How do I install the Ata Ppgl Radionuclide Therapy Selection skill?

Run npx skillmds@latest add dromlakhani/ata-ppgl-radionuclide-therapy-selection 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 Radionuclide Therapy Selection safe to use?

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Which AI agents work with Ata Ppgl Radionuclide Therapy Selection?

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 Radionuclide Therapy Selection free to use?

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Who published Ata Ppgl Radionuclide Therapy Selection?

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

Ata Ppgl Radionuclide Therapy Selection by dromlakhani

Name: Ata Ppgl Radionuclide Therapy Selection
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Ata Ppgl Radionuclide Therapy Selection

The skill selects 131I-MIBG therapy for pheochromocytoma or paraganglioma with positive 123I-MIBG scintigraphy that reduces excess catecholamines, or 177Lu-DOTATATE therapy for lesions with positive somatostatin receptor scintigraphy, both modalities covered by Japanese health insurance. It is invoked when a clinician asks which radionuclide therapy to use for metastatic or unresectable PPGL amenable to targeted treatment.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Select radionuclide therapy for pheochromocytoma and paraganglioma

STEP 1 — Gather Information

Confirm metastatic or unresectable PPGL amenable to targeted radionuclide therapy; obtain 123I-MIBG scintigraphy (e.g., diagnostic 123I-MIBG SPECT/CT) and somatostatin receptor scintigraphy (e.g., 68Ga-DOTATATE PET/CT or 111In-octreotide SPECT) to assess tracer avidity.

STEP 2 — Rule In / Rule Out

Is the 123I-MIBG scintigraphy positive (avid uptake in lesion)? If yes, rule in for 131I-MIBG therapy; if negative, proceed to evaluate somatostatin receptor scintigraphy.

STEP 3 — Classify or Stratify

If 123I-MIBG negative, assess somatostatin receptor scintigraphy: positive uptake indicates eligibility for 177Lu-DOTATATE; if both studies are negative, radionuclide therapy is not indicated (consider alternative systemic treatments).

STEP 4 — Decide

For 123I-MIBG-positive PPGL: administer 131I-MIBG 5.55–7.4 GBq intravenously over 1 hour with thyroid blockade (potassium iodide 130 mg/day 1–3 days before to 7 days after). For somatostatin receptor‑positive PPGL: administer 177Lu-DOTATATE 7.4 GBq intravenously over 30 minutes, repeat up to four times at 8‑week intervals.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on 123I-MIBG in SDHx‑variant PPGL where false negatives occur; avoid 177Lu-DOTATATE if somatostatin receptor scan is negative; ensure thyroid blockade for 131I-MIBG to prevent thyroid stunning; monitor for bone marrow suppression, nephrotoxicity, and hypertension; contraindicated in pregnancy; verify patient can follow radiation protection instructions (independent daily activities).

Concrete Clinical Example

A 58‑year‑old with metastatic abdominal paraganglioma, hypertension, and elevated normetanephrine undergoes 123I-MIBG scintigraphy showing intense uptake in hepatic and osseous lesions; somatostatin receptor scan is negative. The skill selects 131I-MIBG therapy; after thyroid blockade, 6.8 GBq administered, resulting in 50% reduction in urinary metanephrines and improved blood pressure control.

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-radionuclide-therapy-selectiondescription: The skill selects 131I-MIBG therapy for pheochromocytoma or paraganglioma with positive 123I-MIBG scintigraphy that reduces excess catecholamines, or 177Lu-DOTATATE therapy for lesions with positive somatostatin receptor scintigraphy, both modalities covered by Japanese health insurance. It is invoked when a clinician asks which radionuclide therapy to use for metastatic or unresectable PPGL amenable to targeted treatment.---# Select radionuclide therapy for pheochromocytoma and paraganglioma## STEP 1 — Gather InformationConfirm metastatic or unresectable PPGL amenable to targeted radionuclide therapy; obtain 123I-MIBG scintigraphy (e.g., diagnostic 123I-MIBG SPECT/CT) and somatostatin receptor scintigraphy (e.g., 68Ga-DOTATATE PET/CT or 111In-octreotide SPECT) to assess tracer avidity.## STEP 2 — Rule In / Rule OutIs the 123I-MIBG scintigraphy positive (avid uptake in lesion)? If yes, rule in for 131I-MIBG therapy; if negative, proceed to evaluate somatostatin receptor scintigraphy.## STEP 3 — Classify or StratifyIf 123I-MIBG negative, assess somatostatin receptor scintigraphy: positive uptake indicates eligibility for 177Lu-DOTATATE; if both studies are negative, radionuclide therapy is not indicated (consider alternative systemic treatments).## STEP 4 — DecideFor 123I-MIBG-positive PPGL: administer 131I-MIBG 5.55–7.4 GBq intravenously over 1 hour with thyroid blockade (potassium iodide 130 mg/day 1–3 days before to 7 days after). For somatostatin receptor‑positive PPGL: administer 177Lu-DOTATATE 7.4 GBq intravenously over 30 minutes, repeat up to four times at 8‑week intervals.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on 123I-MIBG in SDHx‑variant PPGL where false negatives occur; avoid 177Lu-DOTATATE if somatostatin receptor scan is negative; ensure thyroid blockade for 131I-MIBG to prevent thyroid stunning; monitor for bone marrow suppression, nephrotoxicity, and hypertension; contraindicated in pregnancy; verify patient can follow radiation protection instructions (independent daily activities).## Concrete Clinical ExampleA 58‑year‑old with metastatic abdominal paraganglioma, hypertension, and elevated normetanephrine undergoes 123I-MIBG scintigraphy showing intense uptake in hepatic and osseous lesions; somatostatin receptor scan is negative. The skill selects 131I-MIBG therapy; after thyroid blockade, 6.8 GBq administered, resulting in 50% reduction in urinary metanephrines and improved blood pressure control.**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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