Latest Agent Skills

Calculates the lowest effective glucocorticoid dose (dexamethasone or prednisone) to normalize blood pressure and serum potassium in glucocorticoid-remediable aldosteronism (GRA/FH-I) by titrating to biochemical and clinical targets. Indicated when initiating medical treatment for confirmed GRA, triggered by findings such as early-onset hypertension, family history of stroke before age 40, spontaneous hypokalemia, or suppressed plasma renin activity with elevated aldosterone.

Recommends administering stress-dose glucocorticoids before surgery and tapering after surgery in patients with adrenal insufficiency before repeat testing. Triggers include preoperative planning for surgery in a patient with known or suspected adrenal insufficiency.

Recommends using the lowest tolerable hydrocortisone dose to potentially decrease risks of metabolic and cardiovascular disease in central adrenal insufficiency. Triggers include managing a patient with central adrenal insufficiency requiring glucocorticoid replacement.

Monitors euthyroid adults with growth hormone deficiency (GHD) who are initiating GH replacement therapy for the development of central hypothyroidism (CH). Initiates levothyroxine (L-T4) if free thyroxine (fT4) falls below the laboratory reference range; triggers include GHD patient starting GH replacement.

Recommends using weight‑neutral antipsychotic alternatives when possible and employing shared decision‑making that provides quantitative estimates of expected weight effect to guide drug choice. Triggered when a clinician asks, “How do I involve this patient in choosing an antipsychotic with minimal weight gain?” or “What resources show weight‑change projections for risperidone vs aripiprazole?”.

Advises against testosterone therapy in men with biochemical recurrence after prostate cancer treatment due to very limited data and potential risk of progression. Consider when a patient has a rising PSA after definitive therapy and the clinician evaluates testosterone for hypogonadism, questioning whether TTh is safe in BCR.

This skill recommends computed tomography (CT) as the initial imaging modality for primary aldosteronism (PA) evaluation in Japan, citing its accessibility and comparable performance to MRI. It is triggered when a clinician orders imaging for suspected PA and asks 'What imaging should I start with?' or seeks a cost-effective initial evaluation.

Helps distinguish unilateral from bilateral adrenal disease based on 18-oxocortisol levels, which are typically higher in aldosterone-producing adenoma than idiopathic adrenal hyperplasia. Use when evaluating 18-oxocortisol results during PA workup to guide subtype classification after a positive ARR.

Differentiates aldosterone-producing adenoma from idiopathic adrenal hyperplasia based on 18-hydroxycorticosterone levels, with APA patients generally having levels >100 ng/dL at 8:00 a.m. and IAH patients usually having levels <100 ng/dL. Use when reviewing 18-OHB test results to help subtype PA; triggers include 18-OHB >100 ng/dL (suggesting APA) or <100 ng/dL (suggesting IAH).

Monitor free T4 and adjust levothyroxine after starting antiepileptic drugs in central hypothyroidism

Recommends that all diabetes insipidus patients wear an emergency bracelet or necklace to alert clinicians to their condition if incapacitated. Use when establishing care for a diabetes insipidus patient; triggers include diabetes insipidus diagnosis.

This skill suggests using approved weight‑loss medication over no pharmacological therapy to ameliorate comorbidities and improve physical activity in adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one comorbid condition. It is triggered when a clinician asks, for example, 'Should I add medication to help maintain weight loss in this patient with BMI 31 and diabetes?' or 'Is pharmacotherapy appropriate for long‑term weight control in a patient with BMI 28 and hypertension?'.

Suggests a 3- to 6‑month trial of testosterone dosing to achieve a mid‑normal premenopausal value in a reference assay for postmenopausal women with properly diagnosed HSDD and no contraindications. Triggered when a postmenopausal woman requests therapy for low sexual desire after appropriate HSDD workup and exclusion of contraindications.

Determines when adrenal venous sampling (AVS) is indicated for functional subtyping of primary aldosteronism (PA) when surgical treatment is feasible and desired by the patient. Triggered when a clinician confirms PA diagnosis and asks 'Do I need AVS for subtyping?' or evaluates surgical candidacy.

Determines whether to perform adrenal venous sampling (AVS) to lateralize aldosterone excess in patients with confirmed primary aldosteronism (PA) who are being evaluated for surgical treatment. Indicated when surgery is feasible and desired by the patient, or when subtype workup is planned for a surgical candidate, especially in those younger than 35 years with spontaneous hypokalemia, marked aldosterone excess, and unilateral adrenal lesions on CT.

Recommends using mineralocorticoid receptor antagonists rather than epithelial sodium-channel inhibitors for medical treatment of primary aldosteronism. Use when a clinician asks whether to use an MRA or ENaC inhibitor for medical treatment of PA.

Recommends hydrocortisone replacement dosing of 15–20 mg total daily, administered as a single dose or divided doses with the highest dose given in the morning upon awakening and the second dose in the afternoon (two-dose regimen) or second and third doses at lunch and late afternoon (three-dose regimen). Use when initiating glucocorticoid replacement for adrenal insufficiency; triggers include diagnosing adrenal insufficiency requiring glucocorticoid replacement.

Step-by-step meal planning for a patient with obesity — from diet recall to calorie prescription to macronutrient targets. Use when a clinician asks "how do I plan a diet for my obese patient", "what calorie target for weight loss", "how many calories should I prescribe", "meal plan for obesity", "diet plan for overweight patient", or needs to build an individualised dietary prescription at the clinic.

Guides dose escalation for obesity pharmacotherapy based on efficacy and tolerability while staying within approved upper dose limits. Triggers include clinician questions like "How should I titrate naltrexone/bupropion if the starting dose is tolerated?" or "What is the maximum liraglutide dose I can use?"

Recommends ACE inhibitors, ARBs, or calcium channel blockers as first-line hypertension therapy rather than β‑adrenergic blockers in obese patients with type 2 diabetes. Triggers include when a clinician asks, 'What antihypertensive should I start for this obese patient with T2DM to avoid weight gain?' or 'Should I avoid β‑blockers in this patient with diabetes and hypertension?'

Guides choice among spironolactone, eplerenone, and esaxerenone for primary aldosteronism based on comparative efficacy, safety, and patient-specific factors. Triggers include when initiating MRA therapy and asking 'Which MRA should I prescribe?' or considering switching agents due to adverse effects, cost, or need for potassium supplementation.

Interprets the saline infusion test (SIT) to assess the probability of primary aldosteronism when a patient has a positive aldosterone-to-renin ratio (ARR) and requires confirmatory testing. Triggers include evaluating post‑infusion plasma aldosterone concentration (PAC) after a positive ARR, hypertension work‑up, or when deciding whether to proceed to adrenal venous sampling (AVS).

Determines if primary aldosteronism is confirmed based on upright plasma aldosterone ≤6 ng/dL (170 nmol/L) on day 4 at 10 AM of fludrocortisone suppression test, provided plasma renin activity ≥1 ng/mL/h and plasma cortisol concentration lower than the 7 AM value to exclude ACTH confounding. Use when reviewing FST results to diagnose PA; triggers include "FST", "upright aldosterone ≤6 ng/dL", "PRA ≥1 ng/mL/h", and "cortisol drop".

Evaluates likelihood of primary aldosteronism by measuring plasma aldosterone suppression after oral captopril; normal suppression ≥30% makes PA unlikely, while lack of suppression with persistently suppressed plasma renin activity suggests PA. Use when assessing captopril challenge test (CCT) results for PA diagnosis in patients with positive aldosterone-to-renin ratio.

Determines unilateral vs bilateral aldosterone excess based on cortisol-corrected aldosterone ratios from adrenal venous sampling, with ratio >4:1 indicating unilateral excess, ratio 3:1 suggestive of bilateral hypersecretion, and interpretation dependent on cosyntropin stimulation protocol used during sampling. Use when analyzing AVS results to guide surgical vs medical treatment decisions; triggers include 'AVS lateralization ratio', 'cosyntropin-stimulated AVS', 'aldosterone-to-cortisol ratio >4:1', and 'ratio 3:1 suggestive of bilateral disease'.

Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.

Calculate the Maryland Aggregate Pathology Index (MAPI) on a deceased donor procurement kidney biopsy to predict graft survival and decide single vs dual vs discard allocation. Trigger when a clinician asks "what's the MAPI score", "interpret donor kidney biopsy", "should I use this marginal kidney", "MAPI cutoff for transplant", "procurement biopsy scoring", or has histology results from a deceased donor kidney and needs an objective grading.

Determines levothyroxine dosing for central hypothyroidism to achieve serum free T4 in the mid to upper half of the reference range. Triggers include confirmed central hypothyroidism requiring thyroid hormone replacement when initiating L‑4 therapy.

Calculates the initial growth hormone (GH) replacement dose based on patient age for adults with proven growth hormone deficiency (GHD). Triggers include initiating GH replacement in patients with proven GHD requiring 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 guides perioperative levothyroxine management for adults with preoperative central hypothyroidism undergoing non-emergency surgery. Trigger phrases include "preoperative central hypothyroidism patient requiring non-emergency surgery" and "use when managing preoperative CH patient".

Titrates GH replacement dose to keep IGF-1 below the upper limit of normal and reduces dose when side effects appear. Use when monitoring GH replacement therapy; triggers include patient on GH replacement needing dose adjustment.

This skill guides clinicians to assess whether a patient has achieved ≥5% weight loss at 3 months while on a weight‑loss medication and to determine continuation versus discontinuation based on efficacy and safety. It is triggered when a clinician asks, 'Has this patient lost enough weight at 3 months to continue lorcaserin?' or 'Should I stop phentermine/topiramate because the patient lost only 3% of body weight?'.

Determines whether to add a mineralocorticoid receptor antagonist (e.g., spironolactone or eplerenone) to glucocorticoid therapy in glucocorticoid-remediable aldosteronism when blood pressure fails to normalize with glucocorticoid alone. Triggered by persistent hypertension or inadequate BP control despite optimized glucocorticoid dosing in GRA patients.

We need to output a SKILL.md file with the specified format.

Determines when to test for germline KCNJ5 mutations indicating familial hyperaldosteronism type III in very young patients with primary aldosteronism. Triggered by severe early-onset hypertension with hypokalemia in infants or young children (<20 years) with confirmed PA.

Select oral and injectable glucose-lowering agents for a newly diagnosed patient with type 2 diabetes using a compelling-indication hierarchy (heart failure → ASCVD → DKD → obesity) followed by glucose-pattern matching. Incorporates modern GLP-1 receptor agonists — Ozempic (semaglutide SC, T2D), Mounjaro (tirzepatide), and Wegovy/Noveltreat (semaglutide 2.4 mg, obesity). Use when a clinician asks "what drug to start for newly diagnosed T2D", "which OAD to use", "first-line diabetes medication", "SGLT2i vs GLP-1 in new T2D", or presents a newly diagnosed T2D patient needing a personalised medication plan.

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.

Determines when to pursue genetic testing for glucocorticoid-remediable aldosteronism (FH-I/GRA) in patients with confirmed primary aldosteronism (PA). Indicated when PA onset is before age 20 or there is a family history of PA or stroke before age 40.

This skill guides clinicians in sharing decision‑making when selecting an antiepileptic drug (AED) by providing quantitative estimates of each drug’s expected weight effect. It is triggered when a clinician asks how to discuss weight‑change risks when choosing an AED or what information to provide on weight effects of specific agents such as valproate versus lamotrigine.

Complete bedside prescribing reference for Mirago (mirabegron, beta-3 adrenoceptor agonist) for overactive bladder — covering contraindications, safety screening, drug interactions, dose selection in special populations, titration, and administration. Use when a clinician asks how to start mirabegron, what dose to use in renal or hepatic impairment, is mirabegron safe in this patient, mirabegron drug interactions, or Mirago for OAB.

Look up NHS England genomic tests for rare and inherited diseases. Use this skill whenever a clinician asks what genetic test to order for a condition, which genes are covered for a specific diagnosis, what commissioning category a genomic test falls under (Core, Specialised, or Highly Specialised), or which tests belong to a specialty group (Neurology, Cardiology, Endocrinology, etc.). Also trigger for questions like what panel is used for a condition, whether there is an NHS test for something, what the R number is for a condition, or whether anything has changed in the genomic test directory. Source: NHS England National Genomic Test Directory for Rare and Inherited Disease v9.0 (April 2026).

Refactor given method `${input:methodName}` to reduce its cognitive complexity to `${input:complexityThreshold}` or below, by extracting helper methods.

Update a markdown file section with an index/table of files from a specified folder.

Diátaxis Documentation Expert. An expert technical writer specializing in creating high-quality software documentation, guided by the principles and structure of the Diátaxis technical documentation authoring framework.

Generate a language translation for a mkdocs documentation stack.

Triage and resolve Debian Linux issues with apt, systemd, and AppArmor-aware guidance.

Triage and resolve Arch Linux issues with pacman, systemd, and rolling-release best practices.

Convert Markdown files to HTML similar to `marked.js`, `pandoc`, `gomarkdown/markdown`, or similar tools; or writing custom script to convert markdown to html and/or working on web template systems like `jekyll/jekyll`, `gohugoio/hugo`, or similar web templating systems that utilize markdown documents, converting them to html. Use when asked to "convert markdown to html", "transform md to html", "render markdown", "generate html from markdown", or when working with .md files and/or web a templating system that converts markdown to HTML output. Supports CLI and Node.js workflows with GFM, CommonMark, and standard Markdown flavors.

Prompt for generating an AGENTS.md file for a repository

Generate images using AI. Use when asked to generate, create, or make images, textures, icons, sprites, artwork, visual assets, or mockups. Supports OpenAI (gpt-image-2) and Google Gemini (Nano Banana). Requires an API key for the chosen provider.

Plan a multi-file refactor with proper sequencing and rollback steps

Create a README.md file for the project

Surgical code refactoring to improve maintainability without changing behavior. Covers extracting functions, renaming variables, breaking down god functions, improving type safety, eliminating code smells, and applying design patterns. Less drastic than repo-rebuilder; use for gradual improvements.

File a new GitHub issue in the checked-out repo — search first for duplicates/adjacent issues to update or reference, detect the repo's issue template if any, then compose title/body/labels/milestone matching house style. Use when asked to file, create, open, report, or track an issue.

Audit, write, or revise CONTRIBUTING.md, including the decision of whether one is warranted. Use when creating contribution guidance, editing existing CONTRIBUTING, or when a README points to missing/thin contribution docs. Applies the nayafia/contributing-template framework.

Relate GitHub issues and PRs — pick the right edge type (blocked-by via GraphQL, parent/sub-issue, Closes/Fixes in PR body, plain mention) and apply it. Use when asked to link, block, depend on, make a subtask of, or close-on-merge.

Create, name, scope, assign, and close GitHub milestones. Use when adding a milestone, deciding whether work belongs in one, or naming the next one. One axis per project (release / date / theme); never as labels.

Pick up an existing GitHub issue in the checked-out repo — implement from scratch or take over an in-flight PR. Use when asked to work, take, implement, fix, or close issue

Open a GitHub PR with a tight body — why this change, what'll surprise the reviewer, how we know it's correct — or add a pull_request_template to a repo. Use when asked to open, create, or draft a pull request, compose or regenerate a PR description, or scaffold a repo's PR template. Composes the Summary/Gotchas/Verification structure and detects an existing template first.