菜单
This skill suggests using denosumab rather than an intravenous bisphosphonate for adults with hypercalcemia of malignancy. It is triggered when a clinician questions which antiresorptive to choose first or seeks guidance on drug selection for HCM.
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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 | es-hcm-prefer-dmab-over-bp |
| description | This skill suggests using denosumab rather than an intravenous bisphosphonate for adults with hypercalcemia of malignancy. It is triggered when a clinician questions which antiresorptive to choose first or seeks guidance on drug selection for HCM. |
Confirm hypercalcemia of malignancy (elevated serum calcium with malignancy history). Collect serum calcium, albumin-adjusted calcium, renal function (eGFR, creatinine), vitamin D level, prior antiresorptive exposure, and assess for symptoms severity.
Rule out severe hypercalcemia (albumin-adjusted SCa >14 mg/dL) requiring initial combination therapy with calcitonin plus an antiresorptive. If severe, proceed to combination therapy per Recommendation 3; otherwise continue.
Assess for refractory/recurrent HCM after prior intravenous bisphosphonate. If refractory/recurrent, denosumab is still preferred per Recommendation 4. If not refractory, proceed to preference decision.
Choose denosumab (120 mg subcutaneously) over an intravenous bisphosphonate (e.g., zoledronic acid 4 mg or pamidronate 60–90 mg) as the initial antiresorptive for HCM.
Monitor serum calcium, phosphorus, magnesium, and renal function before and after denosumab; correct vitamin D deficiency and hypocalcemia prior to dosing. Avoid denosumab in patients with eGFR <30 mL/min without dose adjustment and close calcium monitoring. Do not delay antiresorptive therapy while awaiting oncology consultation; hydration remains first-line. Be aware of rare osteonecrosis of the jaw and atypical femoral fractures with long-term use.
A 58-year-old man with metastatic prostate cancer presents with fatigue and nausea; serum calcium 13.0 mg/dL (albumin-adjusted), eGFR 55 mL/min, vitamin D insufficient. He asks which antiresorptive to start. Following the skill, administer denosumab 120 mg subcutaneously, supplement vitamin D, recheck calcium in 48–72 hours, and continue monthly dosing.
Source: Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, DOI: 10.1210/clinem/dgac621