CRH signal transduction requires SHH-pathway zinc finger protein Gli1: in fact, CRH stimulus is impaired in vitro in Gli1-silenced AtT-20 cells; USP48 has been shown to deubiquitinate Gli1 and histone H2A, therefore dysregulating CRH signal transduction and cell growth, possibly resulting in adenoma formation with dysregulated ACTH secretion [41]. This evidence concerns the gene USP48 and adenoma.