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 2007183 | 71