Talk:Adrenal crisis/GA2

GA Review

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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Nominator: CursedWithTheAbilityToDoTheMath (talk · contribs) 02:41, 28 March 2024 (UTC)

Reviewer: Wolverine XI (talk · contribs) 07:27, 18 August 2024 (UTC)

I'll be reviewing this now. Wolverine XI ^{(talk to me)} 07:27, 18 August 2024 (UTC)

Looking at this diff, I see you have done some extensive work with the sourcing but I don't see any work done on prose. Wolverine XI ^{(talk to me)} 07:32, 18 August 2024 (UTC)

Have you completely rewritten the following sections as the last reviewer suggested: Signs and symptoms, Risk factors, Mechanism, and Diagnosis? If not, then I'll give you a few days to adequately address them. Wolverine XI ^{(talk to me)} 07:35, 18 August 2024 (UTC)

@Wolverine XI Thank you for agreeing to review this article, I know it is a big task! I did a lot of my editing spread out so it's a bit hard to find exact diffs for changes in prose. I could have sworn I had made bigger changes to the mechanism, risk factors, and diagnosis section but it appears I didnt. Maybe I left it in a sandbox somewhere. Either way I apologize for not doing my due diligence and double checking that I had properly fixed those concerns. I have made some edits to those sections and I do feel they have improved however I do really struggle with prose and wording things correctly so please let me know if sections need to be improved further. CursedWithTheAbilityToDoTheMath (talk) 22:35, 18 August 2024 (UTC)

I don't think you addressed the concerns brought up by the last reviewer. I'll generate a list of all the parts that need work in about 10 or more hours. Wolverine XI ^{(talk to me)} 04:03, 19 August 2024 (UTC)

Thank you for taking the time to do this. CursedWithTheAbilityToDoTheMath (talk) 22:37, 19 August 2024 (UTC)

The list is almost done; do expect a full set of comments sometime today. Wolverine XI ^{(talk to me)} 03:55, 20 August 2024 (UTC)

Review

• Adrenal crisis can be the first presentation of patients with adrenal insufficiency, occurring in up to 50% of patients with Addison's disease.

I'm not quite sure why you decided to cite the 1994 source used by the 2016 journal article.

Article says

Diagnosis is often delayed since most of the symptoms of adrenal insufficiency are nonspecific and develop insidiously.

Source says

The diagnosis may be delayed, as most of the symptoms and signs of adrenal insufficiency occur insidiously and are nonspecific

First of, the statement that symptoms are mostly nonspecific is not supported, and second the phrasing here is too-close.

Article says

Those in an adrenal crisis often go into hypotensive shock and may exhibit sensorium alterations.

Source says

Patients presenting with adrenal crisis are often in hypotensive shock, and may have altered sensorium.

Again, too-close.

Article says

They often present with gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal pain, which can mistakenly be diagnosed as gastroenteritis or acute abdomen.

Source says

They frequently have gastrointestinal symptoms like abdominal pain, nausea, vomiting and diarrhea, leading to an erroneous diagnosis of an acute abdomen or gastroenteritis.

Yet another example.

Article says

Glucocorticoids have a permissive effect on catecholamine action, which leads to hypotension secondary to hypovolemia and hypocortisolism in adrenal insufficiency.

Source says

Hypotension occurs secondary to hypovolemia, but also due to hypocortisolism, as glucocorticoids exert a permissive effect on catecholamine action.

How come you used the same source as the journal article, just like you did in the first one? Furthermore, the phrasing is close; simply altering the sequence does not absolve you of copyright infringements.

Sample

In secondary adrenal insufficiency, hyponatremia results from decreased kidney excretion of electrolyte-free water and the inability to suppress vasopressin.

I don't see where this is supported.

Article says

Hyponatremia in primary adrenal insufficiency is caused by concurrent aldosterone deficiency, resulting in volume depletion, natriuresis, and hyperkalemia.

I don't see this in the source provided but I do see it in the 2016 source, which again, suffers from too-close paraphrasing.

Source says

In primary adrenal insufficiency, hyponatremia is due to concomitant aldosterone deficiency, which leads to natriuresis, volume depletion, and hyperkalemia.

Article says

Additional biochemical characteristics include hypercalcemia, which is a result of increased bone resorption and reduced renal excretion of calcium, and rarely hypoglycemia.

Source says

Other biochemical features include hypoglycemia and, rarely, hypercalcemia, which is due to decreased renal excretion of calcium and increased bone resorption.

Once more, you referenced the same 2003 source that this 2016 journal offered, which is, if I may say, still a case of close paraphrase.

I decided to do some spot checks before proceeding to other parts of the review, but what I found was discouraging so this where my review ends. Almost every sentence I examined in the signs and symptoms section had some form of close paraphrasing. Additionally, I would want to point out that you only utilized one 2016 source throughout the entire section; the other sources you listed are only those the journal article itself uses. This seems to be a common theme across the entire article, thus I believe it is a good way off GA and needs to be entirely reworked. I'm not sure if this is a clear-clut quickfail, so I'm pinging Thebiguglyalien to confirm. Wolverine XI ^{(talk to me)} 20:06, 20 August 2024 (UTC)

This article is a bit beyond my area of expertise, but it really comes down to whether it's specific instances or a broad problem. If a large portion of your checks turn up the same issue, and it would require significant reworking of the article to remove the issue, then the review should be closed so the article can be reworked. Of particular concern here is WP:MEDRS, which I'm not terribly familiar with but is essential to avoiding OR in medical articles. Regardless of whether this is closed for close paraphrasing, it might be worth getting input from WP:MEDICINE. Thebiguglyalien (talk) 20:57, 20 August 2024 (UTC)

I wrote the majority of this article awhile ago so how I write has changed quite a bit however for most of this article I would read large review papers, like the 2016 one, and then also read the studies they cited to get further insights. I've stopped using this method as much because it did lead to some problems, mainly that it was easy for me to mess up where I was getting my information from when I had so many open tabs. I do struggle a lot with finding ways to put things into my own words without losing the original meaning. How many different ways can you reword "Diagnosis is often delayed since most of the symptoms of adrenal insufficiency are nonspecific and develop insidiously." without losing the original meaning or making it sound overly fluffy?

I am a bit confused by you saying that the source doesn't back up the claim that symptoms are nonspecefic as i cited the Adrenal Crisis: Still a Deadly Event in the 21st Century article which does support that statement.

As for the statement "Hyponatremia in primary adrenal insufficiency is caused by concurrent aldosterone deficiency, resulting in volume depletion, natriuresis, and hyperkalemia." I did cite the 2016 study which backs up this claim.

"Hyponatremia in primary adrenal insufficiency is caused by concurrent aldosterone deficiency, resulting in volume depletion, natriuresis, and hyperkalemia." cites "A Case of Severe Hyponatremia in a Patient With Primary Adrenal Insufficiency" your right that it doesn't support my full claim (doesn't support the volume depletion and natriuresis part) and I should have caught this sooner.

The reason I cited the 2003 source for the "Other biochemical features include hypoglycemia and, rarely, hypercalcemia, which is due to decreased renal excretion of calcium and increased bone resorption." is because I was also using that article to get information.

Thank you for taking the time to review this. I'm more than fine with a quick fail if that is what is appropriate here. CursedWithTheAbilityToDoTheMath (talk) 22:25, 20 August 2024 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.