Contributed by Octavia Graur, MD, PhD and Mohamed A Virji, MD, PhD Published on line in April 2000
Contributed by Octavia Graur, MD, PhD and Mohamed A Virji, MD, PhD
Published on line in April 2000
PATIENT HISTORY:
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This is a 47 year old white postmenopausal female with no significant past medical history who presented with progressive headaches and visual blurring, as well as increased thirst, fatigue, lethargy and a fifty pound weight gain over a period of 1.5 months. She also complained of short-term memory loss. A CT scan of the head showed a 2 cm suprasellar mass (Figs. 01 and 02). A stereotactic biopsy of the lesion was performed.
LABORATORY WORK-UP AND HISTOLOGY
| Test Value | Reference Range | |
|---|---|---|
| Serum Sodium | 150 mEq/l | 136-145 mEq/l |
| Serum Potassium | 4.2 mEq/l | 3.5 - 5.1 mEq/l |
| Serum Osmolality | 321 mOsm/kg | 275-295 mOsm/kg |
| Urine Sodium | 40 mEq/d | 40-220 mEq/d |
| Urine Potassium | 21.3 mEq/d | 25-125 mEq/d |
| Urine Osmolality - 24h | 179 mOsm/kg | 300-900 mOsm/kg |
| Urine Specific Gravity - 24h | 1,003 | 1,015 - 1,025 |
| Prolactin | 67.4 ng/ml | 0.6 - 20.0 ng/ml |
| Growth Hormone | < 1.0 ng/ml | <10.0 ng/ml |
| IGF -1 | 34.6 ng/ml | 90 - 360 ng/ml |
| FSH | 1.4 mIU/ml | Follicular Phase: 3-20 mIU/ml Midcycle Peak: 9-26 mIU/ml Luteal phase:1-12 mIU/ml Postmenopausal Females: 18.0 - 153.0 mIU/ml |
| LH | <0.5 mIU/ml | Follicular Phase: 2-15 mIU/ml Midcycle Peak: 22-105 mIU/ml Luteal phase: 0.6-19 mIU/ml Postmenopausal Females: 16.0 - 64.0 mIU/ml |
| Estradiol | 10 pg/ml | Early Cycle: 10-50 pg/ml Midcycle: 120-375 10 pg/ml Late Cycle: 50-155 pg/ml Postmenopausal Females: <40 pg/ml |
| Thyroxine | 4.3microgram/dl | = 5.0 - 12 microgram/dl |
| T3 Uptake | 1.08 | 0.8-1.2 |
| Free Thyroxine Index | 4.6 | 5 -12 |
| TSH | 1.438 uIU/ml | 0.3 - 5.0 uIU/ml |
| Cortisol - a.m. draw | 1 microgram/dl | 7.0 - 25.0 microgram/dl |
| Cortisol - p.m. draw | 9 microgram/dl | 2.0 - 9.0 microgram/dl |
| ACTH stimulation test | 0 min = 14 microgram/dl 30 min = 27 microgram/dl 60 min = 25 microgram/dl (Interpretation - peak serum cortisol level greater than 20 microgram/dl) |
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Histologic Examination :
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Microscopic examination of the stereotactic biopsy specimen revealed minute fragments of stratified squamous epithelium and adjacent mildly gliotic central nervous system tissue, consistent with craniopharyngioma (Fig. 03 and 04)
