<prompt> After bilateral adrenalectomy, patient developed gradual loss of vision, with hyperpigmentation of skin, and headache. Likely cause is:Addisons diseaseNelsons syndromeCushings diseaseHypopituitarism  <response>: NELSONS SYNDROME Adrenalectomy in the setting of residual coicotroph adenoma tissue predisposes to the development of Nelsons syndrome. Characterized by rapid pituitary tumor enlargement and increased pigmentation secondary to high ACTH levels. Radiation therapy may be indicated to prevent the development of Nelsons syndrome after adrenalectomy. Primary adrenal Cushings syndrome - Adrenalectomy - Loss of negative feedback to pituitary - Development of pituitary adenoma - Nelsons syndrome. 