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1. Name- Sattenapalli Raju Age- 33/M Mrd no- 1356154 Diagnosis – Pituitary macroadenoma Comorbidities- nil

2. 33 year old male, came with c/o decreased vision in right eye, no c/o diplopia no c/o headache, vomiting's, seizure activity no c/o weight gain, rashes over the body not a k/c/o diabetes, HTN married since 1 year, no children no c/o generalized weakness, fatigue no c/o weight gain, constipation, hair loss

3. O/E : patient conscious, Vitals stable GCS-E4V5M6 -CNS examination Higher mental function Normal

4. CRANIAL NERVE EXAMINATION: CN 1: B/L sense of smell normal CN2: VA right –6/24 and left :- 6/6 R ight eye temporal hemianopia Fundus- right- pale disc , left- normal Pupils- right 2.5mm reactive, left – 2.5mm reactive to light. CN 3,4,6 Both- EOM normal No nystagmus , ptosis

5. CN 5- intact CN 7 - normal CN 8 B/L AC>BC webers not lateralised CN 9, 10 Uvula midline Palatal movements normal ,no asymmetry Gag reflex intact CN 11 Shoulder shrugging – Normal on both sides CN 12 No fasciculations of tongue no Tongue deviation Sensory system- normal Cerebellar signs: absent Meningeal signs: no

6. MOTOR SYSTEM: Tone Normal in both upper and lower limbs Bulk Normal in both upper and lower limbs Power - right left Upper limb Shoulder- 5/5 5/5 Elbow- 5/5 5/5 Wrist- 5/5 5/5 Lower limb Hip- 5/5 5/5 Knee- 5/5 5/5 Ankle- 5/5 5/5 EHL- 5/5 5/5 -Hand grip - 100% 100% Reflexes – Superficial reflexes-present DTR: BJ TJ S KJ AJ Right - 2+ 2+ 2+ 2+ 2+ Left - 2+ 2+ 2+ 2+ 2+ Plantars- both flexors

7. Hormone profile- FSH- 4.24 (1.27-19.26) LH- 3.39 (1.24-8.62) PROLACTIN-14.22 (2.63- 13.13) PROLACTIN (Pooled) 1 in 10 DILUTION- 2.6( 2.64-13.13ng/ml TESTOSTERONE- 63 (175-781) CORTISOL- 0.8(5.27-22.45) THYROID PROFILE- 5/4/24 TSH- 20.39 (0.55-4.78) T4- 3.9 (4.5-10.9) T3- 111.35 (60-181)

8. Central Hypothyroidism, HYPOGONADOTROPHIC HYPOGONADISM HYPOCORTISOLISM

9. KNOSP grading- GRADE 3 Left GRADE 2 Right LATERAL ASPECT OF CAVERNOUS SINUS