Claude Skills by dromlakhani

Selects surgical approach for pheochromocytoma and paraganglioma resection based on tumor size, invasion suspicion, metastatic status, and familial bilateral risk when a clinician asks 'What surgical approach should I use for this pheochromocytoma patient?' Triggers include confirmed PPGL requiring surgical intervention.

This skill determines postoperative surveillance intensity for pheochromocytoma and paraganglioma based on hereditary status, catecholamine phenotype, tumor size, and location. Use when a clinician asks 'How long and how often should I follow up this pheochromocytoma patient after surgery?' with triggers such as completed PPGL resection, hereditary PPGL, sporadic PPGL with noradrenaline dominance, tumor diameter ≥5 cm, or extra-adrenal location outside head/neck.

The skill recommends administering potassium iodide (50–150 mg/day) or Lugol's solution (5–10 drops/day) for three days prior to and continuing through the day of 123I-MIBG scintigraphy to reduce thyroid radiation exposure and prevent medullary thyroid cancer in patients undergoing evaluation for pheochromocytoma or paraganglioma. It is triggered when a clinician questions whether to give a thyroid blocking agent for a 123I-MIBG scan, such as when ordering 123I-MIBG scintigraphy for PPGL eval...

Manage pheochromocytoma and paraganglioma in pregnancy by preferring ultrasound or MRI for imaging (avoiding CT/123I-MIBG unless benefits outweigh radiation risks), using selective α-blockers as first-line medical therapy (adding calcium antagonists if needed before delivery), and recommending tumor resection in the second trimester up to 24 weeks gestation when feasible. Triggers include pregnancy with hypertension, headaches, palpitations, or adrenal mass, and the clinician question “How sh...

Algorithm for interpreting metanephrine results and handling borderline elevations in suspected Pheochromocytoma. Trigger when a clinician asks "how to interpret metanephrines", "metanephrine units", or "borderline metanephrine result".

Pre-operative preparation protocol for Pheochromocytoma, focusing on alpha-blockade titration and volume expansion. Trigger when a clinician asks "prep for pheo surgery", "alpha blockade vs beta blockade", or "doxazosin titration".

First-line screening logic to identify patients who require biochemical testing for Pheochromocytoma or Paraganglioma. Trigger when a clinician asks "who to screen for pheo", "evaluation of adrenal incidentaloma", or "workup for paroxysmal hypertension."

Determines when to use 123I-MIBG scintigraphy for PPGL diagnosis and whether thyroid blockade is required. Triggers include: need functional imaging to confirm PPGL origin, evaluating for metastatic PPGL or PGL, preparing for 131I-MIBG therapy requires baseline scintigraphy.

This skill identifies when 18F-FDG PET is indicated for detecting metastatic pheochromocytoma/paraganglioma (PPGL), especially in patients with known SDHx pathogenic variants or negative 123I-MIBG scintigraphy. Clinical triggers include suspected metastatic PPGL with negative MIBG, evaluating PPGL with known SDHx variant, and assessing treatment response in metastatic PPGL.

Determines when to use 68Ga-DOTATATE PET for diagnosing primary head and neck paragangliomas irrespective of genetic variants. Triggers include suspected head/neck PGL requiring sensitive detection, evaluating for SSTR-positive neuroendocrine tumor, and pre-assessment for 177Lu-DOTATATE therapy in HNPGL.

Determines when to add calcium antagonists or metyrosine to an alpha-blocker regimen for inadequate blood pressure control in pheochromocytoma and paraganglioma (PPGL). Indications include blood pressure uncontrolled on maximal alpha-blocker dose, significant side effects from alpha-blocker monotherapy, or development of vasospastic angina during preoperative management, with metyrosine initiated at 0.5 g/day and titrated to a maximum of 4 g/day.

Titrates preoperative alpha-blocker dose based on blood pressure response to achieve target hemodynamics (<130/80 mmHg sitting). Increases dose (e.g., doxazosin) every 2‑3 days until target BP is reached, monitoring for orthostatic hypotension and adjusting accordingly; triggers include 'Patient on preoperative alpha-blocker needs dose adjustment,' 'Blood pressure not at target despite current alpha-blocker dose,' 'Assessing need for alpha-blocker titration during preoperative period.'

Determines the appropriate age to initiate surveillance for asymptomatic genetic carriers of PPGL pathogenic variants. Indicated for a child of a PPGL patient with a known pathogenic variant, identification of an at‑risk relative for PPGL genetic screening, or initiation of surveillance in a pediatric genetic carrier.

Establishes surveillance frequency for asymptomatic genetic carriers of PPGL pathogenic variants after an initial negative genetic screen. It guides clinicians in determining long-term monitoring plans and follow-up schedules for PPGL mutation carriers, recommending annual clinical evaluation, biennial fractionated metanephrines evaluation, and triennial MRI of head/neck/chest/abdomen/pelvis.

Determines the appropriate timing for initiating beta-blocker therapy in patients with pheochromocytoma/paraganglioma (PPGL) to prevent hypertensive crisis. Indicated for tachycardia/tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease only after adequate alpha-blockade; contraindicated before alpha-blocker initiation, and triggered by clinician statements such as “Patient develops tachycardia on alpha-blocker therapy,” “Need to control heart rate in PPGL with cardiac ...

Applies specific cutoff values to interpret biochemical test results for PPGL diagnosis. Uses >3x upper limit of normal for screening tests (random urinary fractionated metanephrines corrected for creatinine, blood fractionated catecholamines, plasma-free fractionated metanephrines) and >2x upper limit of normal for 24-hour urinary fractionated catecholamines confirmation; triggers include interpreting urinary metanephrine screening results, evaluating 24-hour catecholamine excretion for conf...

Selects between external radiation therapy and surgical intervention for bone metastases in PPGL based on lesion characteristics and patient factors. Triggers include: PPGL patient with confirmed bone metastasis, assessing local treatment options for osseous PPGL lesions, determining radiation vs surgery for spinal PPGL metastasis.

Determines when to use bone-modifying agents (e.g., zoledronic acid, denosumab) for skeletal-related event prevention in PPGL bone metastases. Considers BMA as an option for preventing pathological fractures, spinal cord compression, and hypercalcemia, using an approach similar to other solid cancers with monitoring for side effects; triggers include PPGL patient with bone metastasis at risk for SREs, patient experiencing bone pain from metastatic PPGL, and preventing skeletal complications i...

Selects the appropriate functional confirmation test after a positive PPGL screening test to establish biochemical diagnosis. Triggered by statements such as 'Screening test positive for PPGL,' 'Need to confirm PPGL diagnosis before imaging,' or 'Biochemical test results exceed screening thresholds.'

Applies the COPPS score to predict metastasis risk in PPGL by integrating tumor size, necrosis, vascular invasion, and SDHB/S100 immunostaining. Triggered when a PPGL pathology specimen is available for scoring, when calculating metastatic risk index from histology, or when determining need for adjuvant therapy based on tumor biology.

Applies the GAPP score to assess metastasis risk in PPGL based on histopathological features. Triggers include: 'PPGL tumor requiring histopathological risk assessment,' 'Evaluating tumor grade for metastatic potential,' 'Determining follow-up intensity based on histological scoring.'

Selects specific genes to test for PPGL based on clinical presentation and phenotypic characteristics. Indications include abdominal/PGL with metastasis risk (test SDHB), head/neck PGL (test SDHD), bilateral PCC or pancreatic lesions (test VHL), and MEN2-associated mucosal neuromas or medullary thyroid cancer (test RET).

Determines when to suggest genetic testing for PPGL and educates patients about hereditary PPGL prevalence and testing significance, recommending testing for all PPGL patients per international guidelines while informing about the 20-40% hereditary rate and implications for family screening. Triggers include: 'Newly diagnosed PPGL patient,' 'Discussing hereditary risk with PPGL patient,' 'Considering genetic testing for PPGL patient and family.'

Manages gastrointestinal symptoms (constipation, paralytic ileus, mega-colon) in pheochromocytoma and paraganglioma (PPGL) using intravenous phentolamine and oral metyrosine to improve intestinal peristalsis. Indicated for PPGL patients with severe constipation or ileus, GI symptoms suspected due to catecholamine excess, or when improving intestinal motility is needed.

Assesses specific clinical indications warranting surgical resection or radiation therapy for head and neck paraganglioma. Recommends intervention for tympanic PGL with hearing loss, jugular bulb PGL with pulsatile tinnitus, significant skull base compression, catecholamine production, rapid growth, or metastasis; triggers include 'HNPGL patient develops neurological symptoms,' 'Tumor shows rapid growth on serial imaging,' 'Functional testing reveals catecholamine overproduction in HNPGL'.

Decides between surveillance therapy and active intervention for head and neck paraganglioma based on symptomology and tumor behavior. Prefers surveillance for asymptomatic, slow-growing tumors; advises surgical resection or radiation therapy for symptomatic, rapidly growing, or functionally active tumors. Triggers include: 'Newly diagnosed head/neck PGL patient,' 'Assessing management options for HNPGL,' 'Determining if HNPGL requires intervention or observation.'

Executes the hypertensive crisis management algorithm for PPGL by administering intravenous phentolamine infusion followed by oral doxazosin, with addition of oral beta‑blocker for tachycardia after alpha‑blockade is established. It is triggered by clinical phrases such as 'Patient presents with hypertensive crisis suspected PPGL etiology,' 'Sudden severe hypertension with headache/palpitations,' or 'Intraoperative hypertensive surge during PPGL manipulation.'

Selects the first-line imaging modality to localize a PPGL tumor after biochemical confirmation. Common triggers are 'Biochemical tests confirm PPGL, need to localize tumor,' 'Planning surgical approach requires anatomical localization,' and 'Positive screening test warrants imaging for tumor localization.'

Selects the initial biochemical screening test for pheochromocytoma and paraganglioma based on test availability and clinical context. Triggers include patient presenting with palpitations, headaches, or hypertension; need to screen for PPGL in an incidentally discovered adrenal mass; or initial biochemical workup for suspected PPGL.

Determines appropriate postoperative follow-up duration for PPGL based on hereditary status, catecholamine phenotype, tumor size, and location to guide surveillance intensity. Recommends lifelong follow-up for hereditary PPGL and at least 10 years for sporadic PPGL with noradrenaline dominance, tumor ≥5 cm, or extra‑adrenal/PGL location; triggers include 'Post-op PPGL patient requiring follow-up plan,' 'Assessing need for extended surveillance in PPGL survivor,' 'Determining follow-up duratio...

Assesses metastasis risk in PPGL using clinical factors such as age at diagnosis, tumor size, catecholamine secretion pattern, and tumor location. Indicated for newly diagnosed PPGL patients requiring risk stratification, evaluating metastatic potential, or pre-treatment assessment of aggressiveness.

Determines metastasis risk in PPGL using SDHB immunohistochemistry and genetic testing; integrates SDHB loss with tumor size, necrosis, vascular invasion, and S100 loss into COPPS score. Triggers include: 'PPGL tumor tissue available for immunohistochemistry,' 'Genetic testing reveals SDHB variant,' 'Assessing metastatic potential from genetic profile.'

Evaluates metastasis risk in pheochromocytoma and paraganglioma (PPGL) using histopathological scoring systems such as PASS and GAPP. Triggered when a pathology specimen is available from PPGL resection, when assessing tumor malignant potential on histology, or when determining the need for intensified follow-up based on pathology.

Selects between CVD chemotherapy and radionuclide therapy as first-line systemic treatment for metastatic PPGL based on disease progression and imaging results. Triggers include PPGL with distant metastases requiring systemic therapy, assessing first-line treatment options for metastatic PPGL, and determining CVD chemo vs radionuclide therapy for progressive disease.

Selects analgesic medications for PPGL pain management while avoiding agents that may provoke hypertensive crisis. Triggers include metastatic PPGL patient requiring pain management, assessing safe analgesic options in PPGL, and managing pain while preventing hypertensive crisis.

This skill assesses whether partial adrenalectomy is indicated for pheochromocytoma and paraganglioma (PPGL) to preserve adrenal function in patients with familial PPGL syndrome, imaging showing bilateral adrenal tumors or high-risk genetics, or young PPGL patients desiring adrenal function preservation. Indication is considered for familial PCC, tumors ≤5 cm, or high risk of future contralateral adrenal lesions, requiring surgical expertise and informed consent regarding recurrence risk.

This skill applies the PASS score to evaluate malignant behavior in PPGL specimens as a reference tool for metastasis risk assessment. It is triggered by histopathological evaluation requiring PASS scoring, assessment of tumor malignant potential on histology, or determination of need for additional risk stratification based on PASS, noting the weak correlation between PASS scores and metastasis, low inter-observer agreement, and the need for use alongside other markers with validation for lo...

This skill identifies when to investigate pediatric pheochromocytoma and paraganglioma (PPGL) in children presenting with hypertension accompanied by symptoms such as headache, sweating, palpitations, or reduced growth rate. It triggers investigation when blood pressure measurement confirms hypertension in a child with any of these associated symptoms.

Determines surgical approach for PPGL in children considering tumor size, suspected pathogenic gene variants, and hereditary tumor syndromes. Chooses between laparotomy and endoscopic surgery based on child's size and genetic risk; incorporates family history and genetic testing results in decision-making, with triggers such as 'Child diagnosed with PPGL requiring surgery,' 'Need to select surgical approach for pediatric PPGL,' and 'Evaluating surgical options in child with genetic syndrome.'

This skill initiates postoperative follow-up timing for pheochromocytoma and paraganglioma (PPGL) after surgical resection based on biochemical and imaging protocols. It is triggered by events such as the patient completing PPGL surgical resection, entering the post-op period requiring surveillance initiation, or needing to establish a postoperative monitoring timeline.

Selects safe imaging modalities for PPGL evaluation in pregnancy to minimize fetal radiation exposure, preferring ultrasound or MRI and reserving CT or 123I-MIBG scintigraphy for cases where diagnostic benefits outweigh radiation risks after informed consent. Triggered by phrases such as 'Pregnant patient with suspected PPGL symptoms,' 'Need imaging for PPGL in pregnant patient,' or 'Evaluating PPGL while minimizing fetal radiation risk.'

Manages PPGL medically in pregnancy by initiating selective alpha‑blockers at diagnosis and adding calcium antagonists (nifedipine or amlodipine) if blood pressure control is insufficient before delivery. Triggers include: 'Pregnant patient diagnosed with PPGL,' 'Requiring blood pressure control in pregnant PPGL patient,' and 'Medical management of PPGL throughout pregnancy.'

Determines optimal timing for surgical tumor removal in pregnant PPGL patients to balance maternal and fetal risks. Triggered by PPGL diagnosed in pregnant patient, assessing surgical feasibility during pregnancy, or planning intervention for PPGL in gestation.

Selects preoperative alpha-blocker therapy and establishes initial dosing regimen for PPGL blood pressure control. Triggered by biochemically confirmed PPGL requiring surgery, patient needs preoperative blood pressure control, or preparing for adrenalectomy in PPGL patient.

Implements preoperative salt loading and saline infusion to prevent orthostatic hypotension and hemodynamic instability during PPGL surgery. Initiates normal salt diet (9 g/day) on day 3 of alpha-blockers and administers 1-2 L saline infusion from evening before surgery until surgery for patients scheduled for PPGL surgical resection, completing preoperative alpha-blocker titration, or preventing intraoperative hypotension in PPGL surgery.

Selects between 131I-MIBG and 177Lu-DOTATATE radionuclide therapy for PPGL based on imaging results. Triggers include PPGL patient requires radionuclide therapy, positive 123I-MIBG scintigraphy indicating MIBG-avid tumor, and positive somatostatin receptor scintigraphy for SSTR-avid tumor.

This skill selects the surgical approach (laparoscopic/robot-assisted vs open adrenalectomy) for pheochromocytoma and paraganglioma (PPGL) based on tumor size and suspected organ invasion. It is triggered when imaging shows PPGL tumor size approaching 6 cm, suspected tumor invasion into adjacent structures on imaging, or when determining the surgical approach for a confirmed PPGL.

Recommends low-dose GH replacement in patients with cured acromegaly and documented GHD in the absence of known contraindications. Triggers include managing a cured acromegaly patient with documented growth hormone deficiency.

Recommends careful DDAVP and fluid intake titration including frequent weighing and serum sodium level monitoring for adipsic diabetes insipidus. Use when managing adipsic DI requiring fluid balance management.

This skill recommends monitoring desmopressin (DDAVP) doses and adjusting them as needed in patients who have recently started antiepileptic drugs (AEDs). It is triggered when a patient initiates AED therapy and requires DDAVP management for diabetes insipidus.