How do I install the Ata Ppgl Bone Metastasis Management skill?

Run npx skillmds@latest add dromlakhani/ata-ppgl-bone-metastasis-management in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Ata Ppgl Bone Metastasis Management safe to use?

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Which AI agents work with Ata Ppgl Bone Metastasis Management?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Ata Ppgl Bone Metastasis Management free to use?

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Who published Ata Ppgl Bone Metastasis Management?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ata Ppgl Bone Metastasis Management by dromlakhani

Name: Ata Ppgl Bone Metastasis Management
Rating: 4.2 (5 reviews)
Author: dromlakhani

Ata Ppgl Bone Metastasis Management

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.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Manage bone metastases in pheochromocytoma and paraganglioma

STEP 1 — Gather Information

Collect imaging confirming bone metastases (bone scan, MRI, CT, or PET), assess for spinal cord compression symptoms (progressive back pain, neurologic deficit, bowel/bladder dysfunction), check serum calcium, alkaline phosphatase, and performance status; then proceed to evaluate for spinal cord compression.

STEP 2 — Rule In / Rule Out

Determine if spinal cord compression symptoms are present: if yes, proceed to urgent MRI and high-dose steroids; if no, assess for other skeletal-related events (pain, fracture, hypercalcemia) and proceed to classification.

STEP 3 — Classify or Stratify

Classify bone metastasis by location (spine vs. non-spine) and stability (mechanically unstable vs. stable) based on imaging; if unstable spine or neurologic deficit, proceed to urgent intervention; if stable, proceed to decide on local therapy and bone-modifying agents.

STEP 4 — Decide

For spinal cord compression: administer high-dose dexamethasone and obtain urgent MRI; if confirmed, recommend external beam radiation therapy (± surgery) similar to solid cancers; for stable bone metastases: offer external radiation therapy or surgical stabilization; consider bone-modifying agents (e.g., zoledronic acid, denosumab) for skeletal-related event prevention regardless of location.

Clinical Guardrails / Mimics / Pitfalls

Do not delay imaging or steroids for suspected spinal cord compression; avoid bone-modifying agents as sole treatment for mechanically unstable lesions; do not use NSAIDs as primary analgesic in hypertensive PPGL without alpha-blockade; avoid external radiation without prior alpha-blockade if catecholamine excess is uncontrolled.

Concrete Clinical Example

A 58-year-old with known SDHB-mutated PPGL presents with worsening thoracic back pain and leg weakness. MRI shows T8 vertebral body metastasis with epidural cord compression. After dexamethasone and alpha-blockade, urgent SBRT to 24 Gy in 2 fractions is performed; zoledronic acid is started post-radiation for SRE prevention.

Source: Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, doi:10.1507/endocrj.EJ25-0165

---name: ata-ppgl-bone-metastasis-managementdescription: 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.---# Manage bone metastases in pheochromocytoma and paraganglioma## STEP 1 — Gather InformationCollect imaging confirming bone metastases (bone scan, MRI, CT, or PET), assess for spinal cord compression symptoms (progressive back pain, neurologic deficit, bowel/bladder dysfunction), check serum calcium, alkaline phosphatase, and performance status; then proceed to evaluate for spinal cord compression.## STEP 2 — Rule In / Rule OutDetermine if spinal cord compression symptoms are present: if yes, proceed to urgent MRI and high-dose steroids; if no, assess for other skeletal-related events (pain, fracture, hypercalcemia) and proceed to classification.## STEP 3 — Classify or StratifyClassify bone metastasis by location (spine vs. non-spine) and stability (mechanically unstable vs. stable) based on imaging; if unstable spine or neurologic deficit, proceed to urgent intervention; if stable, proceed to decide on local therapy and bone-modifying agents.## STEP 4 — DecideFor spinal cord compression: administer high-dose dexamethasone and obtain urgent MRI; if confirmed, recommend external beam radiation therapy (± surgery) similar to solid cancers; for stable bone metastases: offer external radiation therapy or surgical stabilization; consider bone-modifying agents (e.g., zoledronic acid, denosumab) for skeletal-related event prevention regardless of location.## Clinical Guardrails / Mimics / PitfallsDo not delay imaging or steroids for suspected spinal cord compression; avoid bone-modifying agents as sole treatment for mechanically unstable lesions; do not use NSAIDs as primary analgesic in hypertensive PPGL without alpha-blockade; avoid external radiation without prior alpha-blockade if catecholamine excess is uncontrolled.## Concrete Clinical ExampleA 58-year-old with known SDHB-mutated PPGL presents with worsening thoracic back pain and leg weakness. MRI shows T8 vertebral body metastasis with epidural cord compression. After dexamethasone and alpha-blockade, urgent SBRT to 24 Gy in 2 fractions is performed; zoledronic acid is started post-radiation for SRE prevention.**Source:** Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, doi:10.1507/endocrj.EJ25-0165

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