Beyond Adrenal Crisis: Protean Manifestations of Hypocalcemia in Autoimmune Polyglandular Syndrome Type 1
Bibliographic record
Abstract
Introduction: Autoimmune polyglandular syndrome type 1 (APS1) is associated with adrenal insufficiency, hypoparathyroidism, mucocutaneous candidiasis, and primary ovarian insufficiency. Our objective is to describe 2 acute presentations unrelated to adrenal crisis in a patient with APS1: 1) stress-induced cardiomyopathy presenting as shock and heart failure and 2) acute on chronic urinary retention. Case report: A 40-year-old patient with APS1 was admitted to the intensive care unit with cardiogenic shock. She was diagnosed with nonischemic cardiomyopathy with a left ventricular ejection fraction of 20% to 25% in the setting of severe hypocalcemia. Her heart function recovered after 1 year, and the working diagnosis was stress-induced cardiomyopathy complicated by hypocalcemia.At 50 years old, she presented to the emergency department with abdominal pain and tingling in her hands and feet. She was found to have severe hypocalcemia as well as acute on chronic urinary retention. After intravenous calcium supplementation, her symptoms subsided, and she was able to void once again and was discharged home without urinary catheter. Subsequent urological studies demonstrated detrusor overactivity and severe pelvic floor dysfunction. Discussion: Acute hypocalcemia is known to cause neuromuscular irritability, and there is increasing evidence that this can also precipitate stress-induced cardiomyopathy and urinary retention. Female APS1 patients are further predisposed to both conditions due to hypoestrogenism from primary ovarian failure. Conclusion: Atypical sequelae of hypoparathyroidism-associated hypocalcemia, such as cardiomyopathy and urinary retention, warrant consideration in acute presentations of patients with APS1.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 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".