Pheochromocytoma, cortisol-producing adenoma and bilateral primary aldosteronism in a single patient
Bibliographic record
Abstract
Adrenal incidentalomas are commonly discovered during imaging evaluations conducted for unrelated reasons. The majority are non-functional, benign tumours. We report a woman in her 40s who was found to have two right adrenal nodules, measuring 4.0 and 3.5 cm on MRI during a fertility evaluation. Biochemical testing revealed concurrent catecholamine, cortisol and aldosterone excess. She received preoperative alpha blockade, a salt-liberal diet and fluid repletion for her pheochromocytoma, as well as spironolactone for blood pressure control of her primary aldosteronism before undergoing laparoscopic right adrenalectomy. Surgical pathology was consistent with a moderately differentiated pheochromocytoma, a cortisol-producing cortical adenoma (demonstrated by CYP11B1 immunohistochemistry) and multiple aldosterone-producing micronodules (demonstrated by CYP11B2 immunohistochemistry). Postoperatively, her catecholamine and cortisol excess resolved, while there was partial improvement in her aldosterone excess, consistent with residual primary aldosteronism. In cases of multiple concurrent adrenal pathologies, comprehensive biochemical and immunohistochemical analyses are essential for establishing a definitive diagnosis.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 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".