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概要と使いどころ
Recommends initiating intravenous isotonic saline hydration as initial management for hypercalcemia of malignancy (HCM) while awaiting antiresorptive therapy, with fluid rate adjusted according to cardiac function. Triggered when a clinician encounters a patient with HCM (e.g., serum calcium >12 mg/dL, symptoms of hypercalcemia) and seeks immediate measures before specific drugs are available.
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Determines successful catheterization in adrenal venous sampling by applying selectivity index cut‑offs with and without ACTH stimulation. Triggered during AVS when measuring cortisol levels and asking “Is the catheter properly positioned?” or when reviewing results for technical adequacy.
日本語の概要は準備中です。原文の説明を表示しています。
Recommends performing a dexamethasone suppression test to evaluate for autonomous cortisol secretion in patients with primary aldosteronism and adrenal adenoma. Triggered when a clinician considers whether to perform a dexamethasone suppression test in a patient with PA and adrenal adenoma.
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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.
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Recommends immediate IV hydrocortisone stress dosing for patients with suspected adrenal crisis presenting with severe adrenal insufficiency symptoms such as hypotension, hyponatremia, hyperkalemia, or acute abdominal pain. Use when clinician observes signs of adrenal crisis (e.g., syncope, delirium, marked abdominal tenderness) prior to diagnostic test results.
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Suggests genetic counseling for patients with primary adrenal insufficiency (PAI) when a monogenic disorder is suspected. Use when PAI patient presents with early-onset disease, syndromic features, consanguinity, family history, or negative autoimmune antibodies.
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Recommends increasing hydrocortisone dose in pregnant patients with primary adrenal insufficiency based on individual clinical course, especially during the third trimester. Trigger phrases include "fatigue, postural hypotension, weight loss, or hyperglycemia in pregnant PAI patient" and "need for glucocorticoid dose adjustment in third trimester."
日本語の概要は準備中です。原文の説明を表示しています。
This skill outlines monitoring of mineralocorticoid replacement in primary adrenal insufficiency, focusing on clinical assessment of salt craving, postural hypotension, or edema alongside serum electrolyte measurements. It is initiated when evaluating patients on fludrocortisone therapy to ensure adequate dosing and avoid over- or under-replacement.
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Recommends initiating hydrocortisone replacement at a total starting dose of 8 mg/m2 body surface area per day, given in three or four divided doses, for children with confirmed primary adrenal insufficiency (PAI). Use when starting glucocorticoid therapy in pediatric PAI patients, adjusting the dose according to individual clinical response, growth, and need for stress coverage.
日本語の概要は準備中です。原文の説明を表示しています。
Recommends hydrocortisone stress dosing during the active phase of labor for pregnant patients with primary adrenal insufficiency, using a regimen similar to major surgical stress. Trigger phrases: "active phase of labor", "cervix dilation ≥4 cm", "contractions every 5 minutes", "PAI patient in labor".
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Recommends hydrocortisone replacement dosing of 15–20 mg total daily, administered as a single dose or divided doses with the highest dose given in the morning upon awakening and the second dose in the afternoon (two-dose regimen) or second and third doses at lunch and late afternoon (three-dose regimen). Use when initiating glucocorticoid replacement for adrenal insufficiency; triggers include diagnosing adrenal insufficiency requiring glucocorticoid replacement.
日本語の概要は準備中です。原文の説明を表示しています。
Administers immediate parenteral injection of 50–100 mg hydrocortisone for suspected adrenal crisis secondary to adrenal insufficiency. Triggers include hypotension, hypoglycemia, or acute illness in a patient with known adrenal insufficiency.
日本語の概要は準備中です。原文の説明を表示しています。
Suggests administering 25-75 mg hydrocortisone per 24 hours for 1-2 days in patients with adrenal insufficiency undergoing minor to moderate surgical stress. Triggers include patient undergoing minor to moderate surgery with known or suspected adrenal insufficiency.
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Administers 100-mg hydrocortisone IV bolus followed by continuous IV infusion of 200 mg HC per 24 hours (alternatively 50 mg IV every 6 hours) for patients undergoing major surgical stress. Use when managing patient with major surgical stress; triggers include patient undergoing major surgery.
日本語の概要は準備中です。原文の説明を表示しています。
Recommends using the lowest tolerable hydrocortisone dose to potentially decrease risks of metabolic and cardiovascular disease in central adrenal insufficiency. Triggers include managing a patient with central adrenal insufficiency requiring glucocorticoid replacement.
日本語の概要は準備中です。原文の説明を表示しています。
Recommends performing biochemical testing for HPA axis at least 18-24 hours after last hydrocortisone dose or longer for synthetic glucocorticoids. Use when scheduling HPA axis testing in glucocorticoid-treated patient needing assessment of adrenal reserve.
日本語の概要は準備中です。原文の説明を表示しています。
Suggests avoiding synthetic, long-acting glucocorticoids (e.g., prednisolone, dexamethasone) in children with primary adrenal insufficiency (PAI). Use when selecting glucocorticoid replacement for a child with PAI to prevent Cushingoid side effects and dose titration difficulties.
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Decide whether a kidney from a brain-dead deceased donor (DBD) with diabetes mellitus and/or hypertension is suitable for transplantation, using the ISOT 2025 Delphi consensus and Table 4 eligibility checklist. Trigger when a clinician asks "can I use a kidney from a diabetic deceased donor", "is this DBD with HTN/DM acceptable", "ECD donor with diabetes — accept or decline", "DBD eligibility for hypertensive donor", or shares a deceased donor with diabetes or hypertension and needs an accept/borderline/decline decision.
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Execute a swarm plan wave by wave with filesystem isolation via git worktrees. For each wave, main context decides the scenario recipe + implementation contract for every task, then spawns one swarm-worker per task in parallel. Each worker executes its recipe and reports JSON status. Worktree merge-audit verifies write-set discipline before changes land on main. Aborts remaining waves on any audit or task failure.
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Oracle-bound spec-review check that every structured Rollout prerequisite binds to an enforcement-type acceptance criterion. A prerequisite whose `enforced-by` is missing, dangling, or points at a non-enforcement AC is a BLOCKER (hard-blocks implementation entry via the checker fan-out verdict); a prerequisite left in free prose is ADVISORY. Read-only. Runs in the spec-review fan-out before implementation.
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Dev-only check that a drafted spec for THIS baseline repo won't ship dev-tree references to consumer installs. Catches three failure modes — shipped SKILL.md prose that references paths under `src/`, `tests/`, `scripts/`, `obj/` as runtime invocations (in ```bash fences``` OR `inline backticks`, plus shipped `.mjs`/`.js`/`.sh`/`.py` helper-file imports); new Python helpers added under `.claude/skills/<slug>/` (shipped helpers must be `.sh` or `.mjs`/`.js` going forward); and imports of modules that aren't in `obj/template/.claude/manifest.json` (consumer won't have the file). The aggregate scanner (`scan-shipped-skills.mjs`) walks only baseline-owned skill dirs (via `owner: baseline` frontmatter) at top level — `references/` and other subdirs are documentation, not runtime. BLOCKER findings hard-block implementation entry; ADVISORY surfaces but doesn't block. Read-only — surfaces a punch list; maintainer edits the spec and re-runs until CLEAN.
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Workflow Phase 2 — Codebase Scouting and Constraint Discovery. Maps the relevant slice of the codebase for a given task. Produces a scout report at `docs/scout/<slug>.md` naming the files, modules, and patterns the proposed work touches or constrains. Report decisions execute in main context with full conversation visibility; gathering MAY be delegated to read-only advisory subagents (seed.md §4.2-A).
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Workflow Phase 3 — Research and Solution Exploration. Surfaces 2–4 candidate solution approaches with concrete tradeoffs, grounded in current library docs (fetched through the provider named in `.claude/docs-provider.json`) — never in training-data recall. Output lives at `docs/research/<slug>.md`. Candidate ranking and the memo execute in main context; doc/source gathering MAY be delegated to read-only advisory subagents (seed.md §4.2-A).
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Use for SWOT analysis, or when the user wants to assess where a team, product or company stands: "strengths and weaknesses", "should we enter this market?", "review our position", "competitor comparison". Turns findings into actions. Skip for detailed planning or pure market sizing.
日本語の概要は準備中です。原文の説明を表示しています。