Research

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.

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, ...

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Suggests a single 5‑mg intravenous dose of zoledronate as the treatment of choice in patients with active Paget’s disease who have no contraindication to IV zoledronate. Triggered when initiating pharmacologic therapy for Paget’s disease and confirming absence of renal impairment or other contraindications.

Recommends obtaining plain radiographs of the suspicious regions of the skeleton in patients with suspected Paget's disease. Clinical triggers include unexplained bone pain, elevated alkaline phosphatase, or clinical suspicion based on presentation.

Recommends treatment with a bisphosphonate for most patients with active Paget's disease who are at risk of future complications. Triggers include active Paget's disease with risk of fracture, deformity, or neurologic symptoms.

This skill suggests treatment with a bisphosphonate in patients with Paget's disease who also have symptomatic congestive heart failure. Triggers include the presence of Paget's disease alongside signs or symptoms of congestive heart failure such as dyspnea, orthopnea, or elevated jugular venous pressure.

Advises clinical or biochemical investigation for anabolic steroid abuse when encountering isolated low HDL‑C (<30 mg/dL) without elevated triglycerides. Typical triggers include a patient with HDL‑C <30 mg/dL and normal TG, suspected anabolic steroid use with isolated low HDL, or investigating drug abuse during a dyslipidemia workup.

Determine the supplemental premeal short-acting insulin dose for a hospitalised patient on the GCIH protocol, based on premeal capillary blood glucose. Use two separate scales: standard (experimental/Lakhani protocol) and insulin-resistant (control/Endocrine Society). Trigger when a clinician asks "supplemental insulin dose GCIH", "correction dose for steroid patient before meals", "how much lispro to give before meal in GCIH", "sliding scale for steroid hyperglycemia", or needs premeal insul...

Adjust basal insulin dose day-to-day in a hospitalised patient being managed for glucocorticoid-induced hyperglycemia (GCIH) using the Lakhani protocol. Trigger when a clinician asks "how to titrate basal insulin in steroid patient", "adjust glargine for GCIH", "fasting glucose high on steroid protocol what to do", "increase or decrease basal insulin GCIH", or any day-to-day basal insulin adjustment question in a patient on glucocorticoids.

Recommends non-reconstituted glucagon preparations over reconstituted ones for treating outpatients with severe hypoglycemia. Triggered by questions such as "Should I use non-reconstituted or reconstituted glucagon for this patient with severe hypoglycemia?" or "Is ready-to-use glucagon preferred for emergency treatment?"

Do not administer carbohydrate-containing oral fluids preoperatively to adult patients with diabetes undergoing planned elective surgical procedures. Triggered when clinicians ask, "Should we give this patient a carbohydrate drink before surgery?"

Recommends adding testosterone therapy to phosphodiesterase‑type‑5 inhibitor (PDE5i) for men with erectile dysfunction who do not respond to PDE5i monotherapy. Triggered when a patient reports inadequate response to sildenafil, tadalafil, or vardenafil and the clinician considers whether to add testosterone or pursue combination therapy.

Reserve testosterone monotherapy for men with mild erectile dysfunction and an absolute demonstration of hypogonadism; otherwise combine testosterone therapy with a PDE5 inhibitor. Triggered when a clinician managing erectile dysfunction asks whether testosterone alone is sufficient or a PDE5 inhibitor should be added.

Testosterone therapy is more effective than placebo at correcting anemia in middle-aged and older men with confirmed hypogonadism. Consider this approach when evaluating a hypogonadal man with anemia and questioning whether testosterone will improve hemoglobin or if testosterone therapy should be used for anemia.

This skill applies a total testosterone threshold of less than 12 nmol/L (3.5 ng/mL) to diagnose late-onset hypogonadism. It is triggered when a clinician evaluates a testosterone result and questions whether the level is low enough to diagnose hypogonadism or what cutoff defines low T.

States that testosterone therapy should be restricted to investigational protocols in patients with biochemical recurrence or metastatic prostate cancer due to unknown long-term risks. Triggers when a clinician encounters a patient with rising PSA after definitive treatment or metastatic disease and low testosterone, questioning whether testosterone can be used outside a trial.

Conducts regular monitoring for testosterone therapy response and adverse events. Triggered when testosterone therapy is initiated and the clinician plans follow‑up, asking when to check symptom improvement or what to monitor for side effects.

Advises checking for smaller testes, decreased body hair, and gynecomastia as physical clues to hypogonadism. Triggered when evaluating a man with suspected testosterone deficiency who asks what physical exam findings support the diagnosis or whether any exam signs suggest hypogonadism.

Recommends measuring total testosterone in the morning fasting state (07:00–11:00) using a reliable assay for patients suspected of hypogonadism. Triggered when a clinician orders a testosterone test and questions whether the sample should be drawn fasting and in the morning.

Recommends evaluating testosterone in men presenting with sexual symptoms (low libido, erectile dysfunction, decreased morning erections), metabolic conditions (obesity, type 2 diabetes, metabolic syndrome), HIV infection, opioid or glucocorticoid use, bone density loss, or male infertility. Triggers when a clinician encounters a patient with any of these indications and considers whether to check testosterone levels.

This skill confirms the diagnosis of male hypogonadism by requiring both characteristic clinical symptoms and consistently low total testosterone levels on two separate morning measurements. It is triggered when a clinician evaluates a patient with suspected hypogonadism and wonders whether low testosterone and symptoms are present or if the diagnosis should be confirmed.