How do I install the Endo Pa Screening Method Arr skill?

Run npx skillmds@latest add dromlakhani/endo-pa-screening-method-arr 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.

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Is Endo Pa Screening Method Arr free to use?

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Who published Endo Pa Screening Method Arr?

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

Endo Pa Screening Method Arr by dromlakhani

Name: Endo Pa Screening Method Arr
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Pa Screening Method Arr

Selects the aldosterone-to-renin ratio (ARR) method over hypokalemia for screening hypertensive patients for primary aldosteronism. Use when a clinician asks what test to use for screening hypertensive patients with resistant hypertension or unexplained hypokalemia for PA.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Use aldosterone-to-renin ratio for PA screening

STEP 1 — Gather Information

Collect seated morning blood sample for aldosterone and plasma renin activity (PRA) or direct renin concentration (DRC), serum potassium, and review current medications; ensure no dietary sodium restriction in prior days.
→ Proceed to measure aldosterone and renin.

STEP 2 — Rule In / Rule Out

Assess renin suppression: PRA ≤1 ng/mL/h or DRC ≤8.2 mU/L.
If not suppressed → screen negative, rule out PA.
If suppressed → proceed to evaluate aldosterone level and ARR.

STEP 3 — Classify or Stratify

Calculate ARR: aldosterone (ng/dL) ÷ PRA (ng/mL/h) or aldosterone (pmol/L) ÷ DRC (mU/L).
Apply cutoffs:

Immunoassay: aldosterone ≥10 ng/dL and ARR >20
LC-MS/MS: aldosterone ≥7.5 ng/dL and ARR >15 (≈25% lower threshold)
If both criteria met → screen positive; otherwise → screen negative.
→ Classify screen result.

STEP 4 — Decide

If screen positive → order aldosterone suppression testing for confirmation before PA-specific therapy.
If screen negative but hypokalemia present → correct potassium to reference range and repeat screen.
→ Initiate confirmatory testing or repeat screening as appropriate.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on hypokalemia alone for screening; do not ignore interfering medications (e.g., β-blockers, ACEi/ARBs) without per Table 6/7 strategies; do not screen during sodium restriction; do not use ARR cutoffs without adjusting for assay type (immunoassay vs LC-MS/MS); do not forget to measure potassium to avoid falsely low aldosterone interpretation.

Concrete Clinical Example

A 55-year-old with resistant hypertension (BP 168/94 mmHg) and K+ 3.9 mmol/L has seated morning aldosterone 14 ng/dL (immunoassay) and PRA 0.3 ng/mL/h → ARR 46.7 (>20) → screen positive → proceed to aldosterone suppression testing.

Source: Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2025, https://doi.org/10.1210/clinem/dgaf284

TODO: consider adding scripts/calc.py for the endo-pa-screening-method-arr calculator

---name: endo-pa-screening-method-arrdescription: Selects the aldosterone-to-renin ratio (ARR) method over hypokalemia for screening hypertensive patients for primary aldosteronism. Use when a clinician asks what test to use for screening hypertensive patients with resistant hypertension or unexplained hypokalemia for PA.---# Use aldosterone-to-renin ratio for PA screening## STEP 1 — Gather InformationCollect seated morning blood sample for aldosterone and plasma renin activity (PRA) or direct renin concentration (DRC), serum potassium, and review current medications; ensure no dietary sodium restriction in prior days. → Proceed to measure aldosterone and renin.## STEP 2 — Rule In / Rule OutAssess renin suppression: PRA ≤1 ng/mL/h or DRC ≤8.2 mU/L. If not suppressed → screen negative, rule out PA. If suppressed → proceed to evaluate aldosterone level and ARR.## STEP 3 — Classify or StratifyCalculate ARR: aldosterone (ng/dL) ÷ PRA (ng/mL/h) or aldosterone (pmol/L) ÷ DRC (mU/L). Apply cutoffs: - Immunoassay: aldosterone ≥10 ng/dL **and** ARR >20 - LC-MS/MS: aldosterone ≥7.5 ng/dL **and** ARR >15 (≈25% lower threshold) If both criteria met → screen positive; otherwise → screen negative. → Classify screen result.## STEP 4 — DecideIf screen positive → order aldosterone suppression testing for confirmation before PA-specific therapy. If screen negative but hypokalemia present → correct potassium to reference range and repeat screen. → Initiate confirmatory testing or repeat screening as appropriate.## Clinical Guardrails / Mimics / PitfallsDo not rely on hypokalemia alone for screening; do not ignore interfering medications (e.g., β-blockers, ACEi/ARBs) without per Table 6/7 strategies; do not screen during sodium restriction; do not use ARR cutoffs without adjusting for assay type (immunoassay vs LC-MS/MS); do not forget to measure potassium to avoid falsely low aldosterone interpretation.## Concrete Clinical ExampleA 55-year-old with resistant hypertension (BP 168/94 mmHg) and K+ 3.9 mmol/L has seated morning aldosterone 14 ng/dL (immunoassay) and PRA 0.3 ng/mL/h → ARR 46.7 (>20) → screen positive → proceed to aldosterone suppression testing.**Source:** Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2025, https://doi.org/10.1210/clinem/dgaf284> **TODO:** consider adding scripts/calc.py for the endo-pa-screening-method-arr calculator

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