「renal」の検索結果

This skill recommends glucocorticoid replacement and patient education for hypocortisolemic patients after surgical remission of Cushing's syndrome. Use when a postoperative Cushing's patient exhibits low cortisol (e.g., morning cortisol <5 µg/dL) or symptoms of adrenal insufficiency.

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This skill recommends follow-up morning cortisol and/or ACTH stimulation tests or insulin-induced hypoglycemia to assess HPA axis recovery in postoperative Cushing's syndrome patients with at least one intact adrenal gland. Triggers include postoperative remission (morning cortisol <5 µg/dL or UFC <28–56 nmol/d) and the need to evaluate HPA recovery before glucocorticoid discontinuation.

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Recommends checking and managing vitamin D according to Endocrine Society guidelines to avoid hypocalcemia in patients receiving bisphosphonates or denosumab for hypercalcemia of malignancy. Use when a clinician notes risk factors for hypocalcemia (e.g., low 25‑OH vitamin D, renal insufficiency) and asks about baseline labs before antiresorptive start.

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Determines the appropriate IV pamidronate dose (60‑90 mg) and infusion duration (2‑24 h) for adults with hypercalcemia of malignancy based on renal function. Triggered when a clinician orders pamidronate and asks how to adjust for kidney dysfunction (eGFR < 60 mL/min/1.73 m²).

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Determines whether to recommend adrenalectomy or mineralocorticoid receptor antagonists for primary aldosteronism based on PA subtype and patient/surgical factors. Triggered after subtype confirmation when clinicians ask “Should this patient have surgery or medical treatment?” or discuss treatment options with the patient.

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Recommends antihypertensive therapy including mineralocorticoid receptor antagonists (MRAs) for patients with a positive primary aldosteronism (PA) screening test who decline confirmatory testing. Triggers include when a patient has positive screening but refuses additional tests and asks "What should I treat with?" or initiates empiric therapy, with preference for MRAs in typical PA presentations (e.g., spontaneous hypokalemia, resistant hypertension, adrenal tumor on CT).

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Determines whether a hypertensive patient should be screened for primary aldosteronism based on clinical features associated with higher PA prevalence. Triggered when a clinician asks 'Should I screen this hypertensive patient for PA?' or observes spontaneous hypokalemia, resistant hypertension, hypertension onset before age 40, adrenal tumor, young-onset stroke, or sleep apnea syndrome.

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This skill provides criteria to distinguish unilateral from bilateral primary aldosteronism using adrenal venous sampling results, including lateralization index, contralateral ratio, and clinical factors. It is triggered after AVS when clinicians analyze results and ask 'Is this unilateral or bilateral PA?' or need to guide treatment decisions.

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Provides a checklist of five evidence-based measures to enhance the technical success of adrenal venous sampling procedures. Triggers include when preparing for AVS and asking 'How can I maximize success rate?' or troubleshooting failed attempts.

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Provides evidence-based guidelines for preoperative optimization and postoperative monitoring in patients with primary aldosteronism undergoing adrenalectomy. Triggers include when planning surgery or starting treatment and asking 'What perioperative care is needed?' or managing complications such as resistant hypertension, hypokalemia, or suspected cortisol co-secretion.

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Determines when adrenal venous sampling (AVS) is indicated for functional subtyping of primary aldosteronism (PA) when surgical treatment is feasible and desired by the patient. Triggered when a clinician confirms PA diagnosis and asks 'Do I need AVS for subtyping?' or evaluates surgical candidacy.

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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.

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Recommends initiating glucocorticoid therapy in all patients with confirmed primary adrenal insufficiency (PAI). Use when PAI diagnosis is confirmed by subnormal cortisol response to ACTH stimulation test or elevated ACTH with low cortisol.

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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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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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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 reducing the fludrocortisone dose in patients who develop new-onset hypertension while on fludrocortisone replacement for primary adrenal insufficiency. Consider dose reduction when hypertension arises alongside signs of mineralocorticoid excess such as edema, weight gain, or hypokalemia.

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Suggests using morning cortisol ≤140 nmol/L (5 µg/dL) in combination with ACTH as a preliminary test suggestive of primary adrenal insufficiency when a corticotropin stimulation test is not feasible. Use when patients present with indicative symptoms such as hypotension, hyponatremia, hyperkalemia, or fatigue and corticotropin stimulation testing cannot be performed.

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In pregnant women with primary adrenal insufficiency (PAI), the guideline suggests using hydrocortisone over cortisone acetate, prednisolone, or prednisone for glucocorticoid replacement. It recommends against dexamethasone due to its lack of placental inactivation, which can expose the fetus to excess glucocorticoid exposure.

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Suggests using prednisolone 3–5 mg/d orally once or twice daily as a glucocorticoid alternative in primary adrenal insufficiency. Consider this option when evaluating glucocorticoid therapy, particularly in patients with reduced medication compliance.

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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.

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Recommends fludrocortisone 100 µg daily for children with primary adrenal insufficiency and confirmed aldosterone deficiency; for infants under 12 months, adds sodium chloride supplementation. Triggered by PAI with aldosterone deficiency, evidenced by salt craving, hyponatremia, hyperkalemia, or elevated renin with low aldosterone.

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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.

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。