{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:51:10Z","timestamp":1786125070700,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2017,8,5]],"date-time":"2017-08-05T00:00:00Z","timestamp":1501891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Nelson's syndrome may be a devastating complication for patients with Cushing's disease who underwent a bilateral adrenalectomy. Previous studies have demonstrated that stereotactic radiosurgery (SRS) can be used to treat patients with Nelson's syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To report a retrospective study of patients with Nelson's syndrome treated with Gamma Knife radiosurgery to evaluate the effect of SRS on endocrine remission and tumor control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Twenty-seven patients with Nelson's syndrome treated with Gamma Knife radiosurgery after bilateral adrenalectomy were included in this study. After radiosurgery, patients were followed with serial adrenocorticotropic hormone (ACTH) levels and MRI sequences to assess for endocrine remission and tumor control. Cox proportional hazards regression analysis was used to evaluate the relationship between the time to remission and potential prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      In 21 patients with elevated ACTH prior to SRS and endocrine follow-up data, 14 (67%) had decreased or stable ACTH levels, and 7 achieved a normal ACTH level at a median of 115 mo (range 7-272) post-SRS. Tumor volume was stable or reduced after SRS in 92.5% of patients (25\/27) with radiological follow-up. Time to remission was not significantly associated with the ACTH prior to SRS (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0= .252) or with the margin dose (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0= .3). However, a shorter duration between the patient's immediate prior transsphenoidal resection and SRS was significantly associated with a shorter time to remission (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.045).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>This retrospective analysis suggests that SRS is an effective means of achieving endocrine remission and tumor control in patients with Nelson's syndrome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyx426","type":"journal-article","created":{"date-parts":[[2017,7,18]],"date-time":"2017-07-18T15:11:29Z","timestamp":1500390689000},"page":"430-436","source":"Crossref","is-referenced-by-count":12,"title":["A Long-Term Study of the Treatment of Nelson's Syndrome With Gamma Knife Radiosurgery"],"prefix":"10.1227","volume":"83","author":[{"given":"James P","family":"Caruso","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohana Rao","family":"Patibandla","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Lee","family":"Vance","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia"},{"name":"Department of Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,9]]},"reference":[{"issue":"5","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1038\/nrendo.2011.12","article-title":"Management of Cushing disease","volume":"7","author":"Tritos","year":"2011","journal-title":"Nat Rev Endocrinol."},{"issue":"6","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"988","DOI":"10.3171\/jns.2007.106.6.988","article-title":"Gamma Knife surgery for adrenocorticotropic hormone-producing pituitary adenomas after bilateral adrenalectomy","volume":"106","author":"Mauermann","year":"2007","journal-title":"J Neurosurg"},{"issue":"6","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.3171\/2013.7.JNS13389","article-title":"Effect of stereotactic radiosurgery before bilateral adrenalectomy for Cushing's disease on the incidence of Nelson's syndrome","volume":"119","author":"Mehta","year":"2013","journal-title":"J Neurosurg"},{"issue":"3","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0360-3016(02)02975-9","article-title":"Stereotactic radiosurgery for patients with ACTH-producing pituitary adenomas after prior adrenalectomy","volume":"54","author":"Pollock","year":"2002","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3171\/jns.2006.104.1.157","article-title":"Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. 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on ACTH secretion in Nelson's syndrome and Cushing's disease","volume":"120","author":"Lamberts","year":"1989","journal-title":"Acta Endocrinol"},{"issue":"10","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"4592","DOI":"10.1210\/jc.2010-0644","article-title":"Temozolomide treatment in aggressive pituitary tumors and pituitary carcinomas: a French multicenter experience","volume":"95","author":"Raverot","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1210\/jc.2013-1497","article-title":"Sustained improvements in plasma ACTH and clinical status in a patient with Nelson's syndrome treated with pasireotide LAR, a multireceptor somatostatin analog","volume":"98","author":"Katznelson","year":"2013","journal-title":"J Clin Endocrinol 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