{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T08:32:42Z","timestamp":1774686762155,"version":"3.50.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2007,6]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Patients with adrenocorticotropic hormone (ACTH)\u2013secreting pituitary adenomas may require a bilateral adrenalectomy to treat their Cushing's disease. Approximately one third of these patients, however, will experience progressive enlargement of the residual pituitary adenoma, develop hyperpigmentation, and have an elevated level of serum ACTH. These patients with Nelson's syndrome can be treated with Gamma Knife surgery (GKS).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The prospectively collected University of Virginia Gamma Knife database of patients with pituitary adenomas was reviewed to identify all individuals with Nelson's syndrome who were treated with GKS. Twenty-three patients with a minimum of 6 months of follow up were identified in the database. These patients were assessed for tumor control (that is, lack of tumor growth over time) with neuroimaging studies (median follow-up duration 22 months) and for biochemical normalization of their ACTH levels (median follow-up duration 50 months). Neuroimaging follow-up studies were available for 22 patients, and endocrine follow up was available for 15 patients in whom elevation of ACTH levels was documented prior to GKS.<\/jats:p>\n<jats:p>In the 22 patients in whom neuroimaging follow-up studies were available, 12 had a decrease in tumor size, eight had no tumor growth, and two had an increase in tumor volume. Ten of 15 patients with elevated ACTH levels prior to GKS showed a decrease in their ACTH levels at last follow up; three of these 10 patients achieved normal ACTH levels (&lt; 50 pg\/ml) and the other five patients with initially elevated values had an increase in ACTH levels.<\/jats:p>\n<jats:p>Ten patients were thoroughly evaluated for post-GKS pituitary function; four were found to have new pituitary hormone deficiency and six did not have hypopituitarism after GKS. One patient suffered a permanent third cranial nerve palsy and four patients are now deceased.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Gamma Knife surgery may control the residual pituitary adenoma and decrease ACTH levels in patients with Nelson's syndrome. Delayed hypopituitarism or cranial nerve palsies can occur after GKS. Patients with Nelson's syndrome require continued multidisciplinary follow-up care. Given the difficulties associated with management of Nelson's syndrome, even the modest results of GKS may be helpful for a number of patients.<\/jats:p><\/jats:sec>","DOI":"10.3171\/jns.2007.106.6.988","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T12:48:31Z","timestamp":1201178911000},"page":"988-993","source":"Crossref","is-referenced-by-count":45,"title":["Gamma Knife surgery for adrenocorticotropic hormone\u2013producing pituitary adenomas after bilateral adrenalectomy"],"prefix":"10.3171","volume":"106","author":[{"given":"William J.","family":"Mauermann","sequence":"first","affiliation":[{"name":"Lars Leksell Gamma Knife Center and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason P.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel R.","family":"Chernavvsky","sequence":"additional","affiliation":[{"name":"Lars Leksell Gamma Knife Center and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward R.","family":"Laws","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ladislau","family":"Steiner","sequence":"additional","affiliation":[{"name":"Lars Leksell Gamma Knife Center and"},{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Lee","family":"Vance","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Internal Medicine, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-1060988","series-title":"Acta Endocrinol (Copenh)","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1530\/acta.0.1230423","article-title":"A critical evaluation of transsphenoidal pituitary surgery in the treatment of Cushing's disease: prediction of outcome","volume":"123","author":"Arnott","year":"1990"},{"key":"b2-1060988","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"204","DOI":"10.3171\/jns.1987.66.2.0204","article-title":"Surgical treatment of Cushing's disease","volume":"66","author":"Chandler","year":"1987"},{"key":"b3-1060988","series-title":"Acta Endocrinol (Copenh)","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1530\/acta.0.1120310","article-title":"Long-term results of stereotactic radiosurgery to the pituitary gland in Cushing's disease","volume":"112","author":"Degerblad","year":"1986"},{"key":"b4-1060988","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1056\/NEJM199701163360303","article-title":"The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing's disease","volume":"336","author":"Estrada","year":"1997"},{"key":"b5-1060988","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"520","DOI":"10.3171\/jns.1989.71.4.0520","article-title":"Repeat transsphenoidal surgery for Cushing's disease","volume":"71","author":"Friedman","year":"1989"},{"key":"b6-1060988","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"644","DOI":"10.3171\/jns.2002.97.supplement_5.0644","article-title":"Gamma knife radiosurgery and its possible relationship to malignancy: a review","volume":"97","author":"Ganz","year":"2002"},{"issue":"1 Suppl","key":"b7-1060988","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1159\/000100657","article-title":"The effects of Gamma Knife surgery of pituitary adenomas on tumor growth and endocrinopathies","volume":"61","author":"Ganz","year":"1993"},{"key":"b8-1060988","series-title":"Am J Dis Child","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1001\/archpedi.1977.02120250035005","article-title":"Incidence of Nelson's syndrome after adrenalectomy for Cushing's disease in children: results of a nationwide survey","volume":"131","author":"Hopwood","year":"1977"},{"key":"b9-1060988","series-title":"Neurosurgery","first-page":"284","article-title":"Adrenocorticotropic hormone-producing pituitary tumors: 12-to 22-year follow-up after treatment with stereotactic radiosurgery","volume":"49","author":"Hoybye","year":"2001"},{"key":"b10-1060988","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"634","DOI":"10.3171\/jns.2004.100.4.0634","article-title":"Transsphenoidal surgery in Cushing disease: 10 years of experience in 34 consecutive cases","volume":"100","author":"Hoybye","year":"2004"},{"key":"b11-1060988","series-title":"J Endocrinol Invest","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/BF03345482","article-title":"Progression of a Nelson's adenoma to pituitary carcinoma; 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