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Confirms patient understands that continuous glucose monitoring complements but does not replace self-monitoring of blood glucose. Triggers include: 'Clarify CGM role alongside fingersticks', 'Ensure patient knows CGM does not eliminate need for SMBG'.

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This skill evaluates infusion site health and rotates sites appropriately to prevent lipohypertrophy or infection. It is triggered when clinicians inspect pump sites for irritation or lumps or review site rotation practice at visit.

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Guidance for clinicians managing pregnant individuals with preexisting diabetes mellitus (PDM) who are evaluating daily carbohydrate intake; consider a carbohydrate-restricted diet (<175 g/day) or usual diet (>175 g/day) based on patient factors. Trigger when assessing nutrition in pregnancy for PDM, especially when discussing glycemic targets, weight gain, or fetal growth concerns.

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This skill recommends obtaining serum free T4 and prolactin levels within 1–2 weeks after transsphenoidal surgery (TSS) for Cushing's syndrome to screen for overt hypopituitarism. Use in postoperative Cushing's syndrome patients during the early recovery window when evaluating for new pituitary hormone deficiencies.

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This skill recommends re-evaluating the need for treatment of other pituitary hormone deficiencies in the postoperative period following surgical intervention for Cushing's syndrome. It is triggered when assessing a post-op CS patient for ongoing pituitary function, evaluating for hypopituitarism, or checking HPA axis recovery with morning cortisol/ACTH stimulation tests and pituitary MRI within 1–3 months.

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This skill recommends obtaining a postoperative pituitary MRI within 1–3 months after successful transsphenoidal surgery (TSS) to establish a new baseline for future recurrence assessment. Use when a Cushing’s syndrome patient has achieved biochemical remission post‑TSS and is entering routine follow‑up.

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This skill recommends localizing and resecting ectopic ACTH-secreting tumors with node dissection when ectopic ACTH secretion is suspected or confirmed. Clinical triggers include unexplained persistent hypercortisolism after pituitary surgery, elevated ACTH with negative pituitary MRI, or identification of occult ectopic ACTH syndrome (EAS) on biochemical testing.

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This skill recommends measuring serum cortisol or urine free cortisol off-medication at 6- to 12-month intervals to assess radiation therapy effect in patients with Cushing's syndrome undergoing or post-radiotherapy. It is also indicated when patients on stable medical therapy develop new adrenal insufficiency symptoms such as fatigue, weight loss, or hypotension.

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Work up Malignancy-Associated Hypercalcemia (MAH) — distinguish humoral hypercalcemia of malignancy (HHM, PTHrP-driven), local osteolytic hypercalcemia, 1,25(OH)2D-mediated lymphoma hypercalcemia, ectopic PTH secretion, and multiple myeloma — and pick the right confirmatory tests and therapy direction. Trigger when a clinician asks "is this hypercalcemia from cancer", "PTHrP positive what now", "hypercalcemia in lung cancer / breast cancer / lymphoma / myeloma", "humoral hypercalcemia of malignancy", "MAH workup", or any hypercalcemia case with suppressed PTH and a known or suspected malignancy.

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This skill recommends unilateral resection by an experienced adrenal surgeon for all cases of benign unilateral disease causing Cushing's syndrome. Trigger when a CS patient has a unilateral adrenal lesion confirmed benign via imaging and biochemical assessment.

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Suggests considering mineralocorticoid receptor antagonists when benefits outweigh risks in pregnant or preconception PA patients with uncontrolled hypertension and hypokalemia. Triggered when standard therapy fails and clinicians ask 'Should I consider MRAs despite pregnancy?' or when assessing risk‑benefit of MRA use.

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Computes albumin‑adjusted (corrected) serum calcium using total calcium and albumin to adjust for hypo‑ or hyperalbuminemia. Triggered when a clinician notes hypoalbuminemia and requests corrected calcium to assess true hypercalcemia of malignancy severity.

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Advises evaluating creatinine clearance or estimated glomerular filtration rate prior to intravenous bisphosphonate administration to guide dosing and ensure safety. Triggered when a clinician is planning to give zoledronic acid or pamidronate and asks about renal safety checks.

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Identifies young patients with classic primary aldosteronism features who may proceed directly to unilateral adrenalectomy without adrenal venous sampling based on high probability of unilateral disease. Triggered when a clinician sees a patient <35 years with hypokalemia, unilateral adrenal tumor on CT, and high plasma aldosterone concentration and asks whether AVS can be bypassed.

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Establishes age- and gender-specific blood pressure goals for pediatric patients with primary aldosteronism (PA) using published normative data to assess treatment adequacy and avoid over-treatment. Use when managing hypertension in children with PA to evaluate if BP is adequately controlled; triggers include pediatric PA hypertension, BP not normalized with glucocorticoid therapy, and need for age‑specific BP targets.

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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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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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Interprets the saline infusion test (SIT) to assess the probability of primary aldosteronism when a patient has a positive aldosterone-to-renin ratio (ARR) and requires confirmatory testing. Triggers include evaluating post‑infusion plasma aldosterone concentration (PAC) after a positive ARR, hypertension work‑up, or when deciding whether to proceed to adrenal venous sampling (AVS).

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In patients with primary aldosteronism receiving mineralocorticoid receptor antagonist therapy, the guideline recommends titrating the MRA dose upward to raise renin when blood pressure remains uncontrolled and renin is suppressed. Consider this step when hypertension is not at goal despite MRA therapy and plasma renin activity (or direct renin concentration) is low.

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This skill recommends simultaneous measurement of plasma renin and aldosterone in patients with primary adrenal insufficiency (PAI) to determine the presence of mineralocorticoid deficiency. It is triggered when assessing for mineralocorticoid deficiency in PAI, such as in patients with unexplained hyponatremia, hyperkalemia, or salt craving despite glucocorticoid replacement.

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Suggests that pregnant patients with primary adrenal insufficiency be monitored for clinical signs of glucocorticoid over- or under-replacement such as normal weight or gain, fatigue, postural hypotension or hypertension, and hyperglycemia, with at least one review each trimester. Use when managing a pregnant patient with PAI to assess glucocorticoid dosing adequacy.

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This skill outlines monitoring glucocorticoid replacement in children with primary adrenal insufficiency (PAI) using clinical assessment of growth velocity, weight, blood pressure, and energy levels. Trigger when evaluating a child with PAI for adequacy of glucocorticoid therapy during routine follow-up.

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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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Work a primary-prevention patient through the 2026 ACC/AHA multisociety dyslipidaemia guideline CPR framework — Calculate (10-year and 30-year PREVENT-ASCVD), Classify (low / borderline / intermediate / high), Personalize (demographic, clinical, biomarker, and reproductive risk enhancers), and Reclassify (coronary artery calcium scoring where appropriate). Use when a clinician asks how to assess ASCVD risk for primary prevention, who needs a statin, borderline risk patient what to do, intermediate risk should I start a statin, risk enhancers to look for, premature family history of ASCVD how does it change risk, pregnancy-related risk factors, PCOS and cardiovascular risk. Grounded in the 2026 ACC/AHA multisociety dyslipidaemia guideline.

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。