{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:43:53Z","timestamp":1760244233881,"version":"build-2065373602"},"reference-count":91,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T00:00:00Z","timestamp":1667347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Nelson\u2019s syndrome is a potentially severe condition that may develop in patients with Cushing\u2019s disease treated with bilateral adrenalectomy. Its management can be challenging. Pituitary surgery followed or not by radiotherapy offers the most optimal tumour control, whilst pituitary irradiation alone needs to be considered in cases requiring intervention and are poor surgical candidates. Observation is an option for patients with small lesions, not causing mass effects to vital adjacent structures but close follow-up is required for a timely detection of corticotroph tumour progression and for further treatment if required. To date, no medical therapy has been consistently proven to be effective in Nelson\u2019s syndrome. Pharmacotherapy, however, should be considered when other management approaches have failed. A subset of patients with Nelson\u2019s syndrome may develop further tumour growth after primary treatment, and, in some cases, a truly aggressive tumour behaviour can be demonstrated. In the absence of evidence-based guidance, the management of these cases is individualized and tailored to previously offered treatments. Temozolomide has been used in patients with aggressive Nelson\u2019s with no consistent results. Development of tumour-targeted therapeutic agents are an unmet need for the management of aggressive cases of Nelson\u2019s syndrome.<\/jats:p>","DOI":"10.3390\/medicina58111580","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T03:53:07Z","timestamp":1667447587000},"page":"1580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Nelson\u2019s Syndrome"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9467-3411","authenticated-orcid":false,"given":"Athanasios","family":"Fountas","sequence":"first","affiliation":[{"name":"Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK"},{"name":"Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TT, UK"},{"name":"Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-0643","authenticated-orcid":false,"given":"Niki","family":"Karavitaki","sequence":"additional","affiliation":[{"name":"Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK"},{"name":"Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TT, UK"},{"name":"Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1056\/NEJM195807242590403","article-title":"ACTH-producing tumor of the pituitary gland","volume":"259","author":"Nelson","year":"1958","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"P1","DOI":"10.1530\/EJE-20-1088","article-title":"Corticotroph tumor progression after bilateral adrenalectomy (Nelson\u2019s syndrome): Systematic review and expert consensus recommendations","volume":"184","author":"Reincke","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.3760\/cma.j.issn.0366-6999.2010.13.008","article-title":"Role of adrenalectomy in recurrent Cushing\u2019s disease","volume":"123","author":"Ding","year":"2010","journal-title":"Chin. Med. J."},{"key":"ref_4","first-page":"165","article-title":"The long-term outcome after adrenalectomy and prophylactic pituitary radiotherapy in adrenocorticotropin-dependent Cushing\u2019s syndrome","volume":"80","author":"Jenkins","year":"1995","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1111\/j.1365-2265.1990.tb03883.x","article-title":"Long-term follow-up of low-dose external pituitary irradiation for Cushing\u2019s disease","volume":"33","author":"Littley","year":"1990","journal-title":"Clin. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.jamcollsurg.2009.02.054","article-title":"Bilateral adrenalectomy for refractory Cushing disease: A safe and definitive therapy","volume":"208","author":"Smith","year":"2009","journal-title":"J. Am. Coll. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"825","DOI":"10.3171\/jns.2005.103.5.0825","article-title":"Surgical management of adrenocorticotropic hormone-secreting macroadenomas: Outcome and challenges in patients with Cushing\u2019s disease or Nelson\u2019s syndrome","volume":"103","author":"Vance","year":"2005","journal-title":"J. Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5465","DOI":"10.1210\/jc.2002-020299","article-title":"Neurosurgical treatment of Nelson\u2019s syndrome","volume":"87","author":"Kelly","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1111\/j.1365-2265.1989.tb01255.x","article-title":"Megavoltage pituitary irradiation in the management of Cushing\u2019s disease and Nelson\u2019s syndrome: Long-term follow-up","volume":"31","author":"Howlett","year":"1989","journal-title":"Clin. Endocrinol."},{"key":"ref_10","first-page":"197","article-title":"Treatment of acromegaly, Cushing disease and Nelson syndrome","volume":"133","author":"Lawrence","year":"1980","journal-title":"West. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1210\/clinem\/dgz200","article-title":"Outcomes of patients with Nelson\u2019s syndrome after primary treatment: A multicenter study from 13 UK Pituitary centers","volume":"105","author":"Fountas","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3718","DOI":"10.1210\/jc.2014-1843","article-title":"Changes in plasma ACTH levels and corticotroph tumor size in patients with Cushing\u2019s disease during long-term treatment with the glucocorticoid receptor antagonist mifepristone","volume":"99","author":"Fleseriu","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1530\/EJE-12-0358","article-title":"Efficiency and tolerance of mitotane in Cushing\u2019s disease in 76 patients from a single center","volume":"167","author":"Baudry","year":"2012","journal-title":"Eur. J. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1530\/EJE-07-0514","article-title":"Ketoconazole revisited: A preoperative or postoperative treatment in Cushing\u2019s disease","volume":"158","author":"Castinetti","year":"2008","journal-title":"Eur. J. Endocrinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s11102-020-01097-1","article-title":"Corticotroph tumor progression during long-term therapy with osilodrostat in a patient with persistent Cushing\u2019s disease","volume":"24","author":"Moumdjian","year":"2021","journal-title":"Pituitary"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1007\/s11102-021-01158-z","article-title":"Prevalence of Nelson\u2019s syndrome after bilateral adrenalectomy in patients with cushing\u2019s disease: A systematic review and meta-analysis","volume":"24","author":"Papakokkinou","year":"2021","journal-title":"Pituitary"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/B978-0-444-59602-4.00022-8","article-title":"Nelson syndrome: Definition and management","volume":"124","author":"Barber","year":"2014","journal-title":"Handb. Clin. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.ecl.2020.05.004","article-title":"Nelson\u2019s Syndrome: An Update","volume":"49","author":"Fountas","year":"2020","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1093\/neuros\/nyx426","article-title":"A Long-Term Study of the Treatment of Nelson\u2019s Syndrome with Gamma Knife Radiosurgery","volume":"83","author":"Caruso","year":"2018","journal-title":"Neurosurgery"},{"key":"ref_20","doi-asserted-by":"crossref","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","journal-title":"Stereotact. Funct. Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1159\/000099553","article-title":"Heavy-charged-particle radiosurgery of the pituitary gland: Clinical results of 840 patients","volume":"57","author":"Levy","year":"1991","journal-title":"Stereotact. Funct. Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s11102-014-0584-7","article-title":"Gamma knife radiosurgery for Cushing\u2019s disease and Nelson\u2019s syndrome","volume":"18","author":"Marek","year":"2015","journal-title":"Pituitary"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1016\/j.jocn.2013.12.026","article-title":"Nelson\u2019s syndrome: Single centre experience using the linear accelerator (LINAC) for stereotactic radiosurgery and fractionated stereotactic radiotherapy","volume":"21","author":"Wilson","year":"2014","journal-title":"J. Clin. Neurosci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"336","DOI":"10.3171\/2019.4.JNS19273","article-title":"Gamma Knife radiosurgery for the treatment of Nelson\u2019s syndrome: A multicenter, international study","volume":"133","author":"Cordeiro","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.ijrobp.2014.06.068","article-title":"Outcomes of proton therapy for patients with functional pituitary adenomas","volume":"90","author":"Wattson","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1530\/EJE-08-0687","article-title":"Gamma knife stereotactic radiosurgery of Nelson syndrome","volume":"160","author":"Oksnes","year":"2009","journal-title":"Eur. J. Endocrinol."},{"key":"ref_27","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."},{"key":"ref_28","first-page":"504","article-title":"Outcomes in pituitary surgery in Nelson\u2019s syndrome\u2014Therapeutic pitfalls","volume":"66","author":"Zielinski","year":"2015","journal-title":"Endokrynol. Pol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1046\/j.1365-2265.2001.01187.x","article-title":"Management of Nelson\u2019s syndrome: Observations in fifteen patients","volume":"54","author":"Kemink","year":"2001","journal-title":"Clin. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.3171\/2016.9.JNS161163","article-title":"Characterizing and predicting the Nelson-Salassa syndrome","volume":"127","author":"Graffeo","year":"2017","journal-title":"J. Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.surg.2006.12.003","article-title":"Nelson\u2019s syndrome after bilateral adrenalectomy for Cushing\u2019s disease","volume":"141","author":"Herrera","year":"2007","journal-title":"Surgery"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1210\/jc.2006-1328","article-title":"Corticotroph tumor progression after adrenalectomy in Cushing\u2019s Disease: A reappraisal of Nelson\u2019s Syndrome","volume":"92","author":"Assie","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00000421-199102000-00005","article-title":"Radiation therapy of pituitary tumors: Results in 95 cases","volume":"14","author":"Tran","year":"1991","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1111\/j.1365-2265.1990.tb03890.x","article-title":"Transsphenoidal surgery for Cushing\u2019s disease: Does what is removed determine the endocrine outcome?","volume":"33","author":"Burke","year":"1990","journal-title":"Clin. Endocrinol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/00005792-198101000-00002","article-title":"Cushing\u2019s disease\u201418 years\u2019 experience","volume":"60","author":"Urbanic","year":"1981","journal-title":"Medicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1001\/archinte.1979.03630400056021","article-title":"Nelson\u2019s syndrome and spontaneous pituitary tumor infarction","volume":"139","author":"Jordan","year":"1979","journal-title":"Arch. Intern. Med."},{"key":"ref_37","first-page":"470","article-title":"Long-term outcome after bilateral adrenalectomy in Cushing\u2019s disease with focus on Nelson\u2019s syndrome","volume":"63","author":"Cohen","year":"2019","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_38","first-page":"1150","article-title":"Microsurgical treatment of Nelson\u2019s syndrome","volume":"115","author":"Xing","year":"2002","journal-title":"Chin. Med. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"759","DOI":"10.4158\/EP171756.OR","article-title":"Long-Term Outcome of the Different Treatment Alternatives for Recurrent and Persistent Cushing Disease","volume":"23","author":"Espinosa","year":"2017","journal-title":"Endocr. Pract."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1007\/s40618-021-01531-6","article-title":"Gamma knife radiosurgery in patients with Nelson\u2019s syndrome","volume":"44","author":"Losa","year":"2021","journal-title":"J. Endocrinol. Investig."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1002\/cncr.22128","article-title":"Linear accelerator radiosurgery for pituitary macroadenomas: A 7-year follow-up study","volume":"107","author":"Voges","year":"2006","journal-title":"Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1007\/s00701-021-04823-1","article-title":"Stereotactic radiosurgery before bilateral adrenalectomy is associated with lowered risk of Nelson\u2019s syndrome in refractory Cushing\u2019s disease patients","volume":"163","author":"Bunevicius","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"E13","DOI":"10.3171\/foc.2007.23.3.15","article-title":"Nelson syndrome: Comprehensive review of pathophysiology, diagnosis, and management","volume":"23","author":"Banasiak","year":"2007","journal-title":"Neurosurg. Focus"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1159\/000314296","article-title":"Role of somatostatin receptors in normal and tumoral pituitary corticotropic cells","volume":"92","author":"Hofland","year":"2010","journal-title":"Neuroendocrinology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1210\/jcem-40-6-1125","article-title":"Inhibition by somatostatin of ACTH secretion in Nelson\u2019s syndrome","volume":"40","author":"Tyrrell","year":"1975","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e110","DOI":"10.1097\/MJT.0b013e318255bc07","article-title":"Hormonal secretion and quality of life in Nelson syndrome and Cushing disease after long acting repeatable octreotide: A short series and update","volume":"21","author":"Arregger","year":"2014","journal-title":"Am. J. Ther."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1136\/pgmj.72.843.53","article-title":"The effects of octreotide in a patient with Nelson\u2019s syndrome","volume":"72","author":"Kelestimur","year":"1996","journal-title":"Postgrad. Med. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/BF03347703","article-title":"Long-term treatment of Nelson\u2019s syndrome by octreotide: A case report","volume":"17","author":"Petrini","year":"1994","journal-title":"J. Endocrinol. Investig."},{"key":"ref_49","first-page":"760","article-title":"The effect of the long-acting somatostatin analogue SMS 201\u2013995 on ACTH secretion in Nelson\u2019s syndrome and Cushing\u2019s disease","volume":"120","author":"Lamberts","year":"1989","journal-title":"Acta Endocrinol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"648","DOI":"10.3389\/fendo.2020.00648","article-title":"Medical Treatment of Cushing\u2019s Disease: An Overview of the Current and Recent Clinical Trials","volume":"11","author":"Pivonello","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1055\/a-1158-9214","article-title":"Exceptional Response of Nelson\u2019s Syndrome to Pasireotide LAR in the Long-Term Follow-up of 9 Years","volume":"129","author":"Fill","year":"2021","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40842-020-00110-7","article-title":"Rapid response of Nelson\u2019s syndrome to pasireotide in radiotherapy-naive patient","volume":"6","author":"He","year":"2020","journal-title":"Clin. Diabetes Endocrinol."},{"key":"ref_53","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\u2019s syndrome treated with pasireotide LAR, a multireceptor somatostatin analog","volume":"98","author":"Katznelson","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s11102-017-0853-3","article-title":"A prospective longitudinal study of Pasireotide in Nelson\u2019s syndrome","volume":"21","author":"Daniel","year":"2018","journal-title":"Pituitary"},{"key":"ref_55","first-page":"514","article-title":"Acute effects of bromocriptine, cyproheptadine, and valproic acid on plasma adrenocorticotropin secretion in Nelson\u2019s syndrome","volume":"82","author":"Yanovski","year":"1997","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.1365-2265.1990.tb00855.x","article-title":"The effect of cyproheptadine and\/or bromocriptine on plasma ACTH levels in patients cured of Cushing\u2019s disease by bilateral adrenalectomy","volume":"32","author":"Whitehead","year":"1990","journal-title":"Clin. Endocrinol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1507\/endocrj1954.31.619","article-title":"Effects of bromocriptine and cyproheptadine on basal and corticotropin-releasing factor (CRF)-induced ACTH release in a patient with Nelson\u2019s syndrome","volume":"31","author":"Hirata","year":"1984","journal-title":"Endocrinol. Jpn."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1210\/jcem-51-2-307","article-title":"The mechanism of the suppressive action of bromocriptine on adrenocorticotropin secretion in patients with Cushing\u2019s disease and Nelson\u2019s syndrome","volume":"51","author":"Lamberts","year":"1980","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0140-6736(76)90656-5","article-title":"Bromocriptine in Nelson\u2019s syndrome and Cushing\u2019s disease","volume":"2","author":"Lamberts","year":"1976","journal-title":"Lancet"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/BF03350982","article-title":"Lack of effect of bromocriptine on ACTH levels in patients with bilateral adrenalectomy for pituitary-dependent Cushing\u2019s syndrome","volume":"1","author":"Walker","year":"1978","journal-title":"J. Endocrinol. Investig."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1136\/bmj.2.6192.700","article-title":"Effects of bromocriptine on pituitary tumour size","volume":"2","author":"McGregor","year":"1979","journal-title":"Br. Med. J."},{"key":"ref_62","first-page":"300","article-title":"Nelson\u2019s syndrome: Complete remission with cabergoline but not with bromocriptine or cyproheptadine treatment","volume":"62","author":"Casulari","year":"2004","journal-title":"Horm. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1007\/BF03343660","article-title":"Complete remission of Nelson\u2019s syndrome after 1-year treatment with cabergoline","volume":"22","author":"Pivonello","year":"1999","journal-title":"J. Endocrinol. Investig."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s11102-006-9290-4","article-title":"Clinical and biochemical stabilization of Nelson\u2019s syndrome with long-term low-dose cabergoline treatment","volume":"9","author":"Shimon","year":"2006","journal-title":"Pituitary"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/S0140-6736(81)92349-7","article-title":"Effect of treatment with sodium valproate and diazepam on plasma corticotropin in Nelson\u2019s syndrome","volume":"1","author":"Jones","year":"1981","journal-title":"Lancet"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/j.1365-2265.1981.tb00649.x","article-title":"Effects of valproic acid, naloxone and hydrocortisone in Nelson\u2019s syndrome and cushing\u2019s disease","volume":"15","author":"Elias","year":"1981","journal-title":"Clin. Endocrinol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1210\/jcem-56-5-985","article-title":"The evaluation of sodium valproate in the treatment of Nelson\u2019s syndrome","volume":"56","author":"Dornhorst","year":"1983","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/j.1365-2265.1985.tb00206.x","article-title":"Unaltered stimulation of pituitary adrenocorticotrophin secretion by corticotrophin-releasing factor following sodium valproate administration in a patient with Nelson\u2019s syndrome","volume":"23","author":"Gomi","year":"1985","journal-title":"Clin. Endocrinol."},{"key":"ref_69","first-page":"709","article-title":"ACTH responses to somatostatin, valproic acid and dexamethasone in Nelson\u2019s syndrome","volume":"26","author":"Zgliczynski","year":"2005","journal-title":"Neuroendocrinol. Lett."},{"key":"ref_70","first-page":"435","article-title":"Size reduction of an ACTH-secreting pituitary macroadenoma in Nelson\u2019s syndrome by sodium valproate: Effect of withdrawal and re-institution of treatment","volume":"119","author":"Loli","year":"1988","journal-title":"Acta Endocrinol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/BF03348396","article-title":"Lack of ACTH lowering effect of sodium valproate in patients with ACTH hypersecretion","volume":"7","author":"Loli","year":"1984","journal-title":"J. Endocrinol. Investig."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/j.1365-2265.1988.tb03656.x","article-title":"Long-term treatment of Nelson\u2019s syndrome with sodium valproate","volume":"28","author":"Kelly","year":"1988","journal-title":"Clin. Endocrinol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1007\/BF01726927","article-title":"The effect of sodium valproate in Cushing\u2019s disease, Nelson\u2019s syndrome and Addison\u2019s disease","volume":"66","author":"Reincke","year":"1988","journal-title":"Klin. Wochenschr."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1038\/nm784","article-title":"Functional PPAR-gamma receptor is a novel therapeutic target for ACTH-secreting pituitary adenomas","volume":"8","author":"Heaney","year":"2002","journal-title":"Nat. Med."},{"key":"ref_75","first-page":"430","article-title":"No effect of the PPAR-gamma agonist rosiglitazone on ACTH or cortisol secretion in Nelson\u2019s syndrome and Cushing\u2019s disease in vitro and in vivo","volume":"28","author":"Kreutzer","year":"2009","journal-title":"Clin. Neuropathol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1210\/jc.2006-2005","article-title":"Ineffectiveness of rosiglitazone therapy in Nelson\u2019s syndrome","volume":"92","author":"Munir","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1111\/j.1365-2265.2006.02501.x","article-title":"The PPAR-gamma activator rosiglitazone fails to lower plasma ACTH levels in patients with Nelson\u2019s syndrome","volume":"64","author":"Mullan","year":"2006","journal-title":"Clin. Endocrinol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1530\/eje.1.01994","article-title":"Rosiglitazone for prevention or adjuvant treatment of Nelson\u2019s syndrome after bilateral adrenalectomy","volume":"153","author":"Andreassen","year":"2005","journal-title":"Eur. J. Endocrinol."},{"key":"ref_79","first-page":"305","article-title":"Cyproheptadine therapy in Cushing\u2019s disease and Nelson\u2019s syndrome","volume":"57","author":"Jialal","year":"1980","journal-title":"S. Afr. Med. J."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1056\/NEJM198002213020808","article-title":"Sustained remission of Nelson\u2019s syndrome after stopping cyproheptadine treatment","volume":"302","author":"Aronin","year":"1980","journal-title":"N. Engl. J. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1210\/jcem-46-2-349","article-title":"Cyproheptadine treatment of Nelson\u2019s syndrome: Restoration of plasma ACTH circadian periodicity and reversal of response to TRF","volume":"46","author":"Krieger","year":"1978","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1210\/jcem-43-5-1179","article-title":"Effectiveness of cyproheptadine in decreasing plasma ACTH concentrations in Nelson\u2019s syndrome","volume":"43","author":"Krieger","year":"1976","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1210\/jcem-47-4-837","article-title":"Cortisol and androgen secretion in a case of Nelson\u2019s syndrome with paratesticular tumors: Response to cyproheptadine therapy","volume":"47","author":"Krieger","year":"1978","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S0140-6736(76)92451-X","article-title":"Cyproheptadine in Nelson\u2019s syndrome","volume":"2","author":"Cassar","year":"1976","journal-title":"Lancet"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1023\/A:1009986822146","article-title":"Effect of the serotonin antagonists ritanserin and ketanserin in Cushing\u2019s disease","volume":"3","author":"Sonino","year":"2000","journal-title":"Pituitary"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1136\/bmj.289.6448.787","article-title":"Effect of an oral serotonin antagonist, ketanserin, on plasma ACTH concentrations in Nelson\u2019s syndrome","volume":"289","author":"Prescott","year":"1984","journal-title":"Br. Med. J. (Clin. Res. Ed.)"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1055\/s-2006-921430","article-title":"Nelson\u2019s syndrome\u201446 years later: Clinical experience with 37 patients","volume":"67","author":"Bonicki","year":"2006","journal-title":"Zentralbl. Neurochir."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-17-0796","article-title":"European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas","volume":"178","author":"Raverot","year":"2018","journal-title":"Eur. J. Endocrinol."},{"key":"ref_89","first-page":"623092","article-title":"Temozolomide-Induced Shrinkage of Invasive Pituitary Adenoma in Patient with Nelson\u2019s Syndrome: A Case Report and Review of the Literature","volume":"2015","author":"Kurowska","year":"2015","journal-title":"Case Rep. Endocrinol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1530\/EJE-08-0557","article-title":"Treatment of Nelson\u2019s syndrome with temozolomide","volume":"160","author":"Moyes","year":"2009","journal-title":"Eur. J. Endocrinol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"587893","DOI":"10.1155\/2015\/587893","article-title":"Temozolomide Therapy for Aggressive Pituitary Tumors: Results in a Small Series of Patients from Argentina","volume":"2015","author":"Bruno","year":"2015","journal-title":"Int. J. Endocrinol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1580\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:09:13Z","timestamp":1760144953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,2]]},"references-count":91,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["medicina58111580"],"URL":"https:\/\/doi.org\/10.3390\/medicina58111580","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2022,11,2]]}}}