Persistent cases
Surgery is not always curative and some patients will remain hypercortisolemic following TSS. For patients with post-operative serum cortisol >5 µg/dL, immediate repeat surgery, pituitary irradiation, or medical therapy are possible further treatment options [43, 47]. Bilateral adrenalectomy (BLA) can be an alternative in some cases, although there is a risk of the patient developing Nelson’s syndrome; BLA also necessitates lifelong glucocorticoid and mineralocorticoid replacement therapy.