We present the case of a 40-year-old female who was referred to our Department in 1993, for further management following the diagnosis of Cushings disease. She proceeded to a transsphenoidal adenenomatectomy (TSA) which resulted in a biochemical cure.
In 1998 she presented with recurrence of Cushings Disease, which was managed by a 2nd TSA followed by external beam irradiation.
Bilateral adrenalectomy followed a year later, due to the inability to control her disease.
In 2001 she presented with Nelsons Syndrome managed by a 3rd TSA followed this time with Gamma Knife surgery.
In 2004 she presented with manifestations consistent with recurrence of Nelsons Syndrome and proceeded to a 4th TSA. Despite the risk of blindness, the patient agreed to a second course of Gamma Knife treatment for the possibility of tumour control.
Over the next 2 years her clinical picture deteriorated, resulting in a right partial ptosis and a sixth nerve palsy.
She was referred to an Oncologist who offered her Chemotherapy, but she refused treatment.
The patient was then in the care of the Palliative Care Team and she died peacefully at home in 2006.