Which AI agents work with Ata Ppgl Preoperative Assessment Unclear Overproduction?

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.

Who published Ata Ppgl Preoperative Assessment Unclear Overproduction?

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

Ata Ppgl Preoperative Assessment Unclear Overproduction by dromlakhani

Name: Ata Ppgl Preoperative Assessment Unclear Overproduction
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Ata Ppgl Preoperative Assessment Unclear Overproduction

Determines that α-blockers are generally unnecessary when catecholamine overproduction is unclear in suspected pheochromocytoma or paraganglioma, but requires comprehensive assessment of clinical findings before prescribing α-blockers before surgery. Use when a clinician asks 'Should I prescribe α-blockers preoperatively for this patient with suspected but unconfirmed pheochromocytoma?' Triggers include uncertain biochemical evidence of PPGL despite clinical suspicion.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Assess preoperative need for α-blockade in pheochromocytoma and paraganglioma with unclear catecholamine overproduction

STEP 1 — Gather Information

Collect clinical presentation (symptoms like palpitations, headaches, hypertension), biochemical results (fractionated metanephrines, catecholamines), imaging findings (CT, MRI, 123I-MIBG scintigraphy), and assess for signs of catecholamine excess or tumor characteristics.

STEP 2 — Rule In / Rule Out

Rule out definitive catecholamine overproduction: if any biochemical test (24-hour urinary fractionated metanephrines >3x ULN, plasma-free metanephrines > upper limit, or fractionated catecholamines >3x ULN) is positive, proceed to α-blockade; if all are negative or equivocal, consider catecholamine overproduction unclear.

STEP 3 — Classify or Stratify

If catecholamine overproduction is unclear, classify based on clinical assessment: evaluate for hypertensive episodes, paroxysmal symptoms, tumor size >4 cm, metastatic potential on imaging, or genetic susceptibility; if high clinical suspicion persists despite negative biochemistry, proceed to comprehensive assessment.

STEP 4 — Decide

If catecholamine overproduction remains unclear after comprehensive assessment (including imaging uptake, symptoms, tumor characteristics), α-blockers are generally unnecessary; however, if clinical assessment indicates high risk (e.g., severe hypertension, symptomatic episodes, large tumor), consider preoperative α-blockade after multidisciplinary review.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on normal catecholamine levels to exclude PPGL in symptomatic patients; avoid prescribing α-blockers without assessing clinical risk; beware of false-negative biochemical tests due to intermittent secretion or small tumors; do not delay surgery for prolonged α-blockade titration when overproduction is unclear.

Concrete Clinical Example

A 45-year-old patient presents with episodic headaches and hypertension; urinary metanephrines are twice the upper limit (equivocal), plasma normetanephrine is normal, and adrenal CT shows a 3 cm lesion without clear MIBG uptake. After assessing clinical findings (paroxysmal symptoms, hypertension), the team decides α-blockade is unnecessary preoperatively given unclear overproduction and low tumor risk, proceeding directly to laparoscopic adrenalectomy.

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-preoperative-assessment-unclear-overproductiondescription: Determines that α-blockers are generally unnecessary when catecholamine overproduction is unclear in suspected pheochromocytoma or paraganglioma, but requires comprehensive assessment of clinical findings before prescribing α-blockers before surgery. Use when a clinician asks 'Should I prescribe α-blockers preoperatively for this patient with suspected but unconfirmed pheochromocytoma?' Triggers include uncertain biochemical evidence of PPGL despite clinical suspicion.---# Assess preoperative need for α-blockade in pheochromocytoma and paraganglioma with unclear catecholamine overproduction## STEP 1 — Gather InformationCollect clinical presentation (symptoms like palpitations, headaches, hypertension), biochemical results (fractionated metanephrines, catecholamines), imaging findings (CT, MRI, 123I-MIBG scintigraphy), and assess for signs of catecholamine excess or tumor characteristics.## STEP 2 — Rule In / Rule OutRule out definitive catecholamine overproduction: if any biochemical test (24-hour urinary fractionated metanephrines >3x ULN, plasma-free metanephrines > upper limit, or fractionated catecholamines >3x ULN) is positive, proceed to α-blockade; if all are negative or equivocal, consider catecholamine overproduction unclear.## STEP 3 — Classify or StratifyIf catecholamine overproduction is unclear, classify based on clinical assessment: evaluate for hypertensive episodes, paroxysmal symptoms, tumor size >4 cm, metastatic potential on imaging, or genetic susceptibility; if high clinical suspicion persists despite negative biochemistry, proceed to comprehensive assessment.## STEP 4 — DecideIf catecholamine overproduction remains unclear after comprehensive assessment (including imaging uptake, symptoms, tumor characteristics), α-blockers are generally unnecessary; however, if clinical assessment indicates high risk (e.g., severe hypertension, symptomatic episodes, large tumor), consider preoperative α-blockade after multidisciplinary review.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on normal catecholamine levels to exclude PPGL in symptomatic patients; avoid prescribing α-blockers without assessing clinical risk; beware of false-negative biochemical tests due to intermittent secretion or small tumors; do not delay surgery for prolonged α-blockade titration when overproduction is unclear.## Concrete Clinical ExampleA 45-year-old patient presents with episodic headaches and hypertension; urinary metanephrines are twice the upper limit (equivocal), plasma normetanephrine is normal, and adrenal CT shows a 3 cm lesion without clear MIBG uptake. After assessing clinical findings (paroxysmal symptoms, hypertension), the team decides α-blockade is unnecessary preoperatively given unclear overproduction and low tumor risk, proceeding directly to laparoscopic adrenalectomy.**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

Frequently asked questions