title: Nelson Syndrome: Update on Therapeutic Approaches.
abstract: OBJECTIVE
  To review the pathophysiology and therapeutic modalities availble for Nelson syndrome.
  
  
  METHODS
  We reviewed the current literature including managment for Nelson syndrome.
  
  
  RESULTS
  For patients with NS, surgical intervention is often the first-line therapy. With refractory NS or tumors with extrasellar involvement, radiosurgery offers an important alternative or adjuvant option. Pharmacologic interventions have demonstrated limited usefulness, although recent evidence supports the feasibility of a novel somatostatin analog for patients with NS. Modern neuroimaging, improved surgical techniques, and the advent of stereotactic radiotherapy have transformed the management of NS.
  
  
  CONCLUSIONS
  An up-to-date understanding of the pathophysiology underlying Nelson Syndrome and evidence-based management is imperative. Early detection may allow for more successful therapy in patients with Nelson Syndrome. Improved radiotherapeutic interventions and rapidly evolving pharmacologic therapies offer an opportunity to create targeted, multifocal treatment regiments for patients with Nelson Syndrome.
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
authors: Tej D
authors: TD
authors: Azad
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
authors: Anand
authors: A
authors: Veeravagu
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
authors: Sunny
authors: S
authors: Kumar
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. Electronic address: lkatznelson@stanford.edu.
authors: Laurence
authors: L
authors: Katznelson
mesh_terms: D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D006801:Humans; D009347:Nelson Syndrome / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D016634:Radiosurgery; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D013004:Somatostatin; D000324:Adrenocorticotropic Hormone; C517782:pasireotide
keywords: ACTH; Bilateral adrenalectomy; Cushing's disease; Nelson syndrome; Pituitary