Bibliographic record
Abstract
To the Editor: Pituitary hemorrhage is a rare and possibly life-threatening condition caused by acute bleeding in the pituitary gland, usually within a macroadenoma. In this letter we report a case of a large pituitary hemorrhage that fared well with relatively mild sequelae. An 80-year-old Caucasian woman presented with severe headaches of two days duration that started after a fall in the yard without loss of consciousness. She took aspirin for the headaches without effect. CT of the head showed a suprasellar hemorrhage. MRI showed pituitary enlargement, 20 x 19 x 16 mm, with enhancement in the caudal right aspect of the pituitary gland (Fig. 1-3). The pituitary gland extended cephald to about the optic chiasm. There was blood within the right suprasellar cistern extending into the prepontine cistern along the clivus. On physical exam there were no remarkable findings except for a blood pressure of 148/105 mmHg. Her white blood cell count was 6000 /mm 3 , hemoglobin 13 g/dl, hematocrit 39%, platelets 214000 /mm 3 , prothrombine time 15.7 seconds and INR 1.22. The patient had no significant past medical history. She reported no breast discharge, vision problems or seizures. The patient did not smoke or drink and was on no medications and looked younger than her age. The possibility of a ruptured aneurysm was investigated and excluded on a four-vessel cerebral arteriogram. The clinical and radiological picture was more consistent with a bleeding from a macroadenoma than with a pituitary apoplexy because of the subtle changes in the hormonal homeostasis. The patient was first admitted to ICU then transferred to the floor after four days and discharged two days later. Four years afterward the patient was seen on a follow-up visit; she was on levothryoxine, bromocriptine and risedronate and was doing fine. This case is interesting because of its presentation. Few similar cases of pituitary hemorrhage or apoplexy after a minor trauma were reported in the literature [1-3]. An adenoma may grow silently in a patient and reach considerable measurements and then suddenly reveal itself after a minor trauma in form of hemorrhage or apoplexy. In our case, what may have contributed to the radiological picture is that the patient with evident brain atrophy (as seen on CT) tried to treat pain with aspirin, a strong antiaggregant. This probably prevented a small vascular injury in the pituitary adenoma from occluding itself turning a microscopic-size bleeding into a radiologically-sizable one. In a recently reported study
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.006 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".