{"id":1373,"date":"2021-10-13T14:50:00","date_gmt":"2021-10-13T14:50:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1373"},"modified":"2025-10-01T11:40:31","modified_gmt":"2025-10-01T19:40:31","slug":"usmle-step-2-ck-question-of-the-day-nelson-syndrome","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Nelson Syndrome"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#Check_out_our_free_USMLE%C2%AE_Step_2_Ultimate_Guide\" >Check out our free&nbsp;USMLE\u00ae Step 2 Ultimate Guide!<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#B_Transsphenoidal_resection_of_the_pituitary_gland\" >B. Transsphenoidal resection of the pituitary gland<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#A_Initiation_of_dexamethasone_supplementation\" >A. Initiation of dexamethasone supplementation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#C_Initiation_of_octreotide_therapy\" >C. Initiation of octreotide therapy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#D_Resection_of_the_hypothalamus\" >D. Resection of the hypothalamus<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#E_Initiation_of_chemotherapy\" >E. Initiation of chemotherapy<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;<strong><em>Today&#8217;s case involves a 45-year-old man with morning headaches who underwent bilateral adrenalectomy to treat his Cushing syndrome. Which of the following is the next best step in management?<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 45-year-old man comes to his outpatient provider because of headaches and changes in vision that began one-month ago. The headaches are worse in the morning and improve over the day. Past medical history is notable for&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cushing_syndrome:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">Cushing syndrome<\/a>&nbsp;refractory to medical treatment, for which the patient underwent bilateral adrenalectomy seven months ago. He was prescribed hydrocortisone supplements after the surgery but has been inconsistent in taking his medications. In the office, his temperature is 37.8\u00b0C (100.0\u00b0F) and blood pressure is 120\/79 mmHg. Physical examination is notable for hyperpigmentation of the skin. Visual field testing reveals bitemporal hemianopsia. Laboratory testing is notable for a serum ACTH of 700 pg\/mL. Magnetic resonance imaging confirms the patient\u2019s underlying condition. Which of the following is the next best step in management?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Initiation of dexamethasone supplementation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Transsphenoidal resection of the pituitary gland<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Initiation of octreotide therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Resection of the hypothalamus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Initiation of chemotherapy<\/strong>Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the Universidad Nacional de Colombia\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/thBMBb6juR0?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h5 class=\"wp-block-heading has-text-align-center\"><span class=\"ez-toc-section\" id=\"Check_out_our_free_USMLE%C2%AE_Step_2_Ultimate_Guide\"><\/span>Check out our free<a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-2\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;USMLE\u00ae Step 2 Ultimate Guide!<\/a><span class=\"ez-toc-section-end\"><\/span><\/h5>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Transsphenoidal_resection_of_the_pituitary_gland\"><\/span>B. Transsphenoidal resection of the pituitary gland<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, C, D or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today&#8217;s incorrect answers are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Initiation_of_dexamethasone_supplementation\"><\/span>A. Initiation of dexamethasone supplementation<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Patients who have undergone bilateral adrenalectomy should take glucocorticoid supplements. This helps prevent the symptoms of adrenal insufficiency. In contrast, this patient\u2019s symptoms of morning headaches and visual disturbances are most consistent with Nelson syndrome (post-adrenalectomy enlargement of the pituitary gland).&nbsp;<a href=\"http:\/\/glucocorticoids\/\" target=\"_blank\" rel=\"noreferrer noopener\">Glucocorticoid<\/a>&nbsp;supplements are ineffective in treating Nelson syndrome.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Initiation_of_octreotide_therapy\"><\/span>C. Initiation of octreotide therapy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Octreotide can be used to treat&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Acromegaly\" target=\"_blank\" rel=\"noreferrer noopener\">acromegaly<\/a>&nbsp;and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Gigantism\" target=\"_blank\" rel=\"noreferrer noopener\">gigantism&nbsp;<\/a>in patients with growth hormone-secreting pituitary adenomas. However, there is little data supporting the efficacy of octreotide in treating the ACTH-secreting&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pituitary_adenomas_and_pituitary_hyperfunction:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">pituitary adenomas<\/a>&nbsp;found in patients with Nelson syndrome.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Resection_of_the_hypothalamus\"><\/span>D. Resection of the hypothalamus<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;The patient\u2019s symptom of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Bitemporal_hemianopsia\" target=\"_blank\" rel=\"noreferrer noopener\">bitemporal hemianopsia<\/a>&nbsp;is suggestive of a&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pituitary_adenomas_and_pituitary_hyperfunction:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">pituitary adenoma<\/a>&nbsp;that is compressing the optic chiasm. Surgical intervention should be focused on resecting the enlarged pituitary and not the hypothalamus.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Initiation_of_chemotherapy\"><\/span>E. Initiation of chemotherapy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;A&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pituitary_adenomas_and_pituitary_hyperfunction:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">pituitary adenoma<\/a>&nbsp;can compress the optic chiasm and cause&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Bitemporal_hemianopsia\" target=\"_blank\" rel=\"noreferrer noopener\">bitemporal hemianopsia<\/a>. However, adenomas are benign tumors. Chemotherapy is not indicated in the treatment of pituitary adenomas, and it can lead to severe side-effects in the patient.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has&nbsp;<strong>Nelson syndrome<\/strong>, which is a condition in which the&nbsp;<strong>pituitary gland enlarges after bilateral adrenalectomy<\/strong>. Bilateral adrenalectomy can be performed to treat&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cushing_syndrome:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">Cushing syndrome<\/a>&nbsp;in patients who have failed more conservative treatment options.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The pathophysiology of Nelson syndrome is not fully understood. However, one proposed mechanism is that after the bilateral adrenal glands are excised, there is&nbsp;<strong>removal of negative-feedback to the hypothalamus and pituitary,<\/strong>&nbsp;since endogenous&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cortisol\" target=\"_blank\" rel=\"noreferrer noopener\">cortisol&nbsp;<\/a>is no longer being synthesized. This results in increased corticotropin-releasing hormone (CRH) from the hypothalamus. The elevated CRH subsequently increases&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Adrenocorticotropic_hormone\" target=\"_blank\" rel=\"noreferrer noopener\">ACTH&nbsp;<\/a>production by the pituitary gland. Overtime, the result is pituitary enlargement. In addition, since&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Adrenocorticotropic_hormone\" target=\"_blank\" rel=\"noreferrer noopener\">ACTH&nbsp;<\/a>and melanocyte stimulating hormone (MSH) are derived from the same precursor molecule, increased ACTH production would also lead to increased MSH production.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The enlarged pituitary can compress nearby nerves and cause&nbsp;<strong>headaches<\/strong>. Moreover, the enlarged pituitary can compress the optic chiasm and cause&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Bitemporal_hemianopsia\" target=\"_blank\" rel=\"noreferrer noopener\">bitemporal hemianopsia<\/a><\/strong>. Patients can also have&nbsp;<strong>skin hyperpigmentation<\/strong>&nbsp;secondary to increased MSH production.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Surgical resection&nbsp;<\/strong>of the pituitary is the first-line treatment of Nelson syndrome.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Skin_cancer:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">Radiotherapy<\/a>&nbsp;or radiosurgery<strong>&nbsp;<\/strong>can be utilized in patients who have failed first-line treatment. Medications such as bromocriptine and cabergoline have been tested, but these are generally not as effective as surgical intervention.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Nelson syndrome<\/strong>&nbsp;refers to&nbsp;<strong>pituitary gland enlargement after bilateral adrenalectomy<\/strong>. This is thought to be because removal of the adrenal glands&nbsp;<strong>eliminates negative feedback<\/strong>&nbsp;to the hypothalamus. Nelson syndrome can present with headaches, visual impairments, and hyperpigmentation. First-line treatment is&nbsp;<strong>surgical resection of the pituitary<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Carlstrom, L.P., Graffeo, C.S., Perry, A., Stokken, J.K., Van Gompel, J.J. (2019) Nelson-Salassa syndrome progressing to pituitary carcinoma: A case report and review of the literature.&nbsp;<em>Cureus<\/em>. 11(9), e5595. Doi:&nbsp;<a href=\"https:\/\/www.cureus.com\/articles\/17025-nelson-salassa-syndrome-progressing-to-pituitary-carcinoma-a-case-report-and-review-of-the-literature\" target=\"_blank\" rel=\"noreferrer noopener\">10.7759\/cureus.5595<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u201cNelson Syndrome.\u201d&nbsp;<em>National Organization for Rare Disorders<\/em>. Web Address:&nbsp;<a href=\"https:\/\/rarediseases.org\/rare-diseases\/nelson-syndrome\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/rarediseases.org\/rare-diseases\/nelson-syndrome\/<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patel, J., Eloy, J.A., Liu, J.K. (2015) Nelson\u2019s syndrome: A review of the clinical manifestations, pathophysiology, and treatment strategies.&nbsp;<em>Neurosurgical Focus<\/em>. 38(24), E14. Doi:&nbsp;<a href=\"http:\/\/file\/\/\/C:\/Users\/marti\/Downloads\/[10920684%20-%20Neurosurgical%20Focus]%20Nelson's%20syndrome_%20a%20review%20of%20the%20clinical%20manifestations,%20pathophysiology,%20and%20treatment%20strategies%20(1).pdf\" target=\"_blank\" rel=\"noreferrer noopener\">10.3171\/2014.10.FOCUS14681<\/a>.<\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\">\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013<\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Want more &nbsp;USMLE\u00ae Step 2 CK practice questions?&nbsp;Try Osmosis today!&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">Access your free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ace-your-clerkship-banner-2.png?w=700\" alt=\"Ace your clerkships with clinical practice videos on Osmosis. Watch now.\" class=\"wp-image-544\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ace-your-clerkship-banner-2.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ace-your-clerkship-banner-2.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 45-year-old man with morning headaches who underwent bilateral adrenalectomy to treat his Cushing syndrome. Which of the following is the next best step in management? A 45-year-old man comes to his outpatient provider because of headaches and changes in vision [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1376,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,45],"tags":[],"class_list":["post-1373","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Nelson Syndrome - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Nelson Syndrome - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 45-year-old man with morning headaches who underwent bilateral adrenalectomy to treat his Cushing syndrome. Which of the following is the next best step in management? A 45-year-old man comes to his outpatient provider because of headaches and changes in vision [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-10-13T14:50:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:40:31+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/nelson-syndrome.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-nelson-syndrome\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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