Research

Guides next-step management after a thyroid FNA result using the Bethesda System for Reporting Thyroid Cytopathology (categories I–VI), integrating clinical risk, sonographic pattern, and molecular testing options. Use when a clinician asks "what do I do with a Bethesda III result", "Bethesda IV FNA what next", "should I repeat FNA or do molecular testing", "FLUS result management", "Bethesda II follow-up interval", or any question about acting on a thyroid FNA cytology report. Source: 2015 A...

Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, G...

Recommends against routine 25(OH)D testing during pregnancy. Triggers include: "Should I order a vitamin D level for this pregnant patient?" and "Is vitamin D testing indicated for asymptomatic pregnant patients?"

The skill recommends against routine 25(OH)D testing in adults with dark complexion. Use when a clinician considers ordering a 25(OH)D test for a patient with dark complexion lacking established indications for vitamin D testing.

This skill determines whether screening for adrenocorticotropic hormone deficiency (ACTHD) is indicated in childhood cancer survivors with hypothalamic‑pituitary axis radiation exposure between 24‑30 Gy. Screening is recommended when the survivor is >10 years post‑radiation or presents with clinical symptoms suggestive of adrenal insufficiency (e.g., fatigue, hypotension), triggered by questions such as “Should I screen for ACTHD in this survivor with 25 Gy radiation 12 years ago?” or “Does s...

Recommend performing abdominal ultrasound when a patient on somatostatin receptor ligand (SRL) therapy develops signs or symptoms suggestive of gallstone disease. Trigger phrases include biliary colic, postprandial right upper quadrant pain, Murphy's sign, or suspected cholecystitis.

Recommends transsphenoidal surgery as the primary therapeutic option for most patients with biochemically confirmed acromegaly. Consider this recommendation when evaluating a newly diagnosed patient with elevated IGF-1 and/or clinical features suggestive of GH excess (e.g., acral enlargement, facial changes) to determine initial management.

Recommends measuring serum IGF-1 to exclude acromegaly in any patient discovered to have a pituitary mass on imaging. Triggers include incidental pituitary lesion found on MRI/CT for unrelated reasons.

Suggests screening for colon neoplasia with colonoscopy at the time of acromegaly diagnosis to establish baseline colorectal cancer risk. Trigger when a patient receives a new diagnosis of acromegaly (elevated IGF‑1 with lack of GH suppression after oral glucose tolerance test).

Recommends annual hormonal testing of patients following radiotherapy to monitor for hypopituitarism and other delayed radiation effects. Use in survivorship care after RT when patients have received pituitary or hypothalamic RT/SRT.

Diagnoses gonadotrope dysfunction in postmenopausal women by confirming absent high serum FSH and LH when not on hormone replacement therapy. Use when evaluating a postmenopausal woman for hypogonadism; triggers include postmenopausal woman with suspected hypogonadism.

Recommends against performing dynamic GnRH stimulation testing in the evaluation of hypogonadism, as it provides no additional diagnostic information beyond baseline gonadotropins and sex steroids. Consider this recommendation when evaluating hypogonadism and contemplating GnRH testing.

Suggests discontinuing growth hormone (GH) replacement during pregnancy due to lack of clear evidence for efficacy or safety and placental GH production. Triggers include managing a pregnant patient on GH replacement.

Uses BMI-specific cutoffs to interpret peak GH values during stimulation testing. Use when interpreting GH stimulation test results; triggers include GH stimulation test requiring BMI-adjusted interpretation.

This skill recommends against using growth hormone (GH) to enhance athletic performance, as the practice is illegal, lacks scientific or ethical justification, and has no substantiated efficacy. It is triggered when a patient requests GH for athletic performance enhancement or when considering GH replacement for athletic performance.

This skill guides the simultaneous measurement of serum and urine osmolarity to evaluate polyuria for central diabetes insipidus. It is triggered when a patient presents with polyuria exceeding 50 mL/kg/24 hours or 3.5 L/day in a 70‑kg individual.

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.

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.

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.

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.

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...

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.

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.

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.