How do I install the Ppgl Postoperative Follow Up Timing skill?

Run npx skillmds@latest add dromlakhani/ppgl-postoperative-follow-up-timing 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 Ppgl Postoperative Follow Up Timing free to use?

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Who published Ppgl Postoperative Follow Up Timing?

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

Ppgl Postoperative Follow Up Timing by dromlakhani

Name: Ppgl Postoperative Follow Up Timing
Rating: 4.5 (4 reviews)
Author: dromlakhani

Ppgl Postoperative Follow Up Timing

This skill initiates postoperative follow-up timing for pheochromocytoma and paraganglioma (PPGL) after surgical resection based on biochemical and imaging protocols. It is triggered by events such as the patient completing PPGL surgical resection, entering the post-op period requiring surveillance initiation, or needing to establish a postoperative monitoring timeline.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Postoperative PPGL Follow-Up Timing Initiation

STEP 1 — Gather Information

Collect tumor type (PCC or PGL), tumor size (cm), patient age, preoperative catecholamine status (noradrenaline dominance), hereditary/familial history, and genetic test results for pathogenic variants (e.g., SDHB, VHL, RET).

STEP 2 — Rule In / Rule Out

First binary fork: Is the patient at high risk for recurrence/metastasis? High risk if any of: hereditary PPGL, young age (e.g., <40 years), tumor diameter ≥5 cm, PGL (extra-adrenal location), noradrenaline dominance, or positive pathogenic gene variant. If NO to all risk factors → not high risk (proceed to low-risk pathway). If YES to any risk factor → high risk (proceed to high-risk pathway).

STEP 3 — Classify or Stratify

If high risk: classify as requiring lifelong biochemical and imaging surveillance. If not high risk: classify as requiring minimum 10-year biochemical and imaging surveillance.

STEP 4 — Decide

If lifelong follow-up: Obtain urine/blood metanephrines/catecholamines at 2-6 weeks post-op, then repeat every 6-12 months indefinitely. Perform CT/MRI at 6 months post-op only if 2-6 week biochemical tests are abnormal; repeat imaging every 6-12 months or as indicated by biochemical changes or symptoms. If minimum 10-year follow-up: Obtain urine/blood metanephrines/catecholamines at 2-6 weeks post-op, then at 6 months, and annually for 10 years. Perform CT/MRI at 6 months post-op only if 2-6 week biochemical tests are abnormal; repeat imaging every 1-2 years or as indicated.

Clinical Guardrails / Mimics / Pitfalls

Do not omit the 2-6 week postoperative biochemical test even in biochemically silent preoperatively tumors, as postoperative catecholamine surges can occur. Avoid relying solely on imaging for surveillance without concurrent biochemical testing, as metastases may be biochemically silent. Do not extend surveillance intervals beyond 12 months for biochemical tests in high-risk patients without evidence of sustained remission. Never discontinue follow-up before 10 years in sporadic PPGL without high-risk features, as late recurrences have been documented.

Concrete Clinical Example

A 52-year-old woman with a 4 cm adrenal PCC (no preoperative catecholamine elevation) underwent resection. Step 1: Tumor size 4 cm (<5 cm), PCC (not PGL), age >40, no hereditary history, no genetic variants, no noradrenaline dominance → no high-risk factors. Step 2: Not high risk. Step 3: Classified for minimum 10-year follow-up. Step 4: Urine metanephrines at 4 weeks post-op (normal), then at 6 months (normal), and annually. CT abdomen/pelvis at 6 months post-op was not performed due to normal 4-week biochemistry; next imaging at 2 years if biochemistry remains normal.

Source: Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, 10.1507/endocrj.EJ25-0165

TODO: consider adding scripts/calc.py for the ppgl-postoperative-follow-up-timing calculator

---name: ppgl-postoperative-follow-up-timingdescription: This skill initiates postoperative follow-up timing for pheochromocytoma and paraganglioma (PPGL) after surgical resection based on biochemical and imaging protocols. It is triggered by events such as the patient completing PPGL surgical resection, entering the post-op period requiring surveillance initiation, or needing to establish a postoperative monitoring timeline.---# Postoperative PPGL Follow-Up Timing Initiation## STEP 1 — Gather InformationCollect tumor type (PCC or PGL), tumor size (cm), patient age, preoperative catecholamine status (noradrenaline dominance), hereditary/familial history, and genetic test results for pathogenic variants (e.g., SDHB, VHL, RET).## STEP 2 — Rule In / Rule OutFirst binary fork: Is the patient at high risk for recurrence/metastasis? High risk if any of: hereditary PPGL, young age (e.g., <40 years), tumor diameter ≥5 cm, PGL (extra-adrenal location), noradrenaline dominance, or positive pathogenic gene variant. If NO to all risk factors → not high risk (proceed to low-risk pathway). If YES to any risk factor → high risk (proceed to high-risk pathway).## STEP 3 — Classify or StratifyIf high risk: classify as requiring lifelong biochemical and imaging surveillance. If not high risk: classify as requiring minimum 10-year biochemical and imaging surveillance.## STEP 4 — DecideIf lifelong follow-up: Obtain urine/blood metanephrines/catecholamines at 2-6 weeks post-op, then repeat every 6-12 months indefinitely. Perform CT/MRI at 6 months post-op only if 2-6 week biochemical tests are abnormal; repeat imaging every 6-12 months or as indicated by biochemical changes or symptoms.If minimum 10-year follow-up: Obtain urine/blood metanephrines/catecholamines at 2-6 weeks post-op, then at 6 months, and annually for 10 years. Perform CT/MRI at 6 months post-op only if 2-6 week biochemical tests are abnormal; repeat imaging every 1-2 years or as indicated.## Clinical Guardrails / Mimics / PitfallsDo not omit the 2-6 week postoperative biochemical test even in biochemically silent preoperatively tumors, as postoperative catecholamine surges can occur. Avoid relying solely on imaging for surveillance without concurrent biochemical testing, as metastases may be biochemically silent. Do not extend surveillance intervals beyond 12 months for biochemical tests in high-risk patients without evidence of sustained remission. Never discontinue follow-up before 10 years in sporadic PPGL without high-risk features, as late recurrences have been documented.## Concrete Clinical ExampleA 52-year-old woman with a 4 cm adrenal PCC (no preoperative catecholamine elevation) underwent resection. Step 1: Tumor size 4 cm (<5 cm), PCC (not PGL), age >40, no hereditary history, no genetic variants, no noradrenaline dominance → no high-risk factors.Step 2: Not high risk.Step 3: Classified for minimum 10-year follow-up.Step 4: Urine metanephrines at 4 weeks post-op (normal), then at 6 months (normal), and annually. CT abdomen/pelvis at 6 months post-op was not performed due to normal 4-week biochemistry; next imaging at 2 years if biochemistry remains normal.**Source:** Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, 10.1507/endocrj.EJ25-0165> **TODO:** consider adding scripts/calc.py for the ppgl-postoperative-follow-up-timing calculator

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