Outcomes After Unilateral Adrenalectomy in Asymmetrical Bilateral Primary Aldosteronism
Bibliographic record
Abstract
BACKGROUND: Lateralization by adrenal vein sampling (AVS) is the gold standard for diagnosis of unilateral primary aldosteronism. Aldosterone production from the contralateral gland suggests bilateral disease; however, little is known regarding outcomes from patients with grossly elevated (but asymmetrical) contralateral aldosterone production after unilateral adrenalectomy. METHODS: A retrospective chart review was performed of cases from the Calgary AVS database with (1) successful AVS (selectivity index ≥3 bilaterally after cosyntropin stimulation); (2) lateralization by AVS (lateralization index ≥3), stimulated or unstimulated; (3) absence of contralateral suppression (contralateral suppression index ≥2 on the nondominant side) stimulated or unstimulated; and (4) underwent unilateral adrenalectomy guided by AVS lateralization. Postsurgical outcomes were classified per PASO criteria. RESULTS: A total of 29 cases met inclusion criteria and underwent unilateral adrenalectomy with postsurgical outcomes available. Of patients with biochemical follow-up data, 20 of 27 had a complete biochemical response and 3 of 27 a partial response (median follow-up time of 10.3 weeks, interquartile range, 4.0-18.3). Four of 29 patients had a complete clinical response, while 18 of 29 patients had a partial clinical response (median follow-up time of 27.3 weeks, interquartile range, 10.7-35.6), such that 75% of patients had either complete or partial clinical response to unilateral adrenalectomy. CONCLUSIONS: In patients with bilateral (elevated contralateral suppression index) but asymmetrical primary aldosteronism, unilateral adrenalectomy can achieve positive biochemical and clinical outcomes in the short to mid-term. Elevated contralateral suppression index should not necessarily preclude recommendation of unilateral adrenalectomy in patients with lateralized primary aldosteronism, though longer-term studies are needed to clarify the rates of disease recurrence and benefits of a debulking procedure.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| 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".