How do I install the Ppgl Pediatric Investigation Trigger skill?

Run npx skillmds@latest add dromlakhani/ppgl-pediatric-investigation-trigger 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 Ppgl Pediatric Investigation Trigger 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 Ppgl Pediatric Investigation Trigger?

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 Ppgl Pediatric Investigation Trigger free to use?

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

Who published Ppgl Pediatric Investigation Trigger?

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

Ppgl Pediatric Investigation Trigger by dromlakhani

Name: Ppgl Pediatric Investigation Trigger
Rating: 4.2 (5 reviews)
Author: dromlakhani

Ppgl Pediatric Investigation Trigger

This skill identifies when to investigate pediatric pheochromocytoma and paraganglioma (PPGL) in children presenting with hypertension accompanied by symptoms such as headache, sweating, palpitations, or reduced growth rate. It triggers investigation when blood pressure measurement confirms hypertension in a child with any of these associated symptoms.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Pediatric PPGL Investigation Trigger

STEP 1 — Gather Information

Collect symptom history (headache, sweating, palpitations, reduced growth rate) and measure blood pressure using an appropriately sized cuff after 5 minutes of rest in a quiet setting.

STEP 2 — Rule In / Rule Out

Is the child's systolic and/or diastolic blood pressure ≥ the 95th percentile for age, sex, and height? If yes, rule in PPGL suspicion; if no, rule out PPGL as the primary cause and consider other etiologies.

STEP 3 — Classify or Stratify

Classify as suspected PPGL when hypertension is present alongside any of the hallmark symptoms (headache, sweating, palpitations, reduced growth rate). Ends with decision: proceed to biochemical testing.

STEP 4 — Decide

Order a first-line biochemical test: random urinary fractionated metanephrines corrected for creatinine (or plasma-free fractionated metanephrines if available). If the result is ≥3× the upper limit of normal, advance to confirmatory 24‑hour urine fractionated metanephrines/catecholamines and anatomical imaging (MRI abdomen/pelvis).

Clinical Guardrails / Mimics / Pitfalls

No pediatric reference values exist for PPGL biochemical tests; avoid applying adult cutoffs directly. Ensure proper BP technique (correct cuff size, resting state) to prevent white‑coat overestimation. Symptoms may be episodic; a single normal BP does not exclude PPGL if clinical suspicion remains high. Reduced growth rate is a subtle clue; do not overlook it. Do not delay investigation when hypertension is documented with suggestive symptoms.

Concrete Clinical Example

A 12‑year‑old girl presents with intermittent headaches and palpitations; office BP measures 138/86 mmHg (≥95th percentile for age). Random urine metanephrine/normetanephrine creatinine ratio is 4× the upper limit of normal. Proceed to 24‑hour urine collection and abdominal MRI.

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: ppgl-pediatric-investigation-triggerdescription: This skill identifies when to investigate pediatric pheochromocytoma and paraganglioma (PPGL) in children presenting with hypertension accompanied by symptoms such as headache, sweating, palpitations, or reduced growth rate. It triggers investigation when blood pressure measurement confirms hypertension in a child with any of these associated symptoms.---# Pediatric PPGL Investigation Trigger## STEP 1 — Gather InformationCollect symptom history (headache, sweating, palpitations, reduced growth rate) and measure blood pressure using an appropriately sized cuff after 5 minutes of rest in a quiet setting.## STEP 2 — Rule In / Rule OutIs the child's systolic and/or diastolic blood pressure ≥ the 95th percentile for age, sex, and height? If yes, rule in PPGL suspicion; if no, rule out PPGL as the primary cause and consider other etiologies.## STEP 3 — Classify or StratifyClassify as suspected PPGL when hypertension is present alongside any of the hallmark symptoms (headache, sweating, palpitations, reduced growth rate). Ends with decision: proceed to biochemical testing.## STEP 4 — DecideOrder a first-line biochemical test: random urinary fractionated metanephrines corrected for creatinine (or plasma-free fractionated metanephrines if available). If the result is ≥3× the upper limit of normal, advance to confirmatory 24‑hour urine fractionated metanephrines/catecholamines and anatomical imaging (MRI abdomen/pelvis).## Clinical Guardrails / Mimics / PitfallsNo pediatric reference values exist for PPGL biochemical tests; avoid applying adult cutoffs directly. Ensure proper BP technique (correct cuff size, resting state) to prevent white‑coat overestimation. Symptoms may be episodic; a single normal BP does not exclude PPGL if clinical suspicion remains high. Reduced growth rate is a subtle clue; do not overlook it. Do not delay investigation when hypertension is documented with suggestive symptoms.## Concrete Clinical ExampleA 12‑year‑old girl presents with intermittent headaches and palpitations; office BP measures 138/86 mmHg (≥95th percentile for age). Random urine metanephrine/normetanephrine creatinine ratio is 4× the upper limit of normal. Proceed to 24‑hour urine collection and abdominal MRI.**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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