How do I install the Esa Pa Avs Skip Criteria skill?

Run npx skillmds@latest add dromlakhani/esa-pa-avs-skip-criteria 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 Esa Pa Avs Skip Criteria safe to use?

SkillMD's automated safety review verdict for this skill is PASS. Independent scanners report: SkillSpector: PASS, Skill Scanner: PASS. Capability flags: docs only. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Esa Pa Avs Skip Criteria?

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 Esa Pa Avs Skip Criteria free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Esa Pa Avs Skip Criteria?

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

Esa Pa Avs Skip Criteria by dromlakhani

Name: Esa Pa Avs Skip Criteria
Rating: 4.2 (5 reviews)
Author: dromlakhani

Esa Pa Avs Skip Criteria

Determines when adrenal venous sampling may be skipped in primary aldosteronism. Applies to patients <35 years with spontaneous hypokalemia, marked aldosterone excess, and unilateral adrenal lesions suggestive of cortical adenoma on CT.

dromlakhani Updated Aug 19, 2026 10 repo stars

File contents

Determine When Adrenal Venous Sampling May Be Skipped in PA

STEP 1 — Gather Information

Confirm primary aldosteronism via positive ARR and confirmatory test. Collect age, serum potassium (spontaneous hypokalemia), plasma aldosterone concentration (marked excess), and adrenal CT characteristics (unilateral lesion with cortical adenoma features: size <4 cm, homogeneous attenuation, no irregular margins).

STEP 2 — Rule In / Rule Out

Is the patient younger than 35 years? If no, proceed to adrenal venous sampling. If yes, continue to assess additional criteria.

STEP 3 — Classify or Stratify

Does the patient have spontaneous hypokalemia, marked aldosterone excess (e.g., PAC >20 ng/dL), and a unilateral adrenal lesion on CT with features consistent with a cortical adenoma? If all three are present, AVS may be omitted. If any criterion is missing, proceed to AVS.

STEP 4 — Decide

If criteria are met, proceed directly to unilateral laparoscopic adrenalectomy without adrenal venous sampling. Otherwise, perform adrenal venous sampling to lateralize aldosterone excess before surgery.

Clinical Guardrails / Mimics / Pitfalls

Ensure CT is interpreted by an experienced radiologist to avoid misclassifying hyperplasia or carcinoma as adenoma. Do not skip AVS if the lesion is >4 cm, irregular, or bilateral. Biochemical confirmation of PA is required; do not rely on ARR alone. Avoid in patients with concomitant medications that alter aldosterone/renin. Remember that age <35 alone is insufficient; all three criteria must be satisfied.

Concrete Clinical Example

A 32‑year‑old woman with hypertension and spontaneous hypokalemia (K+ 3.0 mmol/L) has PAC 35 ng/dL, suppressed PRA, and ARR >50. Adrenal CT shows a 1.5 cm homogeneous left adrenal nodule without contralateral lesion. She meets all criteria and proceeds to left laparoscopic adrenalectomy without AVS.

Source: The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2015-4061

---name: esa-pa-avs-skip-criteriadescription: Determines when adrenal venous sampling may be skipped in primary aldosteronism. Applies to patients <35 years with spontaneous hypokalemia, marked aldosterone excess, and unilateral adrenal lesions suggestive of cortical adenoma on CT.---# Determine When Adrenal Venous Sampling May Be Skipped in PA## STEP 1 — Gather InformationConfirm primary aldosteronism via positive ARR and confirmatory test. Collect age, serum potassium (spontaneous hypokalemia), plasma aldosterone concentration (marked excess), and adrenal CT characteristics (unilateral lesion with cortical adenoma features: size <4 cm, homogeneous attenuation, no irregular margins).## STEP 2 — Rule In / Rule OutIs the patient younger than 35 years? If no, proceed to adrenal venous sampling. If yes, continue to assess additional criteria.## STEP 3 — Classify or StratifyDoes the patient have spontaneous hypokalemia, marked aldosterone excess (e.g., PAC >20 ng/dL), and a unilateral adrenal lesion on CT with features consistent with a cortical adenoma? If all three are present, AVS may be omitted. If any criterion is missing, proceed to AVS.## STEP 4 — DecideIf criteria are met, proceed directly to unilateral laparoscopic adrenalectomy without adrenal venous sampling. Otherwise, perform adrenal venous sampling to lateralize aldosterone excess before surgery.## Clinical Guardrails / Mimics / PitfallsEnsure CT is interpreted by an experienced radiologist to avoid misclassifying hyperplasia or carcinoma as adenoma. Do not skip AVS if the lesion is >4 cm, irregular, or bilateral. Biochemical confirmation of PA is required; do not rely on ARR alone. Avoid in patients with concomitant medications that alter aldosterone/renin. Remember that age <35 alone is insufficient; all three criteria must be satisfied.## Concrete Clinical ExampleA 32‑year‑old woman with hypertension and spontaneous hypokalemia (K+ 3.0 mmol/L) has PAC 35 ng/dL, suppressed PRA, and ARR >50. Adrenal CT shows a 1.5 cm homogeneous left adrenal nodule without contralateral lesion. She meets all criteria and proceeds to left laparoscopic adrenalectomy without AVS.**Source:** The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2015-4061

Frequently asked questions