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 [_} (_} $q]} [_] [_] 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