Bibliographic record
Abstract
A 65-year-old woman, with a history of type II diabetes and high blood pressure, was admitted for diverticulitis.Clinical examination showed a central obesity and a moon face.Neurological examination did not reveal any abnormality.Endocrine studies revealed Cushing's syndrome with an increase of urinary free cortisol at 1578nmol/24h (normal values: 30-220 nmol/24h), and a midnight salivary cortisol at 23.53 nmol/l (normal value at midnight: <6.1 nmol/l ).Adrenocorticotropic hormone (ACTH) was increased at 71 ng/l (normal value: 10-60 ng/l), the high dose dexamethasone suppression test (8mg) and the corticotropin releasing hormone (CRH) test were consistent with Cushing's disease.Indeed we noticed a cortisol suppression in response to the high dose test and not to the low dose dexamethasone test.There was also a significant increase of ACTH and cortisol following intravenous administration of a CRH bolus.Clinico-biological status suggested a diagnosis of Cushing's disease.Magnetic resonance imaging (MRI) and computed tomography (CT) (Figure 1), revealed a calcified intrasellar mass, extending to the suprasellar space, without invasion of the optic pathways or cavernous sinus.This mass appeared heterogeneously hypointense in T1 and T2 weightedimages (wi).The periphery of the mass was slightly hyperintense in T1 and T2 wi with an enhancement after gadolinium administration (Figure 2).In addition petrosal sinus sampling was performed, showing an abnormal ACTH secretion in the left side.Investigations suggested a largely calcified pituitary macroadenoma; also named pituitary stone.The hyperintense enhanced peripheral zone corresponds to non-calcified adenoma tissue.Trans-sphenoidal hemi-hypophysectomy, taking the calcified area, was performed.The histological study confirmed a calcified pituitary macroadenoma with a strong immunocytochemistry expression of ACTH within the calcified area; ACTH positivity was also noted in the surrounding tissue.The post-operative course was uneventful and the Cushing's syndrome resolved.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.019 | 0.007 |
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".