Breast and endocrine surgery: Nelson syndrome: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Breast and endocrine surgery: Nelson syndrome

Sample item

A woman who underwent bilateral adrenalectomy for Cushing disease develops progressive skin hyperpigmentation, headaches and bitemporal hemianopia. What is the cause?

AGrowth of a pituitary corticotroph adenomaBInadequate glucocorticoid replacement aloneCRecurrent cortisol secretion from an adrenal remnantDEctopic ACTH secretion by a lung tumour

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Growth of a pituitary corticotroph adenoma

After bilateral adrenalectomy for pituitary-dependent Cushing disease, loss of cortisol feedback allows the corticotroph adenoma to enlarge and secrete large amounts of ACTH and related peptides. This is Nelson syndrome, with hyperpigmentation and visual field loss from chiasmal compression.

Option by option

A. Growth of a pituitary corticotroph adenoma (correct)
Correct. An enlarging ACTH-secreting pituitary adenoma explains pigmentation and the visual field defect.
B. Inadequate glucocorticoid replacement alone
Inadequate replacement causes adrenal insufficiency symptoms and does not produce a field defect.
C. Recurrent cortisol secretion from an adrenal remnant
An adrenal remnant would give recurrent cortisol excess and not hyperpigmentation with a field defect.
D. Ectopic ACTH secretion by a lung tumour
An ectopic ACTH source would have been the reason for the original Cushing syndrome and does not give chiasmal compression.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Growth of a pituitary corticotroph adenoma. After bilateral adrenalectomy for pituitary-dependent Cushing disease, loss of cortisol feedback allows the corticotroph adenoma to enlarge and secrete large amounts of ACTH and related peptides.

Why is "Inadequate glucocorticoid replacement alone" not the answer?

Inadequate replacement causes adrenal insufficiency symptoms and does not produce a field defect.

Why is "Recurrent cortisol secretion from an adrenal remnant" not the answer?

An adrenal remnant would give recurrent cortisol excess and not hyperpigmentation with a field defect.

Why is "Ectopic ACTH secretion by a lung tumour" not the answer?

An ectopic ACTH source would have been the reason for the original Cushing syndrome and does not give chiasmal compression.

What concept does this question test?

It tests Breast and endocrine surgery: Nelson syndrome in General Surgery. This is Nelson syndrome, with hyperpigmentation and visual field loss from chiasmal compression.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Breast and endocrine surgery: Nelson syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.