How do I install the Esa Pa Gra Gluco Dosing skill?

Run npx skillmds@latest add dromlakhani/esa-pa-gra-gluco-dosing 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 Gra Gluco Dosing safe to use?

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

Which AI agents work with Esa Pa Gra Gluco Dosing?

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 Gra Gluco Dosing free to use?

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

Who published Esa Pa Gra Gluco Dosing?

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

Esa Pa Gra Gluco Dosing by dromlakhani

Name: Esa Pa Gra Gluco Dosing
Rating: 4.2 (5 reviews)
Author: dromlakhani

Esa Pa Gra Gluco Dosing

Calculates the lowest effective glucocorticoid dose (dexamethasone or prednisone) to normalize blood pressure and serum potassium in glucocorticoid-remediable aldosteronism (GRA/FH-I) by titrating to biochemical and clinical targets. Indicated when initiating medical treatment for confirmed GRA, triggered by findings such as early-onset hypertension, family history of stroke before age 40, spontaneous hypokalemia, or suppressed plasma renin activity with elevated aldosterone.

dromlakhani Updated Aug 19, 2026 10 repo stars

File contents

Determine Glucocorticoid Dose for Glucocorticoid-Remediable Aldosteronism

STEP 1 — Gather Information

Collect confirmed diagnosis of GRA (CYP11B1/CYP11B2 chimeric gene via genetic testing or dexamethasone suppression test), baseline seated blood pressure, serum potassium, plasma aldosterone concentration (PAC), plasma renin activity (PRA), age, weight, and for children, age- and gender-specific BP norms.

STEP 2 — Rule In / Rule Out

Rule in GRA if genetic testing shows CYP11B1/CYP11B2 chimeric gene OR dexamethasone suppression test shows ≥50% reduction in PAC after 2 mg dexamethasone overnight and clinical phenotype fits; otherwise rule out and evaluate for other PA subtypes (APA, IAH).

STEP 3 — Classify or Stratify

Stratify by age: adult (≥18 years) vs child (<18 years). For children, plan weight‑based glucocorticoid dosing and use age‑specific BP targets from published normative data.

STEP 4 — Decide

Start glucocorticoid at low dose: dexamethasone 0.125–0.25 mg PO daily at bedtime or prednisone 2.5–5 mg PO daily at bedtime. Titrate upward every 1–2 weeks based on seated BP and serum potassium, aiming for BP <140/90 mmHg (or age‑specific target) and potassium ≥3.5 mmol/L. If BP fails to normalize after reaching the maximum tolerated glucocorticoid dose (e.g., dexamethasone 0.75 mg daily) without Cushingoid signs, add an MR antagonist (spironolactone 12.5–25 mg daily). Monitor for iatrogenic Cushing’s (weight gain, facial plethora, striae, hyperglycemia) and reduce dose if occurs.

Clinical Guardrails / Mimics / Pitfalls

Avoid overtreatment causing iatrogenic Cushing’s syndrome; do not use glucocorticoid as primary therapy for unilateral adenoma amenable to laparoscopic adrenalectomy; do not neglect to add an MR antagonist when BP remains elevated despite maximal glucocorticoid; do not initiate in pregnancy without obstetric review; do not rely on glucocorticoid alone if BP remains above target after dose escalation.

Concrete Clinical Example

A 12‑year‑old boy presents with hypertension (150/95 mmHg), hypokalemia (K+ 3.0 mmol/L), suppressed PRA, elevated PAC, and genetic testing confirming a CYP11B1/CYP11B2 chimera. Start prednisone 2.5 mg nightly; after 2 weeks BP is 138/88 mmHg and K+ 3.6 mmol/L. Continue prednisone 2.5 mg nightly; no MR antagonist required.

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

TODO: consider adding scripts/calc.py for the esa-pa-gra-gluco-dosing calculator

---name: esa-pa-gra-gluco-dosingdescription: Calculates the lowest effective glucocorticoid dose (dexamethasone or prednisone) to normalize blood pressure and serum potassium in glucocorticoid-remediable aldosteronism (GRA/FH-I) by titrating to biochemical and clinical targets. Indicated when initiating medical treatment for confirmed GRA, triggered by findings such as early-onset hypertension, family history of stroke before age 40, spontaneous hypokalemia, or suppressed plasma renin activity with elevated aldosterone.---# Determine Glucocorticoid Dose for Glucocorticoid-Remediable Aldosteronism## STEP 1 — Gather InformationCollect confirmed diagnosis of GRA (CYP11B1/CYP11B2 chimeric gene via genetic testing or dexamethasone suppression test), baseline seated blood pressure, serum potassium, plasma aldosterone concentration (PAC), plasma renin activity (PRA), age, weight, and for children, age- and gender-specific BP norms.## STEP 2 — Rule In / Rule OutRule in GRA if genetic testing shows CYP11B1/CYP11B2 chimeric gene OR dexamethasone suppression test shows ≥50% reduction in PAC after 2 mg dexamethasone overnight and clinical phenotype fits; otherwise rule out and evaluate for other PA subtypes (APA, IAH).## STEP 3 — Classify or StratifyStratify by age: adult (≥18 years) vs child (<18 years). For children, plan weight‑based glucocorticoid dosing and use age‑specific BP targets from published normative data.## STEP 4 — DecideStart glucocorticoid at low dose: dexamethasone 0.125–0.25 mg PO daily at bedtime or prednisone 2.5–5 mg PO daily at bedtime. Titrate upward every 1–2 weeks based on seated BP and serum potassium, aiming for BP <140/90 mmHg (or age‑specific target) and potassium ≥3.5 mmol/L. If BP fails to normalize after reaching the maximum tolerated glucocorticoid dose (e.g., dexamethasone 0.75 mg daily) without Cushingoid signs, add an MR antagonist (spironolactone 12.5–25 mg daily). Monitor for iatrogenic Cushing’s (weight gain, facial plethora, striae, hyperglycemia) and reduce dose if occurs.## Clinical Guardrails / Mimics / PitfallsAvoid overtreatment causing iatrogenic Cushing’s syndrome; do not use glucocorticoid as primary therapy for unilateral adenoma amenable to laparoscopic adrenalectomy; do not neglect to add an MR antagonist when BP remains elevated despite maximal glucocorticoid; do not initiate in pregnancy without obstetric review; do not rely on glucocorticoid alone if BP remains above target after dose escalation.## Concrete Clinical ExampleA 12‑year‑old boy presents with hypertension (150/95 mmHg), hypokalemia (K+ 3.0 mmol/L), suppressed PRA, elevated PAC, and genetic testing confirming a CYP11B1/CYP11B2 chimera. Start prednisone 2.5 mg nightly; after 2 weeks BP is 138/88 mmHg and K+ 3.6 mmol/L. Continue prednisone 2.5 mg nightly; no MR antagonist required.**Source:** The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, https://doi.org/10.1210/jc.2015-4061> **TODO:** consider adding scripts/calc.py for the esa-pa-gra-gluco-dosing calculator

Frequently asked questions