Primary Aldosteronism Simulating Polymyositis
Bibliographic record
Abstract
To the Editor: Primary aldosteronism (PA) is a condition in which tumors or hyperplasia of the zona glomerulosa of adrenal cortex cause overproduction of aldosterone and suppression of renin activity, resulting in refractory hypertension, hypokalemic paralysis, and potassium-losing nephropathy. Most patients present with typical features and are easily diagnosed. However, some patients may have special presentations and represent a major challenge for diagnosis and treatment. For example, patients with PA prominently characterized by hypokalemic myopathy (HM) may resemble patients with polymyositis (PM) clinically and pathologically. We describe 3 cases of PA who presented to our hospital with HM as a prominent feature of their hyperaldosteronism. Findings in these patients included muscle pain and weakness, significantly increased creatine kinase (CK), myopathic changes on electromyography (EMG), or inflammatory cell infiltration on muscle biopsy. Early diagnosis and treatment for these patients were delayed because of the PM-like findings. The clinical and enzymatic features of muscle involvement and the electromyographic and/or histological findings of muscles were substantially consistent with the diagnosis of PM1. Few cases of PA chiefly characterized by HM have been reported. A search of reports published in China over the past decade identified 7 cases2,3,4,5,6,7. In order to increase clinicians’ awareness and understanding of PA simulating PM and prevent possible misdiagnosis, we analyzed 3 cases admitted to our institution and 7 treated by others. A 45-year-old previously healthy man presented to our outpatient department with muscle myalgia and weakness involving all extremities for 10 days. Serum CK was 18,561 IU/l and EMG confirmed myogenic damage. He was admitted for suspected PM. Blood pressure (BP) was 185/115 mm Hg. He had a passive position. No rash was observed and thyroid gland was not enlarged. Examination of heart, lung, … Address correspondence to Dr. Tang; E-mail: yt.lyls{at}163.com
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 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".