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Case Reports

Visual vignette- Nelson’s syndrome: a giant pituitary

Authors:

Mahesh Doddabelavangala Mruthyunjaya ,

Christian Medical College, Vellore, IN
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Senthil Kumar,

PSG Hospital, Coimbatore, IN
About Senthil
Department of Endocrinology
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Riddhi Das Gupta,

Christian Medical College, Vellore, IN
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Deepak Abraham,

Christian Medical College, Vellore, IN
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Ari George Chacko,

Christian Medical College, Vellore, IN
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Sunithi Mani,

Christian Medical College, Vellore, IN
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B. Rajesh,

Christian Medical College, Vellore, IN
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Nihal Thomas

Christian Medical College, Vellore, IN
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Abstract

Nelson’s syndrome is an infrequent pituitary mass with an incidence of 8–43% in adults and 25–66% in children that develops following total bilateral adrenalectomy (TBA) for the treatment of Cushing’s disease. It is one of the most challenging of all endocrine conditions. The frequent aggressiveness of the underlying ACTH-secreting pituitary adenoma (corticotrophinoma) necessitates regular biochemical and radiological screening. Current evidence favours a lack of prophylactic neoadjuvant pituitary radiotherapy at the time of TBA and a rapid rise of ACTH levels in the year post TBA as factors that may predict the occurrence of Nelson’s syndrome. Though, computerized tomography (CT)/magnetic resonance imaging (MRI) have led to the early diagnosis and improvement in management. Nelson’s related tumours are sometimes detected late, through clinical manifestations of invasion and compression of the surrounding structures. With this perspective in mind, we describe a 22 year old gentleman 10 years after TBA who presented with right sided hemiparesis due to a corticotroph adenoma.
How to Cite: Mruthyunjaya, M.D., Kumar, S., Gupta, R.D., Abraham, D., Chacko, A.G., Mani, S., Rajesh, B. and Thomas, N., 2019. Visual vignette- Nelson’s syndrome: a giant pituitary. Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 9(1), pp.55–58. DOI: http://doi.org/10.4038/sjdem.v9i1.7375
Published on 05 Apr 2019.
Peer Reviewed

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