Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: penicillins / sulfa (sulfonamides) attending: chief complaint: pituitary macroadenoma major surgical or invasive procedure: transphenoidal pituitary resection and lumbar drain placement history of present illness: patient was recently admitted to from - for syncopal episode, found to have suprasellar mass on ct, and confirmed to have 2.6 x 1.4 x 1.2 cm pituitary mass with some focal hemorrhage infarction. she was seen by neurosurgery as an inpatient, found to be neurologically intact and was discharged to see endocrinology as an outpatient and further neurosurgical evaluation. the patient missed her outpatient endocrine initial appointment on , and had cancelled neurosurgical follow up. multiple attempts to contact the patient went unanswered and multiple messages were left (see omr notes). when i spoke to the patient today, she states that she was in "denial" and had fear and apologizes for the lack of contact and follow up. during a neuro-ophthalmology appointment on , endocrinology was contact and we were able to talk to patient to schedule appropriate follow up and outpatient testing. the patient was seen by neurosurgery in clinic on , and scheduled for surgery due to the size and location of the lesion. she has intact visual fields as assessed by neuro-ophthalmology. her endocrine labs done in the past month are consistent with a likely nonfunctioning pituitary macroadenoma. her gonadotropins are lower than would be expected for her post-menopausal state, and her thyroid and cortisol axes are intact. her 1 mg dex-suppression test suppressed to 3 which does not completely rule out cushings. a normal igf-1 level was done to rule out acromegaly. her prolactin level was mildly elevated at 24. she was electively admitted on to undergo said procedure past medical history: hypertension hypercholesterolemia depression/anxiety roux-en-y gastric bypass in . diabetic prior to gastric bypass pituitary macroadenoma social history: separated with two grown children. works at stop and shop in as a cashier. no smoking or alcohol. family history: m: cad. f: died of some type of heart disorder at age of 45, ? cad. brother: mi at age 47. maternal aunt: breast cancer. no pituitary dysfunction or other endocrine problems in the family. physical exam: on discharge: pt is awake, alert and oriented x3. pupils are equeal round react to light. conjugate gaze. no nystagmus. headaches have been controlled with oral narcotic analgesics. speech is fluent and clear. no paraphrasic errors. motor strength is throughout all muscle groups. there is no tremor. she is tolerating all po food and fluids well and has not had any residual nausea or vomiting. the prior drain site is clean and dry. there is no bleeding or drainage from the prior lumbar drain site. the patient has remained afebrile with minimal nasal drainage and congestion. pertinent results: labs on admission: 04:08am blood wbc-10.8# rbc-4.53 hgb-12.7 hct-37.8 mcv-84 mch-28.1 mchc-33.7 rdw-14.7 plt ct-263 04:08am blood pt-12.8 ptt-25.9 inr(pt)-1.1 04:08am blood calcium-9.1 phos-3.0 mg-1.9 10:47pm blood osmolal-298 labs on discharge: imaging: head ct : findings: the sella is enlarged and measures 13.8 mm in ap diameter. again noted is a heterogeneous mixed attenuation mass arising from the sella and extending into the suprasellar region, best demonstrated on the mri that was concurrently performed. there is calcification of the bilateral cavernous carotid arteries. the left carotid artery is incompletely covered by bone (series 2, image 26). the right carotid artery is completely covered by bone. the sphenoid sinuses and sphenoethmoid recesses are clear. there is no definite evidence for erosion of the clivus. the sphenoid sinus septum inserts approximately 8 mm laterally from the right bony carotid canal. the bilateral maxillary antrum, frontal sinuses, and ethmoid air cells are clear. the nasal cavity is clear. there is slight septal deviation to the left. the bilateral omus are patent. the lateral wall of the infundibulum is formed by the medial wall of the orbit. the cribriform plates are asymmetric in height, the right one lower than the left ( type 1 classification). the visualized portions of the brain parenchyma are unremarkable. there is a focal area of hyperdensity of similar attenuation to the skull likely representing a calcified meningioma or exostosis. there is no hypodensity in the underlying frontal lobe to suggest edema. impression: 1. pituitary mass with extension from the sella to the suprasellar region with no evidence of clival invasion. 2. paranasal sinus anatomy as detailed above. dehiscence of a portion of the left bony carotid canal. mri head : indings: images through the brain demonstrate no evidence of acute infarct. no mass effect or hydrocephalus is seen. no focal abnormalities. images through the sella demonstrate postoperative changes which are new since the previous mri examination of . fluid and high intensity material are seen within the sphenoid sinus and the posterior nasal passage. this is likely related to packing from surgery. a small amount of soft tissue changes are seen in the sellar and suprasellar region with mild enhancement. the majority of the soft tissue mass identified in the sellar and suprasellar region has been resected. the subtle enhancing lesions could be residual mass or due to some postoperative enhancement. impression: 1. no evidence of acute infarcts or mass effect. 2. postoperative changes within the sphenoid sinus and posterior nasal passage and in the pituitary region with high intensity packing material. no hemorrhage. although, high density material is seen within the pituitary fossa, no intracranial hemorrhage seen. majority of the mass has been removed with subtle enhancing soft tissues seen in the suprasellar region with decreased mass effect on the optic chiasm. brief hospital course: pt went to o.r. for a transsphenoidal pituitary tumor resection as scheduled. she remained neurologically intact (including visual acuity and visual fields). she had the intraoperative lumbar drain removed on without event. she has been closely monitored for change in neurologic status, as well as for any evidence of diabetes insipidus or siadh. she has not displayed symptoms consistent with either. endocrinology has been following and guiding the prednisone therapy and will continue to do so as an outpt. medications on admission: lisinopril 20 mg daily simvastatin 40 mg qhs wellbutrin 300 mg daily celexa 40 mg daily stool softener discharge medications: 1. outpatient lab work please have your cortisol level drawn on the morning of your appointment with dr. . please make sure not to take your prednisone prior to this level being drawn. 2. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. prednisone oral 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. bupropion 150 mg tablet sustained release sig: two (2) tablet sustained release po daily (daily). 7. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. clonazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 10. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 11. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days. disp:*3 tablet(s)* refills:*0* 12. hydromorphone 4 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. disp:*60 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: pituitary macroadenoma discharge condition: neurologically stable discharge instructions: general 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. ?????? you have been discharged on prednisone, take it daily as prescribed. ?????? 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. please keep track of your headaches. you should notice improvement daily. if they worsen please notify your surgeon. followup instructions: follow-up appointment instructions ??????please call ( to schedule an appointment with your surgeon, dr. , to be seen in two months. you will need a ct scan of the brain without contrast prior to your appointment. ??????you have an appointment scheduled with , m.d.(endocrinologist) phone: date/time: 5:00. please call if you require directions or need to change your appointment time. procedure: spinal tap incision of lung other repair of cerebral meninges partial excision of pituitary gland, transsphenoidal approach local excision or destruction of lesion of facial bone diagnoses: obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia unspecified essential hypertension long-term (current) use of steroids other nervous system complications dysthymic disorder other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation bariatric surgery status benign neoplasm of pituitary gland and craniopharyngeal duct 

Answer: The patient is high likely exposed to