Nelson's syndrome and spontaneous pituitary tumor infarction
R. M. Jordan, D. M. Cook, J. W. Kendall and C. W. Kerber
Large, adrenocorticotrophic hormone-secreting pituitary tumors (Nelson's
syndrome) developed in four of 12 patients treated with a bilateral
adrenalectomy for Cushing's disease. Two of the patients with Nelson's
syndrome suffered spontaneous pituitary tumor infarctions. One patient
improved under close observation and subsequent radiation therapy, although
she ultimately died from her locally invasive tumor. The condition of the
other patient-which had stabilized-appeared to be worsened by surgical
intervention. The high incidence of these tumors after bilateral
adrenalectomy, their large and agressive nature, and their apparent
propensity to undergo spontaneous infarction supports the position that
initial therapy for Cushing's disease should be directed to the pituitary
gland.