Primary Hyperaldosteronism: Pitfalls in the Diagnosis and a not so Peculiar Evolution - Case Report
Bibliographic record
Abstract
Primar y hyperaldosteronism is now assumed to account for 10-15% of all cases of non selected high blood pressure. The differential diagnosis between bilateral hyperplasia and unilateral adenoma remains however a medical challenge, and the pathogenic stimulus for hyperplasia is still unknown. HS, a female patient aged 32, presented with High Blood Pressure and hypokalemia. An elevated aldosterone/renin ratio and non-suppressed aldosterone levels after saline infusion confirmed the diagnosis of primary hyperaldosteronism. Negative adrenal scintigraphic examination and a marked aldosterone response in the postural test supported the diagnosis of bilateral hyperplasia, despite the presence of left adrenal nodule in the CT-scan. Tetracosactide stimulation revealed a minor 21-hydroxilase defect and a marked ACTH-dependence of aldosterone secretion. Effective treatment with dexamethasone 1.0 mg every other night was maintained for 9 years, while in the meantime the left adrenal nodule apparently resolved and a right adrenal nodule become apparent. Finally worsening of blood pressure levels and increasing aldosterone concentrations with a positive scintigraphic labelling on the right adrenal gland led to right adrenalectomy that was so far curative. This case report demonstrates bilateral hyperplasia-adenoma evolution and suggests ACTH to be the relevant pathogenic stimulus, allowing for effective long-term treatment with dexamethasone. doi: http://dx.doi.org/10.4021/jem113w
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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) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.010 | 0.005 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
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".