Clinical presentation, predictive factors and management of patients with Nelson syndrome: a retrospective study
Authors' conclusion
CTP-BADX/NS occurred in 30% of cases in our cohort. Higher ACTH post-BADX and younger age at CD onset may predict NS. No hormonal or radiological markers reliably predicted tumor progression. SRS before BADX and higher hydrocortisone doses might offer protection. Tumor control often needed a multimodal approach, with limited success from medical therapy alone.
Study context
- Population
- Patients with Cushing disease (CD) who underwent BADX with ≥18 months follow-up (male/female 9/21; median age at CD diagnosis 33 years, IQR 27–42)
- Participants
- 30 patients
- Exposure
- Nelson syndrome (NS) vs non-NS after BADX
- NSn = 9
- Outcome
- Development of NS (CTP-BADX/NS)
Main finding
As reported in the abstract
Incidence of NS · median follow-up 135 months
Patients developing NS
9 of 30
30%
Median time to NS after BADX
60 months
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| ACTH 2 years post-BADXHigher ACTH with NS | P = 0.020 |
| Fludrocortisone doseLower fludrocortisone with NS | P = 0.001 |
| Hydrocortisone doseTrend to less hydrocortisone with NS | P = 0.06 |
| Pre-BADX stereotactic radiosurgery (SRS)SRS more frequent in non-NS | P = 0.11 |
Earlier CD diagnosis in NS
- NS patients had earlier CD diagnosis
Hypertension and diabetes
- Hypertension more common in NS patients
- Diabetes less common in NS patients
Management of CTP-BADX
- Required pituitary surgery and/or radiotherapy
- 6/9
- Medical therapy used, with varied results
- 5 patients
Original publication
Clinical presentation, predictive factors and management of patients with Nelson syndrome: a retrospective study. Pituitary. Published 26 September 2025. doi:10.
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