Nelson syndrome

A 31-year-old woman with a history of Cushing disease presented to the endocrinology clinic with progressively worsening hyperpigmentation of the oral cavity and palmar creases (Figure A & B). Medical history was significant for transsphenoidal resection of an ACTH-secreting pituitary adenoma followed by radiation therapy. Subsequently, bilateral adrenalectomy was performed due to ongoing cortisol excess that was refractory to medical treatment. The patient was prescribed adrenal replacement therapy with hydrocortisone and fludrocortisone.