Nelson Syndrome

Nelson syndrome is progressive growth of an ACTH-secreting pituitary macroadenoma after bilateral adrenalectomy for Cushing disease. Loss of cortisol feedback stimulates the pre-existing corticotroph adenoma. Clinical: marked skin/mucosal hyperpigmentation (high ACTH), headache, visual-field defects, cranial-nerve palsies. Treatment: transsphenoidal surgery, radiotherapy, medical therapy; prophylaxis by pituitary radiation before/after adrenalectomy.

Common Symptoms

Progressive skin/mucosal hyperpigmentation; headache; visual-field loss; elevated ACTH; sellar mass

Causes and Pathogenesis

Bilateral adrenalectomy removes cortisol negative feedback, driving clonal expansion of a pre-existing pituitary corticotroph adenoma.

Treatment

Transsphenoidal surgery; pituitary radiotherapy; medical therapy; careful surveillance post-adrenalectomy

Preventive Measures

Screen pituitary MRI after bilateral adrenalectomy; consider prophylactic pituitary radiation.

Department to Visit

It is recommended to visit the Endocrinology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.