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April 22, 1974

Dissociation of Plasma and Spinal Fluid ACTH in Nelson Syndrome

Author Affiliations

From the University of Minnesota Medical School (Drs. Hoffman and Baumgartner) and the University of California, Davis (Dr. Gold).

JAMA. 1974;228(4):491-492. doi:10.1001/jama.1974.03230290039028

Nine years after a bilateral adrenalectomy for Cushing syndrome and three years after a craniotomy for a chromophobe adenoma, a 51-year-old white woman with marked hyperpigmentation was reexamined because of recurrent visual field losses. Serum and cerebrospinal fluid adrenocorticotropic hormone (ACTH) levels were elevated. Following intravenous administration of hydrocortisone, the serum ACTH levels were only partially suppressed. Unexpectedly, the cerebral spinal fluid ACTH level increased and remained elevated.

(JAMA 228:491-492, 1974)