56 year old patient with empty sella syndrome , generalized weakness
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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.
A 56 year old female who is a house wife by occupation , resident of west bengal ,survived with one kid.
Chief complaints:-
She came for the casualty for a regular checkup
History of presenting illness:-
( Sequence of events)
Patient was apparently asymptomatic 31 years back, in 1990 she had one miscarriage and couldn’t conceive till 9 years. In 1999 she had her first child .
No history of any medications for 9 years .
In 2003, had loose stools and vomitings and went to a near by hospital , didn’t subside on medication and she was taken to CMC vellore
Her complaints subsided , where she was diagnosed with right ectopic kidney , hypothyroidism and hypertension was on thyronorm 50mcg and tab.Telma 40mg.
Regular follow up to CMC 2006, 2009, 2013 no complaints .
In 2016, patient had recurrent loose stools for 2 months , and one episode of seizure was taken to hospital , where on connecting monitor showed flat line CPR was initiated, she was revived after 7 cycles ,and she was having bradycardia and was put on temporary pacemaker , and was also diagnosed with IBS
After follow up , she stopped her anti epileptic medications.
She had similar GE symptoms in between subsided on medication.
In august ‘2021 patient had history of low grade fever for 3 days followed by generalised weakness, and an episode of seizure ,loss of appetite and was admitted in hospital , where her bp was not recordable and was ionotropes and was diagnosed with pneumonia , septic shock , heart failure with reduced ejection fraction 35% which improved to 50% ; patient was on mechanical ventilator for 2 days , indication : low sats as per the attender , cortisol levels where low on test , and MRI was done showing empty Sella ( pan hypopitutarism) and was started on wysolone 5mg . Hospital stay : 20 days , on ventilator for 2 days and ionotropes for 7 days , before her day of discharge , patient had recurrent hypoglycaemic episodes , was put on 25% dextrose .
She was discharged after 20 days.
On discharge Patient attenders observed she was drowsy and she thought due to her medications , she was drowsy for next 2 days , she was taken to the hospital and diagnosed with hyponatremia , was on medication for 2 days , attender observed she had irrelevant talk and self smile psychiatry referral was done diagnosed with schizophrenia .
She was discharged after 4 days
After 1 week patient complained of head ache and on checking her bp was 210/160mmhg
Where she was admitted for 4 days and got discharged.
Current medications :
Tab. Cilinidipine 10mg
Tab. Thyronorm 100mcg
Tab. Levipil 500mg
Tab. Wysolone 5 mg
Tab. Pan -D
Investigations:-
Abnormal parameters in laboratory investigation:-
Complete blood picture ( cbp )
Microbiological investigation:-
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