A case of Nelson’s syndrome with adrenal crisis occurring 21 years post-adrenalectomy for Cushing’s disease

Nelson’s syndrome is a known complication of bilateral adrenalectomy for Cushing’s disease, and lifelong glucocorticoid replacement is essential in these patients to prevent adrenal insufficiency, a condition that can culminate in life-threatening adrenal crisis. This medical emergency, often precipitated by stressors like infection, can be diagnostically challenging as it mimics septic shock. The co-occurrence of Nelson’s syndrome and adrenal crisis is exceptionally rare. To our knowledge, we r