2. History…
36 y.o single Saudi female k/c of HTN, T2DM and dyslipidemia
Direct admission from OPD.
Presented with lower back pain, headache and inability to walk
for 3 months.
referred from KFH (Hafof) for persistent hypokalemia for further
investigation.
3. HPI:
3 months Hx of progressive bilateral lower limbs weakness.
Start as a simple weakness>>can’t carry her weight during
standing>>become wheelchair bound.
Headache and lower back pain.
No Hx of sphincter incontinence.
4. Drug Hx:
Aldactone 50 mg PO BID
Nifedipine 40 mg PO OD
Hydralazine 50 mg PO Q6H
Atorvastatin 20 mg PO OD
Labetalol 100 mg PO BID
Diamicron 90 mg PO OD
5. PH:
uncontrolled HTN >10 years
Dyslipidemia+T2DM ~3month
2ry Amenorrhea ~15 yrs.
His menarche @ 13>> stopped
didn't seek medical advice.
No surgical Hx.
6. FH:
father in good health.
Mother >>HTN
Sis1: HTN+DM
Sis 2: passed away (leukemia)
sis 3: weight gain+2ry amenorrhea
7. Systemic review:
No mood changes
No dizziness
No blurred vision
excessive hair growth
acne
No respiratory or cardiac symptoms
No nausea, vomiting, diarrhea or constipation
No urinary symptoms
9. Examination…
General:
Obese, round face, comfortable in the bed, not in distress.
Vitals: T 37.7 ,p 90, RR 18, BP 160/100
Skin:
hirsutism, facial plethora, acne, dorsocervical fat deposition, supraclavicular fat
deposition.
Chest: clear, good air entry bilateral.
CVS: S1,S2+0
Abdomen: distended, White striae ~0.5-0.7 cm, positive bowel sound.
CNS: conscious, alert
Extremities: bruises
U.L: power 4/5, reflexes normal
L.L: muscles wasting, bruises, no edema, power 3/5, reflexes normal
10. Labs:
Cbc
Liver panel
Renal/lyte
Lipid profile
All within her base line, except for:
HB 12.7
K 2.5
11. Hospital course…
Pt. loss of her consciousness < 1min.
Notice abnormal movement, not typical for convulsion
K 2.4
ICU transferred.
Observation, K-replacement, ECG
17. Brain MRI:
cystic mass lesion 2.5*1.7 cm with evidence of
hemorrhagic is seen, optic chiasma is displaced
cronaly
Finding consistent rathke cleft cyst complicated
by hemorrhagic or cystic degeneration of
pituitary macro-adenoma.