Endocrine Abstracts

Introduction: The Nelson’s syndrom (NS) is defined by the development of an ACTH pituitary adenoma. Complication of bilateral adrenalectomy performed in some cases of Cushing’s disease.

We report the observation of three patients.

Case1: 34-year-old patient, followed for Cushing’s disease with pituitary microadenoma, having undergone pituitary surgery, then bilateral adrenalectomy due to surgical failure. Presented two years later an SN associating skin hyperpigmentation, high level of plasmatic ACTH and a pituitary adenoma measuring 10 mm. Having undergone a pituitary adenomectomy. Because of surgical failure and given the difficulty of surgical revision, a treatment associating Cabergoline with stereotactic radiotherapy was instituted.

Case2: 21-year-old patient, followed for ACTH-dependent Cushing’s syndrome with bilateral thickening of the adrenal glands on CT scan. Patient having benefited from a bilateral adrenalectomy, complicated Nine months later by an NS associating skin hyperpigmentation, high level of plasmatic ACTH and a pituitary microadenoma. In failure after two surgical revisions, he benefited from stereotactic radiotherapy.

Case3: 48-year-old female patient, followed for Cushing’s disease with pituitary microadenoma, having undergone pituitary surgery, then bilateral adrenalectomy due to surgical failure. Present Ten years after an NS, associating skin hyperpigmentation, high level of plasmatic ACTH, and a pituitary adenoma measuring 20 mm. She underwent a pituitary adenomectomy. Faced with the persistence of the NS after surgery, a treatment associating Cabergoline with stereotactic radiotherapy was instituted.

Conclusion: The management of the NS despite the therapeutic advance, remains heavy and associated with significant morbidity, hence the interest of early detection.