Incidence of Adrenal Masses Eventually Discovered in Patients Screened for Primary Aldosteronism
Bibliographic record
Abstract
CONTEXT: Biochemical screening for endocrine hypertension may be complex; the known presence of an adrenal mass markedly increases the pretest probability for adrenal hypertension and may inform diagnostic efforts. OBJECTIVE: Model the potential incidence of adrenal masses that may be detected by routine adrenal imaging in patients with suspected endocrine hypertension. DESIGN: Retrospective cohort study. SETTING: Provincial administrative and clinical databases for radiology and biochemistry, Alberta, Canada. PARTICIPANTS: Patients with hypertension and any measurement of aldosterone-renin ratio (ARR), 2012 to 2019. MAIN MEASURES: Radiology report of any computed tomography or magnetic resonance imaging abdomen performed for any reason 0 to 12 years following ARR. Patients with any pre-ARR imaging data between 2002 and 2024 were excluded. The presence of adrenal mass, size, and density were recorded and stratified by imaging indication. RESULTS: Of 6942 unique hypertension patients with ARR, 1462 (21%) had imaging done at some point after ARR, 912 (62.4%) for indications unrelated to hypertension/adrenal and at a median 771 days (69-1577) post ARR. The incidence rate estimate was 7.2% (5.6-9.2%) of scans showed adrenal mass, median 1.4 cm (1.1-2.3), a rate well above the modern series of adrenal incidentaloma prevalence in unselected adults. The number needed to screen in this population was 14 (11-18) to detect an adrenal mass without a priori indication for adrenal imaging. CONCLUSION: Among patients screened for PA but without prior or subsequent directed adrenal imaging, 1 in 14 were later found to have an adrenal mass on imaging done for other indications. Given the impact on pretest probability for endocrine hypertension and further investigation steps, routine adrenal imaging might be considered whenever PA suspicion is high.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".