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概要と使いどころ

Recommends early delivery based on individualized risk assessment rather than expectant management for pregnant patients with preexisting diabetes mellitus (PDM). Consider when evaluating delivery timing in the presence of diabetes‑related complications, suboptimal glycemia, abnormal fetal growth, or maternal comorbidities that may increase perinatal risk beyond 38 weeks gestation.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

This skill guides postoperative management after Cushing's syndrome surgery by classifying patients into hypocortisolism, hypercortisolism, or eucortisolism based on serum cortisol levels. Use when postoperative cortisol is <5 µg/dL (hypocortisolism), >20 µg/dL (hypercortisolism), or 5-20 µg/dL (eucortisolism) to direct glucocorticoid replacement, further treatment, or monitoring.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

This skill recommends against initiating cortisol-lowering treatment when there is no established diagnosis of Cushing's syndrome. It is triggered when a clinician considers treating suspected CS based only on borderline biochemical abnormalities or nonspecific signs without confirmatory testing; examples include "suspected CS", "borderline UFC", "no confirmed diagnosis", "consider empiric ketoconazole".

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

This skill categorizes hypercalcemia of malignancy (HCM) severity using albumin‑adjusted serum calcium into mild (<12 mg/dL), moderate (12‑14 mg/dL), or severe (>14 mg/dL). Use it when a clinician needs to stage HCM to guide initial therapy choices, such as deciding between observation, IV bisphosphonate/denosumab, or calcitonin‑based combination regimens.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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).

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。

dromlakhani/MD2SKILL142026年10月5日 更新

Determines the appropriate zoledronic acid dose (3‑4 mg IV) and infusion duration based on renal function. Triggered when a clinician prepares to prescribe zoledronic acid for hypercalcemia of malignancy and asks about renal‑adjusted administration.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

Guides selection of the optimal confirmatory test (CCT, SIT, FUT, OSLT) for primary aldosteronism based on patient safety and feasibility. Triggers include when a clinician asks “Which confirmatory test should I use?” or evaluates patient comorbidities before testing.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

Guides choice among spironolactone, eplerenone, and esaxerenone for primary aldosteronism based on comparative efficacy, safety, and patient-specific factors. Triggers include when initiating MRA therapy and asking 'Which MRA should I prescribe?' or considering switching agents due to adverse effects, cost, or need for potassium supplementation.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

Determines age- and body weight-appropriate glucocorticoid dosage for pediatric patients with primary aldosteronism, particularly glucocorticoid-remediable aldosteronism (GRA), to avoid over-treatment. Use when prescribing glucocorticoids to children with confirmed or suspected PA; triggers include pediatric PA, GRA, or need to dose glucocorticoid based on age and weight.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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".

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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".

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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'.

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。

dromlakhani/MD2SKILL142026年10月5日 更新

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).

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。

dromlakhani/MD2SKILL142026年10月5日 更新