Plasma ACTH and Nelson tumors in bilaterally adrenalectomized Cushing patients.

Bilaterally adrenalectomized patients (18) because of Cushing's syndrome were studied. 16 of these 18 persons exhibited fairly high plasma ACTH levels. Distinctly elevated plasma ACTH levels were observed in 6 of them. 5 patients of this group showed an enlarged sella and deep pigmentation of the skin. 4 of the latter group had a mucoid cell adenoma which was removed selectively. After the surgery the ACTH values were found to be within normal range without any significant endocrine dysfunction of the pituitary. A long-term ACTH survey revealed that the ACTH levels remained within the ranges of bilaterally adrenalectomized Cushing patients without concomitant enlargement of the sella or pigmentation.