CHIEF COMPLAINT: pituitary mass

PRESENT ILLNESS: [**Known firstname 92640**] [**Known lastname 1794**] is an 82 yo LH woman with PMHx of DM2, HTN
and HL who represents for reevaluation of a 1.6cm pituitary
mass.

MEDICAL HISTORY: - HTN
- HL
- DM2
- osteoporosis
- arthritis; needs bilateral shoulder surgery for "bone on bone"
arthritis
- 4.8cm ascneding aortic aneurysm, currently being followed with
Q6 month scans as pt refused surgery
- s/p CCY
- s/p appy
- s/p R knee repair surgery

MEDICATION ON ADMISSION: prednisone 17mg, omeprazole, colace, vit d, tylenol, nifedipine,
asa, calcium with vit D

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: AF VSS
Gen: WD/WN, comfortable, NAD.
HEENT: OP clear, Snellen Card vision: 20/40 in L eye and 20/20
in
R eye. Fullophtalmology exam in OMR>
Very mild L facial swelling without erythema, throughout cheek
and temple area
Neck: Supple.
Lungs: no SOB bilaterally.
Cardiac: RRR. slight syst murmur
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: mother died at age 78 of asthma, father died at age 85
of pulmonary edema.
Pt with one sister who died at 60 from an MI and a brother who
died in his 70's of a heart attack.  Pt's daughter has a heart
valve problem.

SOCIAL HISTORY: Patient is a home maker, has 1 daughter and 2
grandchildren.  She smoked for over 40 years and quit 8 years
ago.  She denies EtOH or illicits.
Benign neoplasm of pituitary gland and craniopharyngeal duct,Other nervous system complications,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Benign neo pituitary,Surg comp nerv systm NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Abn reac-organ rem NEC
Admission Date:  [**2110-9-4**]              Discharge Date:   [**2110-9-8**]

Date of Birth:  [**2027-11-2**]             Sex:   F

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
pituitary mass


Major Surgical or Invasive Procedure:
[**2110-9-4**] Transphenoidal resection of Pituitary adenoma
[**2110-9-4**] Lumbar Drain


History of Present Illness:
[**Known firstname 92640**] [**Known lastname 1794**] is an 82 yo LH woman with PMHx of DM2, HTN
and HL who represents for reevaluation of a 1.6cm pituitary
mass.

The patient was initially seen in [**6-14**] for experiencing
headaches, nausea and dizziness and went to [**Hospital 1281**] Hospital where
she had an MRI that showed the above mass.
At that time she also began to notice intermittent eye pain and
L
eye blurry vision, which has remained relatively stable.  Her
nausea and dizziness improved after her hospitalization and she
was subsequently diagnosed with "vertigo" by a neurologist when
she had a "positive head turning test" that sounds c/[**Initials (NamePattern5) **]
[**Last Name (NamePattern5) **]-Hallpike maneuver.  Please see our last OMR note.

Her headaches are annoying and localize tothe L side, pounding
and occasionally sharp and can occur at any time of day. She
treats them with tylenol prn.


Past Medical History:
- HTN
- HL
- DM2
- osteoporosis
- arthritis; needs bilateral shoulder surgery for "bone on bone"
arthritis
- 4.8cm ascneding aortic aneurysm, currently being followed with
Q6 month scans as pt refused surgery
- s/p CCY
- s/p appy
- s/p R knee repair surgery


Social History:
Patient is a home maker, has 1 daughter and 2
grandchildren.  She smoked for over 40 years and quit 8 years
ago.  She denies EtOH or illicits.


Family History:
mother died at age 78 of asthma, father died at age 85
of pulmonary edema.
Pt with one sister who died at 60 from an MI and a brother who
died in his 70's of a heart attack.  Pt's daughter has a heart
valve problem.


Physical Exam:
AF VSS
Gen: WD/WN, comfortable, NAD.
HEENT: OP clear, Snellen Card vision: 20/40 in L eye and 20/20
in
R eye. Fullophtalmology exam in OMR>
Very mild L facial swelling without erythema, throughout cheek
and temple area
Neck: Supple.
Lungs: no SOB bilaterally.
Cardiac: RRR. slight syst murmur
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect. Follows complex commands, but sometimes needs multiple
instructions to complete the task.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils: both briskly reactive, visual fields are full to
confrontation and to finger wiggling.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to finger rub bilaterally.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**6-7**] throughout although unable to
test trapezius as pt has "too much shoulder pain" because of her
arthritis. No pronator drift

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Reflexes: B T Br Pa Ac
Right     2 2 2   0  1
Left      2 2 2   1  1
(of note pt has had R knee repair)

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements

On discharge:
AVVS
NAD
CNII-XII intact
no focal or diffuse nuerologic deficits
normal gate
no drainage from nasal cavity
extremities wwp, 2+ cr


Pertinent Results:
[**9-4**] MRI Brain- IMPRESSION:  Similar appearance of the known
pituitary adenoma.  Otherwise, no acute intracranial process.

[**9-4**] CT Head- IMPRESSION:
Postoperative changes related to transsphenoidal hypophysectomy,
as described above.  Low density material in the resection bed.
High density fluid in the nasopharynx and right maxillary sinus,
likely represents a small hemorrhage. Small amount of
pneumocephalus.

[**2110-9-7**] 05:30AM BLOOD WBC-9.9 RBC-3.74* Hgb-10.8* Hct-33.3*
MCV-89 MCH-28.8 MCHC-32.4 RDW-14.5 Plt Ct-266
[**2110-9-8**] 05:25AM BLOOD Na-137 K-4.2 Cl-103
[**2110-9-7**] 05:30AM BLOOD Glucose-86 UreaN-12 Creat-0.6 Na-141
K-3.6 Cl-106 HCO3-25 AnGap-14
[**2110-9-6**] 09:00PM BLOOD Na-141 K-3.6 Cl-108
[**2110-9-6**] 11:59AM BLOOD Osmolal-293
[**2110-9-6**] 01:10AM BLOOD Osmolal-296
[**2110-9-5**] 08:01PM BLOOD Osmolal-289
[**2110-9-7**] 06:31AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.011
[**2110-9-6**] 11:59AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.002
[**2110-9-6**] 06:43AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.006
[**2110-9-7**] 06:31AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-2* pH-7.0 Leuks-NEG
[**2110-9-6**] 11:59AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG
[**2110-9-6**] 06:43AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-10 Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG
[**2110-9-7**] 06:31AM URINE Hours-RANDOM Na-144 K-25 Cl-144
[**2110-9-6**] 08:59PM URINE Osmolal-586
[**2110-9-6**] 11:59AM URINE Osmolal-184
[**2110-9-6**] 06:43AM URINE Osmolal-400

Brief Hospital Course:
Pt was admitted for elective transphenoidal resection of a
nonfunctioning pituitary adenoma.  ENT assisted in the
transnasal approach and a nasal trumpet and nasal packing were
placed.  A lumbar drain was also placed to prevent CSF leak due
to the quality of the dura at closing. Postoperatively she was
extubated and transfered to the PACU.  She did well and remained
neurologically intact.  Urine output, Urine chemistries and
Serum Sodium were monitored closely for signs of DI.
Endocrinology was consulted. The lumbar drain had a goal
drainage of 30ml Q2hrs and she was kept on bedrest with bathroom
privledges. On [**9-5**] she was neurologically intact and the lumbar
drain was functioning well. All labs remained WNL. On [**9-6**] the
hydrocortisone was discontinued and she was started back on her
home dose of prednisone. In the evening her lumbar drain was
clamped.
On [**9-7**] the patient was again stable and did not have any sign of
drainage from her nose. The lumbar drain was removed without
complication. She was seen by physical therapy who recommended
discharge to acute rehab.
On [**9-8**] she had stable labs and exam. She was cleared for
discharge to home by physicial therapy.


Medications on Admission:
prednisone 17mg, omeprazole, colace, vit d, tylenol, nifedipine,
asa, calcium with vit D

Discharge Medications:
1. Acetaminophen-Caff-Butalbital 2 TAB PO Q4H:PRN headache
RX *Fioricet 50 mg-325 mg-40 mg 2 tablet(s) by mouth Q4HR Disp
#*60 Tablet Refills:*0
2. Bisacodyl 10 mg PO/PR DAILY constipation
3. Docusate Sodium 100 mg PO BID
4. OxycoDONE (Immediate Release)  5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**2-3**] tablet(s) by mouth q4hr Disp #*60 Tablet
Refills:*0
5. PredniSONE 17 mg PO DAILY
start [**2110-9-6**]
RX *prednisone 10 mg 1.5 tablet(s) by mouth daily Disp #*45
Tablet Refills:*0
RX *prednisone 2.5 mg 1 tablet(s) by mouth daily Disp #*30
Tablet Refills:*0
6. Senna 1 TAB PO BID constipation
7. Famotidine 20 mg PO BID
8. Outpatient Lab Work
Serum Na


Discharge Disposition:
Home With Service

Facility:
Multicultural VNA

Discharge Diagnosis:
Pituitary Adenoma


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Continue Sinus Precautions for an additional two weeks.  This
means, no use of straws, forceful blowing of your nose, or use
of your incentive spirometer.
??????	If you have been discharged on Prednisone, take it daily as
prescribed.  If on any day, you are ill, take the prednisone as
you have been instructed by the endocrine team.
??????	If you are required to take Prednisone, an oral steroid, make
sure you are taking a medication to protect your stomach
(Prilosec, Protonix, or Pepcid), as this medication can cause
stomach irritation.  Prednisone should also be taken with a
glass of milk or with a meal.

CALL YOUR DOCTOR IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????	It is normal for feel nasal fullness for a few days after
surgery, but if you begin to experience drainage or salty taste
at the back of your throat, that resembles a ??????dripping??????
sensation, or persistent, clear fluid that drains from your nose
that was not present when you were sent home, please call.
??????	Fever greater than or equal to 101?????? F.
??????	If you notice your urine output to be increasing, and/or
excessive, and you are unable to quench your thirst, please call
your endocrinologist.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with your
surgeon, Dr. [**Last Name (STitle) **], to be seen in two months. You will need an
MRI with contrast of the brain prior to this appointment.
??????    You have a couple staples in your back that need to be
removed around [**9-14**]. This can be done at your rehab facility or
by your PCP. [**Name10 (NameIs) **] there are questions or concerns please have them
call [**Telephone/Fax (1) 1669**].

??????Please call ([**Telephone/Fax (1) 5120**] to schedule Formal Visual Field
Testing to be done before you are seen in follow-up with your
surgeon.  The Ophthalmology department is located on the [**Hospital Ward Name **] in the [**Hospital Ward Name 23**] building, [**Location (un) 442**].

??????     You have an appointment with Endocrinology scheduled with
[**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 1803**] Date/Time:[**2110-9-15**] 11:20
??????     You will need to have the following labs checked ****



Completed by:[**2110-9-10**]
{'Benign neoplasm of pituitary gland and craniopharyngeal duct,Other nervous system complications,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: pituitary mass

PRESENT ILLNESS: [**Known firstname 92640**] [**Known lastname 1794**] is an 82 yo LH woman with PMHx of DM2, HTN
and HL who represents for reevaluation of a 1.6cm pituitary
mass.

MEDICAL HISTORY: - HTN
- HL
- DM2
- osteoporosis
- arthritis; needs bilateral shoulder surgery for "bone on bone"
arthritis
- 4.8cm ascneding aortic aneurysm, currently being followed with
Q6 month scans as pt refused surgery
- s/p CCY
- s/p appy
- s/p R knee repair surgery

MEDICATION ON ADMISSION: prednisone 17mg, omeprazole, colace, vit d, tylenol, nifedipine,
asa, calcium with vit D

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: AF VSS
Gen: WD/WN, comfortable, NAD.
HEENT: OP clear, Snellen Card vision: 20/40 in L eye and 20/20
in
R eye. Fullophtalmology exam in OMR>
Very mild L facial swelling without erythema, throughout cheek
and temple area
Neck: Supple.
Lungs: no SOB bilaterally.
Cardiac: RRR. slight syst murmur
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: mother died at age 78 of asthma, father died at age 85
of pulmonary edema.
Pt with one sister who died at 60 from an MI and a brother who
died in his 70's of a heart attack.  Pt's daughter has a heart
valve problem.

SOCIAL HISTORY: Patient is a home maker, has 1 daughter and 2
grandchildren.  She smoked for over 40 years and quit 8 years
ago.  She denies EtOH or illicits. 

### Response:
{'Benign neoplasm of pituitary gland and craniopharyngeal duct,Other nervous system complications,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
