菜单
Determines if PAC/PRA ratio and PAC levels indicate positive or provisionally positive screening for primary aldosteronism. Triggered when a clinician has PAC and PRA results and asks “Is this screening test positive for PA?” or needs to interpret borderline results.
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
基于 SOC 职业分类
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| name | jes-pa-screening-arr-pra |
| description | Determines if PAC/PRA ratio and PAC levels indicate positive or provisionally positive screening for primary aldosteronism. Triggered when a clinician has PAC and PRA results and asks “Is this screening test positive for PA?” or needs to interpret borderline results. |
Collect plasma aldosterone concentration (PAC) in pg/mL and plasma renin activity (PRA) in ng/mL/h (or active renin concentration ARC in pg/mL/h). Ensure samples are drawn after overnight fasting, seated or supine, and that the patient is on medications that minimize interference (e.g., calcium channel blockers or alpha‑blockers; avoid beta‑blockers, ACEi/ARBs, diuretics if possible). Record units and note any interfering drugs.
Calculate ARR = PAC (pg/mL) ÷ PRA (ng/mL/h). If ARR ≥ 200 and PAC ≥ 60 pg/mL → screen positive. If ARR between 100–200 and PAC ≥ 60 pg/mL → provisionally positive. If using ARC, calculate ARR = PAC ÷ ARC; positive if ≥40 and PAC ≥60 pg/mL, provisionally positive if 20–40 and PAC ≥60 pg/mL. Otherwise screen negative.
Classify result as: Positive screening (ARR ≥200 or PAC/ARC ≥40 with PAC ≥60), Provisionally positive (ARR 100–200 or PAC/ARC 20–40 with PAC ≥60), or Negative (below these thresholds). Note that provisionally positive results require individualized next steps.
If screen positive → proceed to a confirmatory test (e.g., captopril challenge or saline infusion). If provisionally positive → individualize management: consider patient age, hypokalemia, adrenal tumor on CT, desire for further testing, and either proceed to confirmatory test or monitor. If screen negative → consider alternative causes of hypertension; remember that PA is not completely excluded by a negative screen.
Avoid false‑positive spikes from beta‑blockers (raise ARR) or false‑negative drops from diuretics (lower PAC). Low PRA (<0.5 ng/mL/h) can inflate ARR; verify renin measurement adequacy. ACE inhibitors, ARBs, and direct renin inhibitors may suppress renin and alter ARR; hold if possible. Ensure PAC assay is CLEIA‑based; if using RIA, apply conversion (≈0.65×). Do not rely solely on ARR without PAC ≥60 pg/mL cutoff.
A 58‑year‑old hypertensive patient has PAC 55 pg/mL and PRA 0.2 ng/mL/h. ARR = 55 ÷ 0.2 = 275, PAC <60 pg/mL → screen negative despite high ARR; advise repeat PAC after correcting for assay cutoff or consider clinical suspicion.
Source: Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021, Japan Endocrine Society, 2021
TODO: consider adding scripts/calc.py for the jes-pa-screening-arr-pra calculator