Surprisingly low aldosterone levels in peripheral veins following intravenous sedation during adrenal vein sampling
Bibliographic record
Abstract
BACKGROUND: Constituitively high and nonsuppressible aldosterone levels are considered to be the hallmark of primary aldosteronism. We observed a high proportion of primary aldosteronism patients with surprisingly low aldosterone levels in peripheral veins during adrenal vein sampling (AVS) and sought to further characterize the phenomenon. METHODS: Database analysis of patients with primary aldosteronism at the University of Calgary who underwent AVS under intravenous sedation. Aldosterone levels following sedation were compared with aldosterone measured at diagnosis in the free-living state. A validation analysis was performed on a similar database from the University of British Columbia. RESULTS: Seventy-two percent of 127 patients had AVS aldosterone levels more than 30% lower than their outpatient aldosterone measure (468 vs. 278 pmol/l, P < 0.001). Thirty-nine percent of patients had aldosterone levels less than 200 pmol/l and 13% had levels less than 140 pmol/l during AVS. Repeat analysis on the UBC cohort produced similar results with 88% having an aldosterone more than 30% lower than the outpatient measure (median aldosterone 568 vs. 201 pmol/l, P < 0.001). CONCLUSION: A majority of primary aldosteronism patients have markedly lower aldosterone levels during sedated AVS compared with those found during outpatient diagnosis. In the absence of confounding medications, hypokalemia, circadian timing, postural variation and with low correlation to measures of hypothalamic-pituitary-adrenal activity, this suggests that many primary aldosteronism patients may, at times, have aldosterone levels that are surprisingly low-normal. This finding challenges the concept that a persistently high and nonsuppressible aldosterone level is a sine qua non of primary aldosteronism.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".