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Determines unilateral vs bilateral aldosterone excess based on cortisol-corrected aldosterone ratios from adrenal venous sampling, with ratio >4:1 indicating unilateral excess, ratio 3:1 suggestive of bilateral hypersecretion, and interpretation dependent on cosyntropin stimulation protocol used during sampling. Use when analyzing AVS results to guide surgical vs medical treatment decisions; triggers include 'AVS lateralization ratio', 'cosyntropin-stimulated AVS', 'aldosterone-to-cortisol ratio >4:1', and 'ratio 3:1 suggestive of bilateral disease'.

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Determines if primary aldosteronism is confirmed based on upright plasma aldosterone ≤6 ng/dL (170 nmol/L) on day 4 at 10 AM of fludrocortisone suppression test, provided plasma renin activity ≥1 ng/mL/h and plasma cortisol concentration lower than the 7 AM value to exclude ACTH confounding. Use when reviewing FST results to diagnose PA; triggers include "FST", "upright aldosterone ≤6 ng/dL", "PRA ≥1 ng/mL/h", and "cortisol drop".

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Helps distinguish unilateral from bilateral adrenal disease based on 18-oxocortisol levels, which are typically higher in aldosterone-producing adenoma than idiopathic adrenal hyperplasia. Use when evaluating 18-oxocortisol results during PA workup to guide subtype classification after a positive ARR.

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The Endocrine Society recommends a standard-dose corticotropin (ACTH) stimulation test to confirm primary adrenal insufficiency when clinical suspicion arises from symptoms such as hypotension, hyponatremia, hyperkalemia, or unexplained fatigue. Dosing is weight/age based: 250 µg for adults and children ≥2 years, 15 µg/kg for infants, and 125 µg for children <2 years.

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Determines whether to screen a patient with hypertension for primary aldosteronism based solely on the presence of hypertension. Use when a clinician asks whether to screen a hypertensive patient for PA, triggered by phrases such as "should we screen for aldosteronism" or "evaluate for secondary hypertension".

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Determines when to avoid aldosterone suppression testing in hypertensive patients with a positive PA screen who have normokalemia and suppressed aldosterone below assay‑specific cutoffs (<11 ng/dL immunoassay or <8 ng/dL LC‑MS/MS), indicating low likelihood of primary aldosteronism. Use when a clinician asks whether to skip confirmatory suppression testing based on low pretest probability.

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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."

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Differentiates aldosterone-producing adenoma from idiopathic adrenal hyperplasia based on 18-hydroxycorticosterone levels, with APA patients generally having levels >100 ng/dL at 8:00 a.m. and IAH patients usually having levels <100 ng/dL. Use when reviewing 18-OHB test results to help subtype PA; triggers include 18-OHB >100 ng/dL (suggesting APA) or <100 ng/dL (suggesting IAH).

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Suggests using hydrocortisone 15–25 mg or cortisone acetate 20–35 mg daily in two or three divided oral doses for adult primary adrenal insufficiency (PAI) patients initiating glucocorticoid replacement. The highest dose is given upon awakening, with the second dose either early afternoon (≈2 h after lunch) or split into lunch and afternoon doses; consider total daily dose calculation based on chosen formulation and frequency.

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The Endocrine Society guideline recommends against routine hormonal monitoring of glucocorticoid replacement in primary adrenal insufficiency and advises adjusting therapy solely based on clinical response. Use when evaluating glucocorticoid dose adequacy, such as when patients report fatigue, weight loss, hypotension, or signs of Cushingoid over-replacement.

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Recommends adjusting glucocorticoid doses on the day of surgery based on illness severity and magnitude of surgical stress. Triggers when managing a patient requiring surgery needing perioperative glucocorticoid management, such as "patient on HC for central AI undergoing major abdominal surgery" or "patient with hypopituitarism scheduled for minor procedure".

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Guide pre-endoscopy management decisions for patients on GLP-1 receptor agonists (semaglutide, tirzepatide, liraglutide etc.), deciding whether to proceed, delay, or modify the approach based on GI symptoms, fasting status, and indication. Trigger when a clinician asks about GLP-1 RA and endoscopy, semaglutide before colonoscopy, Ozempic before procedure, or whether to hold a GLP-1 agonist before endoscopy.

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Guide a non-stigmatising pediatric obesity consultation using the 5As framework (Ask, Assess, Advise, Agree, Assist) and 4Ms assessment (Metabolic, Mechanical, Mental Health, Social Milieu), based on the CMAJ 2025 guideline. Trigger when a clinician asks how to approach a weight conversation with a child or family, how to use the 5As for obesity, how to assess a child with obesity, or how to conduct a non-judgmental obesity visit.

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Remove signs of AI-generated writing from text. Use when editing or reviewing text to make it sound more natural and human-written. Based on Wikipedia's comprehensive "Signs of AI writing" guide. Detects and fixes patterns including: inflated symbolism, promotional language, superficial -ing analyses, vague attributions, em dash overuse, rule of three, AI vocabulary words, negative parallelisms, and excessive conjunctive phrases. Credits: Original skill by @blader - https://github.com/blader/humanizer

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Azure Identity SDK for Rust authentication. Use for DeveloperToolsCredential, ManagedIdentityCredential, ClientSecretCredential, and token-based authentication.

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Core UI/UX engineering skill for building highly interactive, spatial, weightless, and glassmorphism-based web interfaces using GSAP and 3D CSS.

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Diff a live page's accessibility violations against a baseline — by default compares uncommitted changes (stash-based), or pass --branch [<name>] to diff against a branch. Reports only new violations introduced, violations fixed, and pre-existing count. Use `scan` for a full audit with no diffing.

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Interact with Langfuse and access its documentation. Use when needing to (1) query or modify Langfuse data programmatically via the CLI — traces, prompts, datasets, scores, sessions, and any other API resource, (2) look up Langfuse documentation, concepts, integration guides, or SDK usage, or (3) understand how any Langfuse feature works. This skill covers CLI-based API access (via npx) and multiple documentation retrieval methods.

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Standalone browser-based visual companion for interactive mockups, diagrams, wireframes, layout comparisons, visual brainstorming, and clickable visual option selection.

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Run a Codex prompt repeatedly on a fixed interval. Use for "/loop", "run this every N minutes/hours", "poll X every 5 minutes", "repeat this Codex prompt", or any recurring interval-based Codex job. This is the interval-repeat companion to the separate `schedule` skill (cron / specific-time). For a durable, always-on alternative that survives reboots and terminal exits, prefer Codex app Automations; this local CLI is a terminal fallback that only fires while its daemon process is running.

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Use when a user wants a standalone browser-based visual companion for interactive mockups, diagrams, wireframes, layout comparisons, visual brainstorming, or clickable visual option selection. Starts a local zero-dependency Node server, writes HTML screens, and reads browser click events.

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Govern the SemVer release process — versioning discipline, tag-based GitHub releases, changelog hygiene, and the ADR that confirms the release strategy is agreed. Trigger when setting up a release process, before a first public release, or when release practice has become inconsistent. Owned by delivery-orchestrator.

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Design, implement, and evaluate risk-based software tests across unit, integration, contract, end-to-end, and regression layers. Use when adding tests, reproducing bugs, improving coverage, diagnosing flaky tests, or defining a test strategy; do not use to change production behavior unless the user also requests implementation.

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Verify like Fable 5 — obsessive, systematic, evidence-based quality assurance woven into your reasoning. Use this skill when you have just written or modified code, need to confirm something works, are running tests, or need to validate output against requirements.

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