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概要と使いどころ
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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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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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 perform adrenal venous sampling (AVS) to lateralize aldosterone excess in patients with confirmed primary aldosteronism (PA) who are being evaluated for surgical treatment. Indicated when surgery is feasible and desired by the patient, or when subtype workup is planned for a surgical candidate, especially in those younger than 35 years with spontaneous hypokalemia, marked aldosterone excess, and unilateral adrenal lesions on CT.
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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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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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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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Recommends measurement of plasma ACTH to establish primary adrenal insufficiency (PAI) diagnosis in patients with confirmed cortisol deficiency; a plasma ACTH concentration ≥2-fold the upper limit of the reference range supports PAI. Use when evaluating plasma ACTH in a patient with low morning cortisol or abnormal corticotropin stimulation test.
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Report the health of the central system spec at `docs/system/` across seven checks — coverage gaps, stale elements, dangling anchors, duplicate anchors, orphan shards, unillustrated elements, and shards missing their kind annotation. Report-first and read-only: it repairs nothing until a human confirms a specific item. Use when the corpus has drifted, after a merge that touched `docs/system/`, or from `/archive` Step 5.5 in report-only mode. Requires `memory.architecture_map.enabled`.
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PM-mode brainstorm helper. Captures the requirement via Socratic dialogue before any entry phase (`/intake`, `/spec`, `/tdd`) drafts its artifact. Stage 0 skip-check, Stage 1 gap-analysis, Stage 2 probe-loop, Stage 3 confirm-and-persist. Output lives at `docs/brief/<slug>.md`. Never proposes solutions — Stage 2 dialogue discipline is structurally enforced via `discipline.mjs`.
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Propose the next dependency-ready sprint from the ALREADY-DECOMPOSED roadmap — standup's active sibling. Reads docs/roadmap-execution-plan.md + the memory backlog, computes per-task readiness from the roadmap's machine-readable status, orders with roadmap-planner's graph engine, and emits a proposed task-set (sprint-plan manifest shape) with per-feature done-criteria, excluding unready tasks and naming their unmet prerequisite. PROPOSES ONLY — the human confirms/edits before /triage routes it (typically to the `power` track). Distinct from `sprint-plan`, which decomposes a fresh vision.
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Bootstrap the central system spec at `docs/system/` for a repository that has never had one. Scans the governed surface, proposes a concept map clustered by directory, and materializes elements + shards ONLY after a human confirms that map. Use when adopting the baseline on an existing project, or when the corpus needs re-deriving from scratch. Re-runnable. Requires `memory.architecture_map.enabled` and a declared `governed_surface`.
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Senior embedded software engineer specializing in firmware and driver development for ARM Cortex-M microcontrollers (Teensy, STM32, nRF52, SAMD).
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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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Use when about to claim work is complete, fixed, or passing, before committing or creating PRs - requires running verification commands and confirming output before making any success claims; evidence before assertions always
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Generate guided Chinese software copyright application materials from a real project. Use this skill when the user asks for 软件著作权, 软著申请资料, 软著代码材料, 操作手册, 申请表信息, or wants Word/TXT materials for software copyright registration. The workflow analyzes the imported project, extracts real source code, creates Markdown drafts for user confirmation, then uses bundled DOCX tooling to produce final Word documents and TXT.
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Finalize an implemented rolling-wave slice for user review. Use when the user wants Codex to review the current branch state against a ready-for-review or in-review slice contract, confirm and fix required findings, repeat review and verification until no required findings remain, ask before accepting findings that materially change project shape or contradict project assumptions, record review state, and leave the clean slice in review for complete-slice.
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Merge the current branch's PR after confirmation
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Govern discovery, eligibility, and submission of a plugin or skill to official directories, registries, marketplaces, and curated GitHub lists. Use when preparing or sending plugin listings, marketplace forms, directory PRs, or repository recommendations; require current policy evidence and a final human confirmation before every external submission.
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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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GitHub Pull Request creation specialist. Analyzes user requirements to create PRs with structured titles and bodies matching the user's query language. Handles git change analysis, PR draft creation, user confirmation, and final PR creation via gh CLI.
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Use to iterate a change until tests/quality checks pass — bounded run→revise→re-run gated by a numeric threshold, then a judge confirms. Triggers 'iterate to green', 'keep fixing until tests pass'.
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Use when the feature is implementation-complete and the next step is 'ship it' — verifies, cleans up, routes to merge/PR/park/discard; never destroys work without explicit confirmation.
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Turn a confirmed brand identity into a DTCG .tokens.json source of truth — emit CSS vars + Tailwind via design-tokens, export locked brand deck templates.
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