Claude Skills by dromlakhani

Recommends against routine laboratory evaluation for endocrine etiologies of pediatric obesity unless the patient exhibits attenuated stature or decreased height velocity relative to genetic/familial potential and pubertal stage. Clinical trigger phrases include short stature for target height, slowed growth velocity, or crossing downward on height percentile curves.

Interprets fasting plasma glucose to screen for prediabetes and diabetes in children and adolescents with BMI ≥85th percentile (overweight/obese). Trigger phrases include 'overweight or obese', 'BMI ≥85th percentile', 'screening for comorbidities', and 'fasting plasma glucose'.

This skill suggests genetic testing for pediatric patients with extreme early onset obesity (onset before 5 years of age) who exhibit clinical features of genetic obesity syndromes such as extreme hyperphagia, or who have a family history of extreme obesity. It helps clinicians identify when to refer for genetic evaluation to diagnose rare monogenic obesity syndromes.

Interprets HbA1c to screen for prediabetes and diabetes in overweight or obese children (BMI ≥85th percentile) being evaluated for comorbidities. Triggers include HbA1c results, BMI percentile, and clinical suspicion of dysglycemia.

Interprets HDL cholesterol levels to screen for dyslipidemia in pediatric patients using thresholds of <40 mg/dL low, 40–45 mg/dL borderline low, and ≥45 mg/dL acceptable. Triggered during lipid panel review for overweight or obese children (BMI ≥85th percentile) or when evaluating for cardiometabolic risk.

Prescribes specific healthy eating habits for pediatric obesity prevention and treatment, focusing on avoiding calorie-dense nutrient-poor foods and encouraging whole fruits over juice. Trigger phrases include well-child visit, BMI ≥85th percentile, excessive juice intake, frequent fast food or sugary beverage consumption.

Diagnoses obesity in infants and toddlers under 2 years of age when sex-specific weight-for-recumbent length is at or above the 97.7th percentile on WHO growth charts. Consider this assessment during well-child visits when caregivers report excessive weight gain, crossing of percentile channels, or when length and weight measurements suggest disproportionate adiposity.

Interprets LDL cholesterol levels to screen for dyslipidemia in children and adolescents with obesity (BMI ≥85th percentile). Acceptable <110 mg/dL, borderline high 110-129 mg/dL, high ≥130 mg/dL triggers further evaluation or lifestyle intervention.

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Interprets the 2-hour plasma glucose from an oral glucose tolerance test (OGTT) to screen for prediabetes and diabetes in children and adolescents with overweight or obesity. Uses thresholds of <140 mg/dL (normal), 140–199 mg/dL (impaired glucose tolerance, IGT), and ≥200 mg/dL (diabetes) per ADA criteria referenced in the guideline.

Interprets free and total testosterone and SHBG levels to screen for hyperandrogenism in adolescents with obesity, using Endocrine Society PCOS guidelines. Trigger phrases include oligomenorrhea, hirsutism, acne, and elevated androgen symptoms prompting PCOS evaluation.

Determines when to administer FDA-approved obesity pharmacotherapy in pediatric patients, requiring a concomitant lifestyle modification program of the highest intensity and prescribing only by experienced clinicians. Triggers include documented failure of intensive lifestyle modification to limit weight gain or ameliorate comorbidities in patients with obesity (BMI ≥95th percentile).

Determines when to discontinue obesity pharmacotherapy due to lack of efficacy. Trigger phrases include “<4% BMI/BMI z score reduction after 12 weeks at full dosage” or “insufficient weight loss on antiobesity medication.”

Determines when to initiate pharmacotherapy for pediatric obesity after a formal intensive lifestyle modification program fails to limit weight gain or ameliorate comorbidities. Trigger phrases include "failed intensive lifestyle modification," "no weight loss despite lifestyle program," and "persistent comorbidities despite lifestyle intervention."

Prescribes physical activity for pediatric obesity prevention and treatment in children and adolescents with BMI at or above the 85th percentile. Recommends at least 20 minutes, optimally 60 minutes, of vigorous physical activity on ≥5 days per week to improve metabolic health and reduce obesity risk.

This skill guides clinicians to evaluate for psychosocial comorbidities in pediatric obesity and to initiate assessment/counseling when psychosocial problems are suspected. Trigger phrases include family dysfunction, stressors, bullying, low self-esteem, depression, anxiety, eating disorders, or substance abuse.

This skill guides clinicians to identify maladaptive rearing patterns related to diet, activity, and screen time in pediatric patients with overweight or obesity. It prompts evaluation of screen time, dietary habits, physical activity, and family eating cues to target education on healthy food and exercise habits.

Recommends limiting non-academic screen time to 1-2 hours per day and decreasing other sedentary behaviors. Trigger phrases include "excessive screen time," "digital activities," and "sedentary behaviors."

This skill interprets fasting total cholesterol levels to screen for dyslipidemia in children and adolescents undergoing obesity evaluation. Triggered by pediatric obesity screening (BMI ≥85th percentile) or dyslipidemia evaluation, it classifies cholesterol as acceptable (<170 mg/dL), borderline high (170‑199 mg/dL), or high (≥200 mg/dL) per Endocrine Society guidelines.

Interprets fasting triglyceride levels to screen for dyslipidemia in children aged 0–9 years during obesity evaluation. Triggered by BMI ≥85th percentile, well-child visit, or concern for metabolic comorbidity.

Interprets fasting triglyceride levels to screen for dyslipidemia in overweight or obese children aged 10-19 years. Triggered by pediatric obesity screening, fasting lipid panel, or BMI ≥85th percentile with clinical concern for dyslipidemia.

Diagnose monogenic and syndromic obesity in children and adolescents using a structured step-by-step algorithm. Use this skill whenever a clinician suspects a genetic cause of obesity, asks about leptin deficiency, MC4R mutation, POMC deficiency, PCSK1 deficiency, leptin receptor deficiency, Bardet-Biedl syndrome, Prader-Willi syndrome, Alström syndrome, or any case of early-onset severe obesity with hyperphagia. Also trigger for questions about targeted pharmacotherapy including setmelanotid...

Guide a non-stigmatising pediatric obesity consultation using the 5As framework (Ask, Assess, Advise, Agree, Assist) and 4Ms assessment (Metabolic, Mechanical, Mental Health, Social Milieu), based on the CMAJ 2025 guideline. Trigger when a clinician asks how to approach a weight conversation with a child or family, how to use the 5As for obesity, how to assess a child with obesity, or how to conduct a non-judgmental obesity visit.

Screen a child with obesity for red flags suggesting monogenic, syndromic, or secondary endocrine causes — distinguishing atypical from typical exogenous obesity. Trigger when a clinician asks whether obesity could be genetic or hormonal, suspects Prader-Willi syndrome, Cushing disease, hypothyroidism, ROHHAD, Bardet-Biedl syndrome, leptin deficiency, or craniopharyngioma, or when a child has early-onset severe obesity, short stature with obesity, hyperphagia, hypotonia, dysmorphic features, ...

Select the right treatment tier for a child with obesity — behavioural, pharmacologic, or surgical — using the CMAJ 2025 pediatric obesity guideline. Trigger when a clinician asks what to do for a child with obesity, which intervention to start, whether to escalate treatment, or when to consider medication or surgery for pediatric obesity.

Select the right pharmacologic agent for a child aged 12+ with obesity using the CMAJ 2025 guideline — choosing between GLP-1 receptor agonists, metformin, or orlistat with monitoring guidance. Trigger when a clinician asks which medication to use for pediatric obesity, whether to start semaglutide or metformin in a child, or how to manage obesity pharmacologically in adolescents.

Screen a child aged 13+ with obesity for eligibility for bariatric surgery (laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass) using the CMAJ 2025 guideline. Trigger when a clinician asks whether a child qualifies for weight loss surgery, bariatric surgery in adolescents, sleeve gastrectomy in a teenager, or when to refer for surgical management of pediatric obesity.

Orders mandatory MRI, contrast CT, and somatostatin receptor nuclear imaging when a non-catecholamine-producing pheochromocytoma or paraganglioma is suspected based on imaging findings with normal fractionated metanephrines and catecholamines. Considers SDHD germline genetic testing in hereditary head/neck paraganglioma cases triggered by multifocal or familial head/neck lesions.

Investigates for pheochromocytoma and paraganglioma in children presenting with hypertension plus symptoms such as headache, excessive sweating, or palpitations. Notes the absence of pediatric reference values for endocrine tests and selects tumor resection as first-line treatment when triggered by pediatric hypertension with associated symptoms like headache or excessive sweating.

Recommends against fine needle cytology for pathological diagnosis of head and neck paraganglioma due to its low accuracy and risk of misdiagnosis. Use when a clinician asks 'Should I perform fine needle cytology for suspected head and neck paraganglioma?' — triggers include suspicion of head and neck paraganglioma requiring pathological confirmation.

This skill guides the use of biomarkers to prognosticate metastatic pheochromocytoma and paraganglioma (PPGL) by applying independent prognostic factors such as older age, larger tumor size, metastases at diagnosis, multiple metastases, high chromogranin A, plasma fractionated metanephrines ≥5× ULN, or elevated plasma 3‑MT; for head‑and‑neck PPGL, only high blood 3‑MT predicts disease‑specific survival. It is triggered when a clinician asks about prognosis based on biomarker results or encoun...

This skill guides management of bone metastases in pheochromocytoma and paraganglioma, recommending external radiation therapy and surgical approaches similar to other solid cancers. It is triggered by known or suspected bone metastases, spinal cord compression symptoms, bone pain, pathological fracture, or hypercalcemia in a PPGL patient, emphasizing prompt diagnosis/treatment for spinal cord compression and consideration of bone-modifying agents for skeletal-related event prevention.

Recommends CVD chemotherapy as first-line systemic treatment for unresectable pheochromocytoma/paraganglioma with rapid progression or when radionuclide therapy is not applicable. Considers disease progression rate and feasibility to choose between CVD chemotherapy and radionuclide therapy in patients with positive nuclear imaging when progression is slow and radionuclide therapy feasible.

Selects the appropriate confirmatory test after a positive pheochromocytoma/paraganglioma (PPGL) screening test. Triggers include elevated random urinary metanephrines (>3× ULN after creatinine correction), blood catecholamines (>3× ULN), or plasma-free fractionated metanephrines (>ULN).

Recommends stereotactic radiotherapy for local control of head and neck paraganglioma and postoperative radiotherapy for incompletely resectable spinal paraganglioma; considers external beam radiation therapy for local control of pheochromocytoma and paraganglioma outside the head and neck. Indicated when a clinician asks whether to recommend radiation therapy for local control in a PPGL patient, triggered by unresectable or incompletely resected PPGL lesion.

This skill interprets SDHx and fumarate hydratase gene variants to assess metastasis risk in pheochromocytoma and paraganglioma patients. Triggered by identification of SDHB pathogenic variant (or negative SDHB immunostaining), FH variant, or other SDHx mutations when a clinician asks how genetic results affect metastasis risk assessment.

Indicates and performs genetic testing for pheochromocytoma and paraganglioma when a clinician questions whether to order testing for a PPGL patient, using triggers such as any PPGL diagnosis, family history of PPGL, young age at onset (<50 years), bilateral adrenal tumors, or extra-adrenal (paraganglioma) location. It guides collection of detailed family and medical history, considers SDHB testing for high metastatic risk (35–75%), informs patients about hereditary PPGL significance, and rec...

This skill selects a treatment algorithm for pheochromocytoma and paraganglioma based on identified germline pathogenic variants, enabling personalized management per syndrome-specific guidelines. It is triggered when a clinician identifies RET, VHL, NF1, or SDHx pathogenic variants and asks how genetic results should change management.

Manages gastrointestinal symptoms from catecholamine excess in pheochromocytoma and paraganglioma, addressing constipation, paralytic ileus, megacolon, or intestinal pseudo-obstruction/perforation. Triggered by clinician queries about treating GI symptoms in PPGL patients with constipation, abdominal distension, or nausea/vomiting.

This skill confirms pheochromocytoma and paraganglioma (PPGL) diagnosis on histopathology by requiring immunostaining positive for Chromogranin A and negative for cytokeratin in tumor tissue, with SDHB negativity indicating SDHx pathogenic variants that predict metastasis or recurrence. It is triggered when a clinician asks 'How do I confirm pheochromocytoma diagnosis on pathology?' or encounters resected adrenal or paraganglioma tissue needing a definitive diagnosis.

Applies histopathological scoring systems (GAPP, COPPS, PASS) to estimate metastasis risk in pheochromocytoma and paraganglioma. Used when a clinician asks 'What is the metastasis risk based on this pheochromocytoma pathology report?' and triggered by availability of histopathological specimen from PPGL resection.

Administers intravenous phentolamine followed by infusion, then transitions to oral doxazosin after the acute phase resolves, while avoiding β-blockers before α-blockade. Indicated for severe hypertension (>180/110 mmHg) with headache, palpitations, or diaphoresis in known or suspected pheochromocytoma or paraganglioma.

Selects the initial imaging modality (CT, MRI, 123I-MIBG scintigraphy, or 18F-FDG PET) for suspected pheochromocytoma and paraganglioma based on clinical question (tumor localization vs metastasis detection) and patient factors. Triggered by biochemical confirmation of PPGL or strong clinical suspicion when clinicians ask 'What imaging test should I order for suspected pheochromocytoma?'

Initiates and adjusts medical treatment for functional pheochromocytoma and paraganglioma. Starts with selective α-blocker for catecholamine excess hypertension or symptoms, adds calcium antagonists or metyrosine if BP control insufficient, and adds β-blockers only after adequate α-blockade for tachycardia/tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease.

Assesses metastasis risk in pheochromocytoma and paraganglioma using age at diagnosis, tumor size, catecholamine secretion pattern, timing of metastatic lesion diagnosis, tumor localization, disease type, histopathological findings, SDHB gene pathogenic variants, and SDHB immunohistochemistry status. Use when a clinician asks 'What is the metastasis risk for this pheochromocytoma patient?' Triggers include new PPGL diagnosis or change in clinical status during follow-up.

Coordinates multidisciplinary treatment with palliative care unit for pain management while avoiding medications that risk inducing hypertensive crisis (e.g., metoclopramide, certain antidepressants) in PPGL patients. Triggered by reports of pain in PPGL patient, especially with bone involvement.

Manages perioperative volume for pheochromocytoma and paraganglioma by initiating a normal salt diet (9 g/day) on day 3 of α‑blocker therapy, titrating intake to blood pressure and orthostatic changes, and administering 1–2 L saline pre‑operatively. Triggered when planning fluid/salt management for scheduled PPGL resection.

Determines that α-blockers are generally unnecessary when catecholamine overproduction is unclear in suspected pheochromocytoma or paraganglioma, but requires comprehensive assessment of clinical findings before prescribing α-blockers before surgery. Use when a clinician asks 'Should I prescribe α-blockers preoperatively for this patient with suspected but unconfirmed pheochromocytoma?' Triggers include uncertain biochemical evidence of PPGL despite clinical suspicion.

The skill selects 131I-MIBG therapy for pheochromocytoma or paraganglioma with positive 123I-MIBG scintigraphy that reduces excess catecholamines, or 177Lu-DOTATATE therapy for lesions with positive somatostatin receptor scintigraphy, both modalities covered by Japanese health insurance. It is invoked when a clinician asks which radionuclide therapy to use for metastatic or unresectable PPGL amenable to targeted treatment.

Chooses the initial screening test for suspected pheochromocytoma and paraganglioma when evaluating hypertension with paroxysmal symptoms, adrenal incidentaloma, or family history of PPGL. Selects among random urinary fractionated metanephrines (creatinine corrected), blood fractionated catecholamines, or plasma-free fractionated metanephrines.