{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:45:50Z","timestamp":1790696750612,"version":"4.1.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Nelson's syndrome (NS) is a significant and frequent risk for patients with Cushing's disease (CD) who undergo bilateral adrenalectomy. A recent study has shown tumor progression in 47% of patients at risk for NS. The authors sought to define the rate of NS in patients who were treated with Gamma Knife stereotactic radiosurgery (GK SRS) prior to bilateral adrenalectomy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Consecutive patients with CD who were treated with GK SRS after pituitary surgery but before bilateral adrenalectomy were included. Serial MRI sequences were analyzed to evaluate for pituitary tumor growth. Clinical evaluations were performed to screen for NS. Follow-up for adrenocorticotropic hormone levels and hormone studies of other pituitary axes was performed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Twenty consecutive patients were followed with neuroimaging and clinically for a median of 5.4 years (range 0.6\u201312 years). One patient (5%) developed pituitary tumor growth consistent with NS 9 months after adrenalectomy. By Kaplan-Meier analysis, progression-free survival was 94.7% at 1, 3, and 7 years. No predisposing factors were identified for the tumor progression. Two patients developed new pituitary dysfunction and no patient developed cranial neuropathy or visual deficit after GK SRS.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>These findings suggest that GK SRS not only serves a role as second-line therapy for CD, but that it also provides prophylaxis for NS when used before bilateral adrenalectomy.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.7.jns13389","type":"journal-article","created":{"date-parts":[[2013,8,16]],"date-time":"2013-08-16T14:03:20Z","timestamp":1376661800000},"page":"1493-1497","source":"Crossref","is-referenced-by-count":27,"title":["Effect of stereotactic radiosurgery before bilateral adrenalectomy for Cushing's disease on the incidence of Nelson's syndrome"],"prefix":"10.3171","volume":"119","author":[{"given":"Gautam U.","family":"Mehta","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Lee","family":"Vance","sequence":"additional","affiliation":[{"name":"Medicine, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns13389","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1210\/jc.2006-1328","article-title":"Corticotroph tumor progression after adrenalectomy in Cushing's disease: a reappraisal of Nelson's syndrome","volume":"92","author":"Assi\u00e9","year":"2007"},{"key":"b2-jns13389","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"2454","DOI":"10.1210\/jc.2007-2734","article-title":"Treatment of adrenocorticotropin-dependent Cushing's syndrome: a consensus statement","volume":"93","author":"Biller","year":"2008"},{"key":"b3-jns13389","series-title":"Eur J Endocrinol","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1530\/eje.1.02323","article-title":"Gamma knife radiosurgery is a successful adjunctive treatment in Cushing's disease","volume":"156","author":"Castinetti","year":"2007"},{"key":"b4-jns13389","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.3171\/2012.2.JNS111630","article-title":"Cranial nerve dysfunction following Gamma Knife surgery for pituitary adenomas: long-term incidence and risk factors. 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