Barber et al listed criteria for the diagnosis of Nelson syndrome. Early diagnosis and treatment can avoid life-threatening complications. The authors are from the University of Oxford.
Criteria for the diagnosis of Nelson's syndrome:
(1) history of total bilateral adrenalectomy (TBA) for treatment of Cushing's disease
(2) one or more of the following:
(2a) an expanding pituitary mass lesion seen in imaging studies after TBA as compared to images taken prior to TBA
(2b) (after TBA surgery) AND (an elevated plasma ACTH at 8 AM taken prior to steroid administration > 500 ng/L) AND (progressive elevations of plasma ACTH concentrations taken on >= 3 consecutive occasions) AND (elevation in ACTH is > 130% of initial sample following TBA)
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