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May 1978

Nelson's Syndrome

Author Affiliations

The Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, OH 44106

Arch Intern Med. 1978;138(5):691-692. doi:10.1001/archinte.1978.03630290011008

Chickens, Eggs, and Seller Explosions  In 1958, Nelson and his colleagues described a patient who was discovered to have a sizable, chromophobe pituitary tumor three years after bilateral adrenalectomy for Cushing's disease.1 The temporal sequence of "Cushing's disease, bilateral adrenalectomy, symptomatic pituitary tumor" has been documented repeatedly since. The Nelson's syndrome literature contains no little admonition to follow the radiographic anatomy of the sella turcica sequentially in those patients deprived of their adrenals for the conquest of Cushing's disease, to take neuroendocrinologic alarm from the appearance of progressive skin hyperpigmentation, and to follow the plasma levels of adrenocorticotropic hormone (ACTH) in such patients. Aggrandizement in any of these measures signals the presence of a functioning pituitary mass.The further caveat has also been issued that prophylactic pituitary irradiation does not eliminate the risk of a new, hazardous pituitary growth in patients who have undergone therapeutic adrenal deprivation.2,3 Not

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