasia 1 75
Massive Macronodular Adrenocortical Disease 53
Primary Macronodular Adrenal Hyperplasia 53
Cushing Syndrome, Adrenal, Due to Aimah 57
Adrenal Cushing Syndrome Due to Aimah 75
Acth-Independent Cushing Syndrome 75
Aimah 53
Mmad 53

Characteristics:

OMIM:

57
Inheritance:
isolated cases

Miscellaneous:
adult onset (40 to 60 years old)
variable expressivity, some patients may be clinically asymptomatic


HPO:

32
acth-independent macronodular adrenal hyperplasia:
Onset and clinical course adult onset
Inheritance autosomal dominant inheritance sporadic


Classifications:



Summaries for Acth-Independent Macronodular Adrenal Hyperplasia

NIH Rare Diseases : 53 The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs.Orpha Number: 189427Disease definitionACTH-independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing syndrome (CS; see this term) characterized by nodular enlargement of both adrenal glands (multiple nodules above 1 cm in diameter) that produce excess cortisol and features of adrenocorticotropic hormone (ACTH) independent CS (see this term).EpidemiologyPrevalence of endogenous CS is estimated at 1/26,000 and AIMAH represents less than 1% of the cases.Clinical descriptionThe disease presents a bimodal age distribution with a rare subset presenting in the first years of life, particularly associated to McCune-Albright syndrome (MAS; see this term). Most patients present in their 5th or 6th decade and the disease might be more prevalent in females. AIMAH most frequently presents as clinical or subclinical CS and signs usually become apparent only after several decades of life. However, in some patients the adrenal lesions are found incidentally, in the process of radiological investigation of another disease. The adrenal glands can be massively enlarged bilaterally with the presence of numerous macronodules; however diffuse adrenal enlargement without nodules has been described.EtiologyThe exact etiology is unknown but the adrenal overgrowth seen in AIMAH may be due to the expression of aberrant membrane receptors found in the adrenal cortex that regulate cortisol secretion and which are stimulated by gastric inhibitory polypeptide (GIP), vasopressin, serotonin, catecholamines and luteinizing hormone (LH).Diagnostic methodsDiagnosis is based on the clinical picture of CS, the demonstration of ACTH-independent hypercortisolism (decreased levels of ACTH in plasma, non suppressible cortisol level after dexamethasone administration), and bilateral adrenal nodular enlargement on radiological imaging. Diagnosis is often difficult because hypercortisolism usually develops slowly over years, may be cyclical and is often associated with subtle CS. Radiological imaging is helpful, but occasionally nodularity is indistinguishable from that in normal elderly persons. Diagnosis can be confirmed by histological examination. Hormonal investigations can demonstrate aberrant receptor expression with abnormal stimulation of cortisol secretion by various hormones such as GIP in cases of food-dependent CS and gonadotropin-releasing hormone (GnRH) in cases of LH-dependent CS.Differential diagnosisDifferential diagnoses include other causes of ACTH-independent CS (adrenal adenoma and carcinoma), ACTH-dependent CS including pituitary (Cushing disease) or extra-pituitary tumors (ectopic ACTH secretion; see these terms), polycystic ovary syndrome and metabolic syndrome.Genetic counselingAIMAH is most often reported as sporadic but there are increasing reports of familial cases with autosomal dominant transmission. As the genetics of this disease are largely unknown genetic counseling is not yet possible.Management and treatmentTreatment can be medical if aberrant adrenal receptors are identified and can be blocked (i.e. with propranolol, somatostatin or GnRH analogs). If the blockade is not possible, treatment will be chosen depending on the level of steroid excess. Unilateral adrenalectomy can be proposed for patients with a moderate increase in hormone production, while bilateral adrenalectomy is recommended for patients with significant overproduction. After bilateral adrenalectomy, glucocorticoid and mineralocorticoid replacement is required.PrognosisPrognosis after treatment is good but quality of life may be affected due to the long-term effects of hypercortisolemia. Without treatment the disease is life-threatening as in the case of manifest hypercortisolism. In cases of moderate hypercortisolism, long-term morbidity is due to the increased cardiovascular and metabolic risk factors associated with mild CS.Visit the Orphanet disease page for more resources.

MalaCards based summary : Acth-Independent Macronodular Adrenal Hyperplasia, also known as adrenocorticotropic hormone-independent macronodular adrenal hyperplasia, is related to primary pigmented nodular adrenocortical disease and acth-independent macronodular adrenal hyperplasia 2, and has symptoms including agitation and generalized fatigue. An important gene associated with Acth-Independent Macronodular Adrenal Hyperplasia is GNAS (GNAS Complex Locus), and among its related pathways/superpathways are Signaling by GPCR and Peptide ligand-binding receptors. The drugs Epinephrine and Racepinephrine have been mentioned in the context of this disorder. Affiliated tissues include adrenal gland, pituitary and ovary, and related phenotypes are round face and psychosis

OMIM : 57 ACTH-independent macronodular adrenal hyperplasia (AIMAH) is an endogenous form of adrenal Cushing syndrome characterized by multiple bilateral adrenocortical nodules that cause a striking enlargement of the adrenal glands. Although some familial cases have been reported, the vast majority of AIMAH cases are sporadic. Patients typically present in the fifth and sixth decades of life, approximately 10 years later than most patients with other causes of Cushing syndrome (Swain et al., 1998; Christopoulos et al., 2005). Approximately 10 to 15% of adrenal Cushing syndrome is due to primary bilateral ACTH-independent adrenocortical pathology. The 2 main subtypes are AIMAH and primary pigmented nodular adrenocortical disease (PPNAD, see 610489), which is often a component of the Carney complex (160980) and associated with mutations in the PRKAR1A gene (188830) on chromosome 17q23-q24. AIMAH is rare, representing less than 1% of endogenous causes of Cushing syndrome (Swain et al., 1998; Christopoulos et al., 2005). See also ACTH-independent Cushing syndrome (615830) due to somatic mutation in the PRKACA gene (601639). Cushing 'disease' (219090) is an ACTH-dependent disorder caused in most cases by pituitary adenomas that secrete excessive ACTH. (219080)

UniProtKB/Swiss-Prot : 75 ACTH-independent macronodular adrenal hyperplasia 1: A rare adrenal defect characterized by multiple, bilateral, non- pigmented, benign, adrenocortical nodules. It results in excessive production of cortisol leading to ACTH-independent Cushing syndrome. Clinical manifestations of Cushing syndrome include facial and truncal obesity, abdominal striae, muscular weakness, osteoporosis, arterial hypertension, diabetes.

Related Diseases for Acth-Independent Macronodular Adrenal Hyperplasia

Graphical network of the top 20 diseases related to Acth-Independent Macronodular Adrenal Hyperplasia:



Diseases related to Acth-Independent Macronodular Adrenal Hyperplasia

Symptoms & Phenotypes for Acth-Independent Macronodular Adrenal Hyperplasia

Symptoms via clinical synopsis from OMIM:

57
Cardiovascular Vascular:
hypertension

Skeletal:
osteoporosis
decreased bone mineral density

Neurologic Behavioral Psychiatric Manifestations:
anxiety
psychosis
agitation
mood changes
depression

Growth Weight:
truncal obesity

Muscle Soft Tissue:
muscle wasting

Neoplasia:
no progression to cancer

Skeletal Spine:
kyphosis

Skin Nails Hair Skin:
thin skin
easy bruising
striae

Head And Neck Face:
round face

Endocrine Features:
macronodular adrenal hyperplasia
cushing syndrome
acth-independent hypercortisolemia
enlarged adrenal glands

Neurologic Central Nervous System:
cognitive decline

Laboratory Abnormalities:
increased serum cortisol
cortisol does not decrease on dexamethasone suppression test
decreased serum acth


Clinical features from OMIM:

219080

Human phenotypes related to Acth-Independent Macronodular Adrenal Hyperplasia:

32 (show all 32)
# Description HPO Frequency HPO Source Accession
1 round face 32 hallmark (90%) HP:0000311
2 psychosis 32 HP:0000709
3 agitation 32 HP:0000713
4 depressivity 32 frequent (33%) HP:0000716
5 anxiety 32 frequent (33%) HP:0000739
6 hypertension 32 frequent (33%) HP:0000822
7 osteopenia 32 HP:0000938
8 osteoporosis 32 HP:0000939
9 thin skin 32 hallmark (90%) HP:0000963
10 bruising susceptibility 32 frequent (33%) HP:0000978
11 striae distensae 32 frequent (33%) HP:0001065
12 mental deterioration 32 HP:0001268
13 mood changes 32 HP:0001575
14 primary hypercorticolism 32 HP:0001579
15 truncal obesity 32 hallmark (90%) HP:0001956
16 neoplasm 32 HP:0002664
17 kyphosis 32 HP:0002808
18 decreased circulating acth level 32 HP:0002920
19 skeletal muscle atrophy 32 HP:0003202
20 macronodular adrenal hyperplasia 32 HP:0008231
21 nephrolithiasis 32 frequent (33%) HP:0000787
22 infertility 32 frequent (33%) HP:0000789
23 diabetes mellitus 32 frequent (33%) HP:0000819
24 acne 32 frequent (33%) HP:0001061
25 muscle weakness 32 frequent (33%) HP:0001324
26 failure to thrive 32 hallmark (90%) HP:0001508
27 generalized hirsutism 32 frequent (33%) HP:0002230
28 hypokalemia 32 frequent (33%) HP:0002900
29 adrenocortical hypoplasia 32 hallmark (90%) HP:0008182
30 vestibular areflexia 32 hallmark (90%) HP:0008568
31 fatigue 32 frequent (33%) HP:0012378
32 menometrorrhagia 32 frequent (33%) HP:0400008

UMLS symptoms related to Acth-Independent Macronodular Adrenal Hyperplasia:


agitation, generalized fatigue

MGI Mouse Phenotypes related to Acth-Independent Macronodular Adrenal Hyperplasia:

46
# Description MGI Source Accession Score Top Affiliating Genes
1 behavior/neurological MP:0005386 9.87 AVPR1A AVPR1B AVPR2 EDNRA GNAS MC2R
2 endocrine/exocrine gland MP:0005379 9.73 AVPR1A AVPR1B EDNRA GNAS GNRH1 MC2R
3 hematopoietic system MP:0005397 9.63 AVPR1A AVPR2 EDNRA GNAS GNRH1 MC2R
4 homeostasis/metabolism MP:0005376 9.5 AVPR1A AVPR1B AVPR2 EDNRA GNAS GNRH1
5 nervous system MP:0003631 9.17 GNRH1 MC2R PDE11A AVPR1A AVPR1B EDNRA

Drugs & Therapeutics for Acth-Independent Macronodular Adrenal Hyperplasia

Drugs for Acth-Independent Macronodular Adrenal Hyperplasia (from DrugBank, HMDB, Dgidb, PharmGKB, IUPHAR, NovoSeek, BitterDB):

(show all 18)
# Name Status Phase Clinical Trials Cas Number PubChem Id
1
Epinephrine Approved, Vet_approved Phase 2 51-43-4 5816
2
Racepinephrine Approved Phase 2 329-65-7 838
3 Adrenocorticotropic Hormone Phase 2
4 Epinephryl borate Phase 2
5
Mifepristone Approved, Investigational 84371-65-3 55245
6 Adrenergic Agents
7 Adrenergic Agonists
8 Adrenergic alpha-Agonists
9 Adrenergic beta-Agonists
10 Anti-Asthmatic Agents
11 Autonomic Agents
12 Bronchodilator Agents
13 Hormones
14 Mydriatics
15 Neurotransmitter Agents
16 Peripheral Nervous System Agents
17 Respiratory System Agents
18 Vasoconstrictor Agents

Interventional clinical trials:


# Name Status NCT ID Phase Drugs
1 Study of Efficacy and Safety of Osilodrostat in Cushing's Syndrome Recruiting NCT02468193 Phase 2 Osilodrostat
2 Study of Adrenal Gland Tumors Recruiting NCT00005927
3 Retrospective Chart Review Study of Korlym for the Treatment of ACTH Independent Cushing's Syndrome Enrolling by invitation NCT02663609

Search NIH Clinical Center for Acth-Independent Macronodular Adrenal Hyperplasia

Genetic Tests for Acth-Independent Macronodular Adrenal Hyperplasia

Anatomical Context for Acth-Independent Macronodular Adrenal Hyperplasia

MalaCards organs/tissues related to Acth-Independent Macronodular Adrenal Hyperplasia:

41
Adrenal Gland, Pituitary, Ovary, Adrenal Cortex, Cortex, Testes, Skin

Publications for Acth-Independent Macronodular Adrenal Hyperplasia

Articles related to Acth-Independent Macronodular Adrenal Hyperplasia:

(show all 27)
# Title Authors Year
1
Whole-genome sequencing revealed armadillo repeat containing 5 (ARMC5) mutation in a Chinese family with ACTH-independent macronodular adrenal hyperplasia. ( 29279458 )
2017
2
Classification, diagnosis and treatment of ACTH-independent macronodular adrenal hyperplasia. ( 24069103 )
2013
3
Laparoscopic enucleation of macronodules in a patient with ACTH-independent macronodular adrenal hyperplasia 7 years after unilateral adrenalectomy: consideration of operative procedure. ( 23486077 )
2013
4
Whole exome sequencing identifies mutation of EDNRA involved in ACTH-independent macronodular adrenal hyperplasia. ( 23754170 )
2013
5
Genome-wide gene expression profiling identifies overlap with malignant adrenocortical tumours and novel mechanisms of inefficient steroidogenesis in familial ACTH-independent macronodular adrenal hyperplasia. ( 22383426 )
2012
6
Phosphodiesterase 11A (PDE11A) gene defects in patients with acth-independent macronodular adrenal hyperplasia (AIMAH): functional variants may contribute to genetic susceptibility of bilateral adrenal tumors. ( 22996146 )
2012
7
Assessment of long-term efficacy and safety of metyrapone monotherapy in a patient with ACTH-independent macronodular adrenal hyperplasia. ( 22038492 )
2012
8
Usefulness and limitations of unilateral adrenalectomy for ACTH-independent macronodular adrenal hyperplasia in a patient with poor glycemic control. ( 22790131 )
2012
9
A case of ACTH-independent macronodular adrenal hyperplasia associated with multiple endocrine neoplasia type 1. ( 21415556 )
2011
10
A rare case of ACTH-independent macronodular adrenal hyperplasia associated with aldosterone-producing adenoma. ( 21297325 )
2011
11
Unilateral adrenalectomy can be an alternative therapy for infantile onset Cushing' s syndrome caused by ACTH-independent macronodular adrenal hyperplasia with McCune-Albright syndrome. ( 20543510 )
2010
12
Aberrant expression of glucagon receptors in adrenal glands of a patient with Cushing's syndrome and ACTH-independent macronodular adrenal hyperplasia. ( 20529775 )
2010
13
Aberrant expression of multiple hormone receptors in ACTH-independent macronodular adrenal hyperplasia causing Cushing's syndrome. ( 20460422 )
2010
14
ACTH-independent macronodular adrenal hyperplasia. ( 19500767 )
2009
15
Role of unilateral aderenalectomy in ACTH-independent macronodular adrenal hyperplasia. ( 18825451 )
2009
16
Familial vasopressin-sensitive ACTH-independent macronodular adrenal hyperplasia (VPs-AIMAH): clinical studies of three kindreds. ( 19018784 )
2009
17
The role of unilateral adrenalectomy in ACTH-independent macronodular adrenal hyperplasia (AIMAH). ( 18214589 )
2008
18
ACTH-independent macronodular adrenal hyperplasia: imaging findings of a rare condition : A case report. ( 17502981 )
2008
19
Cushing's syndrome secondary to ACTH-independent macronodular adrenal hyperplasia. ( 18209860 )
2007
20
Ectopic expression of vasopressin V1b and V2 receptors in the adrenal glands of familial ACTH-independent macronodular adrenal hyperplasia. ( 16343095 )
2005
21
Clinical and subclinical ACTH-independent macronodular adrenal hyperplasia and aberrant hormone receptors. ( 16215323 )
2005
22
A case of ACTH-independent macronodular adrenal hyperplasia: simultaneous expression of several aberrant hormone receptors in the adrenal gland. ( 12940463 )
2003
23
An unusual case of Cushing's syndrome due to ACTH-independent macronodular adrenal hyperplasia. ( 12744099 )
2003
24
Unilateral adrenalectomy improves insulin resistance and diabetes mellitus in a patient with ACTH-independent macronodular adrenal hyperplasia. ( 14709842 )
2003
25
A case of severe hypertension caused by ACTH-independent macronodular adrenal hyperplasia. ( 11936469 )
2002
26
Is unilateral adrenalectomy an alternative treatment for ACTH-independent macronodular adrenal hyperplasia?: Long-term follow-up of four cases. ( 11834434 )
2002
27
Simultaneous bilateral laparoscopic adrenalectomy in ACTH-independent macronodular adrenal hyperplasia. ( 11389748 )
2001

Variations for Acth-Independent Macronodular Adrenal Hyperplasia

UniProtKB/Swiss-Prot genetic disease variations for Acth-Independent Macronodular Adrenal Hyperplasia:

75
# Symbol AA change Variation ID SNP ID
1 GNAS p.Arg201His VAR_003441 rs121913495
2 GNAS p.Arg201Ser VAR_017846 rs11554273

ClinVar genetic disease variations for Acth-Independent Macronodular Adrenal Hyperplasia:

6
# Gene Variation Type Significance SNP ID Assembly Location
1 GNAS NM_000516.5(GNAS): c.601C> T (p.Arg201Cys) single nucleotide variant Pathogenic/Likely pathogenic rs11554273 GRCh37 Chromosome 20, 57484420: 57484420
2 GNAS NM_000516.5(GNAS): c.601C> T (p.Arg201Cys) single nucleotide variant Pathogenic/Likely pathogenic rs11554273 GRCh38 Chromosome 20, 58909365: 58909365
3 GNAS NM_000516.5(GNAS): c.602G> A (p.Arg201His) single nucleotide variant Pathogenic/Likely pathogenic rs121913495 GRCh37 Chromosome 20, 57484421: 57484421
4 GNAS NM_000516.5(GNAS): c.602G> A (p.Arg201His) single nucleotide variant Pathogenic/Likely pathogenic rs121913495 GRCh38 Chromosome 20, 58909366: 58909366
5 GNAS NM_000516.5(GNAS): c.601C> A (p.Arg201Ser) single nucleotide variant Pathogenic rs11554273 GRCh37 Chromosome 20, 57484420: 57484420
6 GNAS NM_000516.5(GNAS): c.601C> A (p.Arg201Ser) single nucleotide variant Pathogenic rs11554273 GRCh38 Chromosome 20, 58909365: 58909365
7 GNAS NM_080425.3(GNAS): c.1200C> A (p.Ala400=) single nucleotide variant Uncertain significance rs908810796 GRCh37 Chromosome 20, 57429520: 57429520
8 GNAS NM_080425.3(GNAS): c.1200C> A (p.Ala400=) single nucleotide variant Uncertain significance rs908810796 GRCh38 Chromosome 20, 58854465: 58854465
9 GNAS NM_080425.3(GNAS): c.1455C> A (p.Ala485=) single nucleotide variant Uncertain significance rs55890501 GRCh37 Chromosome 20, 57429775: 57429775
10 GNAS NM_080425.3(GNAS): c.1455C> A (p.Ala485=) single nucleotide variant Uncertain significance rs55890501 GRCh38 Chromosome 20, 58854720: 58854720

Expression for Acth-Independent Macronodular Adrenal Hyperplasia

Search GEO for disease gene expression data for Acth-Independent Macronodular Adrenal Hyperplasia.

Pathways for Acth-Independent Macronodular Adrenal Hyperplasia

Pathways related to Acth-Independent Macronodular Adrenal Hyperplasia according to GeneCards Suite gene sharing:

(show all 12)
# Super pathways Score Top Affiliating Genes
1
Show member pathways
13.67 AVPR1A AVPR1B AVPR2 EDNRA GNAS GNRH1
2
Show member pathways
12.97 AVPR1A AVPR1B AVPR2 EDNRA GNAS GNRH1
3
Show member pathways
12.62 ARMC5 GNAS MC2R PDE11A
4
Show member pathways
12.27 EDNRA GNAS GNRH1
5
Show member pathways
12.26 AVPR1A AVPR1B EDNRA GNAS
6
Show member pathways
11.95 AVPR1A AVPR1B AVPR2 GNAS
7
Show member pathways
11.88 EDNRA GNAS MC2R
8
Show member pathways
11.53 AVPR1A AVPR1B EDNRA GNAS
9 11.31 EDNRA GNAS
10 11.12 AVPR2 GNAS
11 11.09 AVPR2 GNAS MC2R PDE11A
12 10.96 EDNRA GNAS

GO Terms for Acth-Independent Macronodular Adrenal Hyperplasia

Cellular components related to Acth-Independent Macronodular Adrenal Hyperplasia according to GeneCards Suite gene sharing:

# Name GO ID Score Top Affiliating Genes
1 integral component of plasma membrane GO:0005887 9.02 AVPR1A AVPR1B AVPR2 EDNRA MC2R

Biological processes related to Acth-Independent Macronodular Adrenal Hyperplasia according to GeneCards Suite gene sharing:

(show all 15)
# Name GO ID Score Top Affiliating Genes
1 signal transduction GO:0007165 9.76 AVPR1A AVPR1B AVPR2 EDNRA GNAS GNRH1
2 positive regulation of cytosolic calcium ion concentration GO:0007204 9.65 AVPR1A AVPR1B EDNRA
3 cellular response to hormone stimulus GO:0032870 9.61 AVPR1A AVPR1B AVPR2
4 activation of adenylate cyclase activity GO:0007190 9.58 AVPR2 EDNRA GNAS
5 adenylate cyclase-activating G-protein coupled receptor signaling pathway GO:0007189 9.55 GNAS MC2R
6 adenylate cyclase-modulating G-protein coupled receptor signaling pathway GO:0007188 9.54 AVPR2 GNAS
7 positive regulation of vasoconstriction GO:0045907 9.54 AVPR1A AVPR1B AVPR2
8 renal water homeostasis GO:0003091 9.52 AVPR2 GNAS
9 telencephalon development GO:0021537 9.51 AVPR1A AVPR2
10 activation of phospholipase C activity GO:0007202 9.5 AVPR1A AVPR1B EDNRA
11 positive regulation of blood pressure GO:0045777 9.49 AVPR1A AVPR2
12 positive regulation of systemic arterial blood pressure GO:0003084 9.46 AVPR1A AVPR2
13 response to peptide GO:1901652 9.43 AVPR1A AVPR1B AVPR2
14 G-protein coupled receptor signaling pathway GO:0007186 9.23 AVPR1A AVPR1B AVPR2 EDNRA GNAS GNRH1
15 regulation of systemic arterial blood pressure by vasopressin GO:0001992 9.13 AVPR1A AVPR1B AVPR2

Molecular functions related to Acth-Independent Macronodular Adrenal Hyperplasia according to GeneCards Suite gene sharing:

# Name GO ID Score Top Affiliating Genes
1 G-protein coupled receptor activity GO:0004930 9.65 AVPR1A AVPR1B AVPR2 EDNRA MC2R
2 peptide binding GO:0042277 9.33 AVPR1A AVPR1B AVPR2
3 protein kinase C binding GO:0005080 9.32 AVPR1A AVPR1B
4 vasopressin receptor activity GO:0005000 9.13 AVPR1A AVPR1B AVPR2
5 obsolete signal transducer activity GO:0004871 9.1 AVPR1A AVPR1B AVPR2 EDNRA GNAS MC2R

Sources for Acth-Independent Macronodular Adrenal Hyperplasia

3 CDC
7 CNVD
9 Cosmic
10 dbSNP
11 DGIdb
17 ExPASy
19 FMA
28 GO
29 GTR
30 HGMD
31 HMDB
32 HPO
33 ICD10
34 ICD10 via Orphanet
35 ICD9CM
36 IUPHAR
37 KEGG
38 LifeMap
40 LOVD
42 MedGen
44 MeSH
45 MESH via Orphanet
46 MGI
49 NCI
50 NCIt
51 NDF-RT
54 NINDS
55 Novoseek
57 OMIM
58 OMIM via Orphanet
62 PubMed
64 QIAGEN
69 SNOMED-CT via HPO
70 SNOMED-CT via Orphanet
71 TGDB
72 Tocris
73 UMLS
74 UMLS via Orphanet
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