PA: 08.29 - 0088
Admitted on 8-23-82
CHIEF COMPLAINT:
Followup evaluation.
WISTORY
OF PRESENT
ILLNESS:
Obtained from the charts and with translater.
This is the second NIH
admission for this 29-year-old female from the Marshall Islands.
She was
initially evaluated for amenorrhea and
levels are 400 to 600 ng/ml.
galactorrhea and
serum prolactin
The patient was living on the Larger island of Ebeye when doctors
working on the Marshall Islands found an elevated prolactin level.
At that
time her main complaint. was amenorrhea.
She states that her growth and
developmene had been normal.
She had menarche
at
age
13.
Her menses were
regular and then suddenly stopped in 1969 and she only had occasional
spotting.
In 1974, she developed galactorrhea which has persisted.
Her onlv
other complaint was headache without any visual changes.
She was initially worked up at the Brookhaven National Laboratory.
Her
testing included a chest x-ray which was normal, a negative pregnancy test, a
negative RPR, a serum protein electrophoresis which was normal, visual acuity
which was normal, triglyceride Level of 227, and increased white blood count
of
11,600 and increased platelet count of 465,000.
Function
LN9.
tests,
with
SGOT of
83,
and
SGPT
Stools were positive for whipworm.
thyroid
function
tests,
and
trace
protein
123,
She had abnormal liver
and alkaline
phosphatase
of
She had a uric acid of 8.3, normal
in her urine.
She was then sent to the NIA for more extensive evaluation.
She had a
careful pelvic examination which was entirely normal.
Sella x-rays showed an
enlarged sella with ballooning anteriorly.
A CT scan of the head showed a
1.2 cm, mass in the anterior sella and slightly to the left.+
The mass
enhanced with contrast.
There was no suprasellar extension.
Visual fields
were normal at that time.
Her serum prolactin levels were 500 to 650 ng/ml.
DHAS was 326 mcg/dl., cortisol was 8.1 mcg/dl., l?-hydroxysteroids were
4.0 mg./24 hours.
Her T3 was 128, TSH 3.4,°TBG was 33, T4& 9.6 and free T4
was
1.4.
She had an ACTH stimulation test.
Her baseline cortisol was
6.6 mcg/dl.
After ACTH at 30 minutes the cortisol rose to 26 meg/dl. and ac
hO
minutes
it
was
26 mcg/dl.
of TSH at -15 minutes was
1.1;
She
had
a
TRH
stimulation
at 0 it was 0.6;
minutes 4.9; at 30 minutes 5.8; and at
and SGPT 139, and alkaline phosphatase
test
and
the values
after the TRF it was at
normal abdominal echo.
She had a liver-spleen scan which was normal.
hepatitis B surface antigen was negative.
Ceruloplasmin was 290 mg/l.
Admitted
on
8-23-82
20
60 minutes 3.5.
She had an SGOT of
82, and bilirubin 0.8.
She had a
Her
Her
(C] Operation Report (OPN)
<1 History ond Physical Examination (HPE)
[-] Dischorge Summary (DS)
([} DS Combined with HPE
(_} Interim Summary (!5)
{_] IS Combined with HPE
{_] Addendum Summary (AS)
‘~
THE CLINICAL CENTER
29
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