PA: 09-25-0098
Admitted on 8-23-82
Discharged on 9-24-82
SIGNIFICANT FINDINGS:
Laboratory:
bicarbonate 23,
acid
7.9,
7.7,
free
SGPT 61,
Her glucose was 99, sodium 140, potassium 4.0, choride 102,
calcium 5.2,
phosphorus 4.5,
total blirubin was
SGOT 30,
0.4,
GGTP was 50,
T,
was
1.6 and
0,
it was
alkaline
CPK 83,
TSH was
4.9.
BUN 12,
creatinine 0.9, uric
phosphatase was
cholesterol 209.
Her white blood
113,
LDH was
Her total T,
count was
178,
was
10, #00,
hemoglobin ta.9, hematocrit 42, differential count on that was 36 polys, t
eosinophil, 5 basophils, 55 lymphocytes and 3 monocytes.
Her platelet count
was 354,000.
She had an ACTH stimulation test before the surgery.
Her
baseline was 24.4 mcg. per deciliter; at 30 minutes she was 30.9 mcg. per
deciliter and at 60 minutes she was 33.5 mcg. per deciliter.
She also had an
ITT before surgery and the results of that for the glucose at -15, glucose
was
85
at
also
85
at
20 minutes,
it was
69 at
30 minutes,
it was
62
at 45 minutes, it was 64 at 60 minutes, and at 90 minutes it was 88.
Her
corresponding cortisols were at -15 8.8, at 0 6.6, at 20 minutes 10.6, at 30
minutes
12.5,
at
45
minutes
21.2,
at
60 minutes
30.6
She essentially received 0.1 units of insulin per kg.
and at
90 minutes 28.4.
and got a dose of 6.8
units of insulin for her ITT.
Her urinalysis, except for small
hemoglobin with some white cells, and a few red cells, a repeat
amounts
of that
of
showed no red blood ceils or white blood cells and only a small amount of
hemoglobin.
SHe had an electrocardiogram which was normal.
X-rays:
Her chest x-ray showed no active lung disease.
THere was no
pulmonary infiltrates or nodules seen.
She had a repeat scan of her sella
and the impression was a pituitary microadenoma, predominantly left sided.
THere was no extension into the suprasella cistern or invasion to the left
cavernous sinus.
The patient was seen in consultation by Neurosurgery and it was decided
in terms of her living on the Marshall Islands that the best form of therapy
for her hyperprolactinoma was to have a surgical resection.
COURSE IN HOSPITAL:
The patient was taken to the operating room on September 1, 1982 and she
had a transsphenoidal removal of her intrasellar tumor.
A soft tissue tumor
which was moderately gritty and firm in consistency and was composed of
multiple very small cysts with a yellowish white translucent color was
encountered.
THe leison was thought to lie in the left two thirds of the
patient's sella and had displaced the normal appearing pituitary gland to the
right and inferiorly.
During the removal of the lesion it was apparent that
the
tumor was
adherent
to
the
superior aspect
[_}
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[_]
[_]
Admitted on 8-23-82
Discharged on 9-24-82
.
.
sella
and
that
it
Operation Report (OPN)
History ond Physical Examinotion (HPE)
Discharge Summary (DS)
DS Combined with HPE
Interim Summary (15)
[_] Addendum Summary (AS)
32
Co)
the
(_] 1S Combined with HPE
~
cy
of