Progression of a Nelson's adenoma to pituitary carcinoma; a case report and review of the literature

A 25-year-old woman developed Nelson's syndrome, 3 years after successful b ilateral adrenalectomy for Gushing's disease. Despite pituitary surgery and radiotherapy the tumour showed invasive growth, leading to visual disturba nce, paresis of the oculomotor nerve and, 34 years after adrenalectomy, to death by widespread purulent leptomeningitis. Autopsy revealed a large aden ohypophyseal carcinoma with a metastasis attached to the dura, both tumours showing immunocytochemical staining for ACTH and TSH. We review the litera ture on metastatic adenohypophyseal carcinoma in Gushing's disease and Nels on's syndrome and discuss the role of proliferation markers as indicators o f malignant progression. (J. Endocrinol. Invest. 22: 70-75, 1999) (C)1999, Editrice Kurtis.