{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T23:29:09Z","timestamp":1780788549584,"version":"3.54.1"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Nelson\u2019s syndrome is a rare and challenging neuroendocrine disorder, and it is associated with elevated adrenocorticotrophic hormone (ACTH) level, skin hyperpigmentation, and pituitary adenoma growth. Management options including resection and medical therapy are traditional approaches. Ionizing radiation in the form of Gamma Knife radiosurgery (GKRS) is also being utilized to treat Nelson\u2019s syndrome. In the current study the authors sought to better define the therapeutic role of stereotactic radiosurgery (SRS) in Nelson\u2019s syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Study patients with Nelson\u2019s syndrome were treated with single-fraction GKRS (median margin dose of 25 Gy) at 6 different centers as part of an International Radiosurgery Research Foundation (IRRF) investigation. Data including neurological function, endocrine response, and radiological tumor response were collected and sent to the study-coordinating center for review. Fifty-one patients with median endocrine and radiological follow-ups of 91 and 80.5 months from GKRS, respectively, were analyzed for endocrine remission, tumor control, and neurological outcome. Statistical methods were used to identify prognostic factors for these endpoints.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>At last follow-up, radiological tumor control was achieved in 92.15% of patients. Endocrine remission off medical management and reduction in pre-SRS ACTH level were achieved in 29.4% and 62.7% of patients, respectively. Improved remission rates were associated with a shorter time interval between resection and GKRS (p = 0.039). Hypopituitarism was seen in 21.6% and new visual deficits were demonstrated in 15.7% of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>GKRS affords a high rate of pituitary adenoma control and improvement in ACTH level for the majority of Nelson\u2019s syndrome patients. Hypopituitarism is the most common adverse effect from GKRS in Nelson\u2019s syndrome patients and warrants longitudinal follow-up for detection and endocrine replacement.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.4.jns19273","type":"journal-article","created":{"date-parts":[[2019,7,13]],"date-time":"2019-07-13T00:07:34Z","timestamp":1562976454000},"page":"336-341","source":"Crossref","is-referenced-by-count":9,"title":["Gamma Knife radiosurgery for the treatment of Nelson\u2019s syndrome: a multicenter, international study"],"prefix":"10.3171","volume":"133","author":[{"given":"Diogo","family":"Cordeiro","sequence":"first","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":"Chelsea E.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Iorio-Morin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery, Universit\u00e9 de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery, Universit\u00e9 de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel D.","family":"Sisterson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kano","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Attuati","sequence":"additional","affiliation":[{"name":"Neurosurgery and Gamma Knife Radiosurgery, Humanitas Research Hospital, Rozzano, Milano, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Picozzi","sequence":"additional","affiliation":[{"name":"Neurosurgery and Gamma Knife Radiosurgery, Humanitas Research Hospital, Rozzano, Milano, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimball A.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-chia","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, People\u2019s Republic of China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Liscak","sequence":"additional","affiliation":[{"name":"Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Jezkova","sequence":"additional","affiliation":[{"name":"Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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