How do I install the Jes Pa Screening Positive Treatment skill?

Run npx skillmds@latest add dromlakhani/jes-pa-screening-positive-treatment 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 Jes Pa Screening Positive Treatment safe to use?

This skill has not completed SkillMD's automated safety review yet. 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 Jes Pa Screening Positive Treatment?

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 Jes Pa Screening Positive Treatment free to use?

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

Who published Jes Pa Screening Positive Treatment?

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

Jes Pa Screening Positive Treatment by dromlakhani

Name: Jes Pa Screening Positive Treatment
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Jes Pa Screening Positive Treatment

Recommends antihypertensive therapy including mineralocorticoid receptor antagonists (MRAs) for patients with a positive primary aldosteronism (PA) screening test who decline confirmatory testing. Triggers include when a patient has positive screening but refuses additional tests and asks "What should I treat with?" or initiates empiric therapy, with preference for MRAs in typical PA presentations (e.g., spontaneous hypokalemia, resistant hypertension, adrenal tumor on CT).

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Select antihypertensive treatment for PA-screen-positive patients avoiding further testing

STEP 1 — Gather Information

Confirm PA screening positivity: ARR ≥200 (PAC/PRA) or PAC/ARC ≥40 with PAC ≥60 pg/mL by CLEIA. Document patient refusal of confirmatory testing (e.g., adrenal venous sampling, saline infusion test). Assess for typical PA features: spontaneous hypokalemia (<3.5 mEq/L), resistant hypertension, hypertension onset <40 years, adrenal tumor on CT, young-onset stroke, or sleep apnea syndrome.

STEP 2 — Rule In / Rule Out

Is the patient refusing confirmatory testing?

Yes → Proceed to step 3 (empiric treatment pathway).
No → Recommend confirmatory testing per guideline (outside scope of this skill).

STEP 3 — Classify or Stratify

Do typical PA clinical features are present?

Yes → Classify as typical PA (strong indication for MRA).
No → Classify as atypical PA (weaker indication; MRAs still an option).

STEP 4 — Decide

If typical PA: Initiate MRA therapy (e.g., spironolactone 25–50 mg daily), monitor serum potassium and creatinine, titrate to blood pressure and potassium targets.
If atypical PA: Initiate antihypertensive therapy including an MRA as a first-line option (e.g., spironolactone 25 mg daily) or alternative agents based on comorbidities; monitor for efficacy and adverse effects.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on screening in atypical cases without considering confirmatory testing if feasible. Avoid MRAs in hyperkalemia (K+ >5.0 mmol/L) or severe renal impairment (eGFR <30 mL/min/1.73 m²). Do not combine eplerenone or esaxerenone with potassium supplements. Monitor for gynecomastia with spironolactone, especially in men. Do not delay definitive diagnosis if symptoms worsen or hypokalemia persists. MRAs may mask biochemical cure; consider surgical evaluation if patient reconsiders testing.

Concrete Clinical Example

A 58‑year‑old hypertensive patient with spontaneous hypokalemia (K+ 3.0 mEq/L) and a 1.2 cm adrenal nodule on CT has ARR 250 and PAC 80 pg/mL but refuses adrenal venous sampling. Typical PA features present → start spironolactone 25 mg daily, check K+ and creatinine in 1 week, up‑titrate to 50 mg daily if needed.

Source: Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021, Japan Endocrine Society, 2022, DOI: 10.1007/s00223-022-00903-0

---name: jes-pa-screening-positive-treatmentdescription: Recommends antihypertensive therapy including mineralocorticoid receptor antagonists (MRAs) for patients with a positive primary aldosteronism (PA) screening test who decline confirmatory testing. Triggers include when a patient has positive screening but refuses additional tests and asks "What should I treat with?" or initiates empiric therapy, with preference for MRAs in typical PA presentations (e.g., spontaneous hypokalemia, resistant hypertension, adrenal tumor on CT).---# Select antihypertensive treatment for PA-screen-positive patients avoiding further testing## STEP 1 — Gather InformationConfirm PA screening positivity: ARR ≥200 (PAC/PRA) or PAC/ARC ≥40 with PAC ≥60 pg/mL by CLEIA. Document patient refusal of confirmatory testing (e.g., adrenal venous sampling, saline infusion test). Assess for typical PA features: spontaneous hypokalemia (<3.5 mEq/L), resistant hypertension, hypertension onset <40 years, adrenal tumor on CT, young-onset stroke, or sleep apnea syndrome.## STEP 2 — Rule In / Rule OutIs the patient refusing confirmatory testing? - Yes → Proceed to step 3 (empiric treatment pathway). - No → Recommend confirmatory testing per guideline (outside scope of this skill).## STEP 3 — Classify or StratifyDo typical PA clinical features are present? - Yes → Classify as typical PA (strong indication for MRA). - No → Classify as atypical PA (weaker indication; MRAs still an option).## STEP 4 — DecideIf typical PA: Initiate MRA therapy (e.g., spironolactone 25–50 mg daily), monitor serum potassium and creatinine, titrate to blood pressure and potassium targets. If atypical PA: Initiate antihypertensive therapy including an MRA as a first-line option (e.g., spironolactone 25 mg daily) or alternative agents based on comorbidities; monitor for efficacy and adverse effects.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on screening in atypical cases without considering confirmatory testing if feasible. Avoid MRAs in hyperkalemia (K+ >5.0 mmol/L) or severe renal impairment (eGFR <30 mL/min/1.73 m²). Do not combine eplerenone or esaxerenone with potassium supplements. Monitor for gynecomastia with spironolactone, especially in men. Do not delay definitive diagnosis if symptoms worsen or hypokalemia persists. MRAs may mask biochemical cure; consider surgical evaluation if patient reconsiders testing.## Concrete Clinical ExampleA 58‑year‑old hypertensive patient with spontaneous hypokalemia (K+ 3.0 mEq/L) and a 1.2 cm adrenal nodule on CT has ARR 250 and PAC 80 pg/mL but refuses adrenal venous sampling. Typical PA features present → start spironolactone 25 mg daily, check K+ and creatinine in 1 week, up‑titrate to 50 mg daily if needed.**Source:** Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021, Japan Endocrine Society, 2022, DOI: 10.1007/s00223-022-00903-0

Frequently asked questions