Claude Skills by dromlakhani

Recommends measuring serum IGF-1 to exclude acromegaly in any patient discovered to have a pituitary mass on imaging. Triggers include incidental pituitary lesion found on MRI/CT for unrelated reasons.

Recommends measuring serum IGF-1 to screen for acromegaly in patients presenting with typical acral and facial manifestations such as enlarging ring or shoe size, macroglossia, or frontal bossing. Trigger phrases include “acral enlargement,” “facial coarsening,” “prognathism,” or “spade‑like hands” prompting IGF-1 measurement.

This skill suggests initiating either a somatostatin receptor ligand (SRL) or pegvisomant as adjuvant medical therapy in patients with moderate-to-severe signs and symptoms of GH excess and no local mass effects following transsphenoidal surgery. Clinical triggers include postoperative IGF-1 elevation, persistent acromegalic symptoms, or residual tumor without compressive mass effect.

This skill outlines monitoring of liver function tests (LFTs) during pegvisomant therapy for acromegaly. It recommends obtaining LFTs monthly for the first 6 months and then every 6 months, with consideration of discontinuing pegvisomant if transaminases exceed three times the upper limit of normal.

This skill recommends performing an imaging study to assess tumor size, appearance, and parasellar extent once biochemical diagnosis of acromegaly is confirmed. Trigger when IGF-1 is elevated and GH fails to suppress to <0.4 µg/L during an oral glucose tolerance test.

Measures serum IGF-1 and a random GH level at 12 weeks or later after transsphenoidal surgery for acromegaly to evaluate biochemical remission. Trigger phrases: “postoperative follow‑up at 12 weeks”, “assess remission after surgery”, “check IGF‑1 and random GH”.

Recommends performing an imaging study at least 12 weeks after transsphenoidal surgery for acromegaly to visualize residual tumor and adjacent structures, with MRI as the preferred modality. Use this skill when assessing surgical outcomes once adequate postoperative healing has occurred.

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Suggests measuring a nadir GH level after an oral glucose load in patients with a postoperative random GH greater than 1 µg/L. Use to further evaluate GH suppression when baseline GH is elevated postoperatively.

This skill suggests preoperative somatostatin receptor ligand (SRL) therapy to reduce anesthetic risk in acromegaly patients with severe pharyngeal thickness, obstructive sleep apnea, or high-output heart failure. It is triggered when assessing preoperative risk before transsphenoidal surgery and phrases like "severe pharyngeal thickening", "sleep apnea syndrome", or "high-output heart failure" are identified.

Recommends transsphenoidal surgery as the primary therapeutic option for most patients with biochemically confirmed acromegaly. Consider this recommendation when evaluating a newly diagnosed patient with elevated IGF-1 and/or clinical features suggestive of GH excess (e.g., acral enlargement, facial changes) to determine initial management.

Suggests considering repeat surgery in patients with residual intrasellar disease after initial surgical resection. Consider when postoperative imaging demonstrates persistent intrasellar tumor.

Suggests radiation therapy for residual tumor mass after surgery when medical therapy is unavailable, unsuccessful, or not tolerated. Trigger phrases include "residual tumor mass following surgery", "medical therapy unavailable", "medical therapy unsuccessful", "medical therapy not tolerated".

The skill advises maintaining the same GH and IGF-1 assay throughout a patient's management to ensure comparable serial measurements. Trigger when ordering serial hormone tests for acromegaly monitoring, such as before and after therapy changes or during routine follow-up.

This skill suggests serial MRI imaging to assess tumor size in patients receiving pegvisomant therapy for acromegaly. Use when initiating pegvisomant or during follow‑up to monitor for tumor growth.

Recommends serial visual field testing during pregnancy for patients with acromegaly who harbor a macroadenoma to monitor for neurologic deterioration. Trigger when a pregnant acromegaly patient has a known pituitary macroadenoma.

Recommends initiating a somatostatin receptor ligand (SRL) as primary medical therapy for acromegaly when curative surgery is not possible. Consider this approach in patients with extensive cavernous sinus invasion, absence of chiasmal compression, or those deemed poor surgical candidates.

Recommends stereotactic radiotherapy (SRT) over conventional radiotherapy for acromegaly when adjuvant radiation is indicated after surgery or failed medical therapy, unless SRT is unavailable, there is significant residual tumor burden, or the tumor’s proximity to the optic chiasm predicts an exposure exceeding 8 Gy. Trigger phrases include ‘residual tumor mass’, ‘SRT not available’, ‘optic chiasm dose >8 Gy’.

This skill suggests surgical debulking for parasellar disease when total resection is unlikely due to extensive extrasellar extension seen on imaging, aiming to improve subsequent response to medical therapy. Trigger phrases include parasellar disease, extensive extrasellar extension, and non-curative resection on MRI/CT.

Suggests a biochemical treatment goal of age-normalized serum IGF-1 value to indicate disease control in acromegaly. Use when setting therapeutic targets after initiating medical therapy or surgery, e.g., post-op IGF-1 at 12 weeks or random GH >1 µg/L.

Suggests using a random GH level <1.0 µg/L as a therapeutic goal to assess biochemical control of acromegaly during follow‑up after surgery or medical therapy. Use when evaluating post‑treatment response, particularly when random GH is measured alongside IGF‑1 to determine if disease is controlled.

Suggests a trial of a dopamine agonist, usually cabergoline, as initial adjuvant therapy in patients with only modest IGF-1 elevations and mild GH excess symptoms after surgery. Use when postoperative IGF-1 is mildly elevated and symptoms of GH excess are mild.

Recommend performing abdominal ultrasound when a patient on somatostatin receptor ligand (SRL) therapy develops signs or symptoms suggestive of gallstone disease. Trigger phrases include biliary colic, postprandial right upper quadrant pain, Murphy's sign, or suspected cholecystitis.

Recommends utilizing short-acting octreotide subcutaneous injections for disease control while awaiting conception after discontinuing long-acting somatostatin receptor ligands or pegvisomant. Trigger phrases include “preconception window,” “discontinuing long-acting SRL,” and “short-acting octreotide as needed until conception.”

Suggests performing formal visual field testing when imaging reveals tumor abutting the optic chiasm to evaluate for visual pathway compression. Trigger phrases include MRI or CT showing tumor-chiasm contact.

This skill determines the appropriate screening and dynamic testing procedures (e.g., insulin tolerance test, standard or high-dose ACTH stimulation) for diagnosing adrenocorticotropic hormone deficiency in childhood cancer survivors, recommending the same methods used in the noncancer population. Triggers include clinician questions such as “How should I test for ACTHD in this survivor?” or “What dynamic test is appropriate for adrenal insufficiency evaluation?”

This skill outlines the essential patient education points for childhood cancer survivors with adrenocorticotropic hormone deficiency (ACTHD), covering stress‑dose glucocorticoid instructions, emergency injectable glucocorticoid administration, and the need for medical alert identification and an emergency kit. It is triggered when a clinician asks, “What should I teach this patient about adrenal crisis management?” or “How do I prepare this survivor for potential adrenal insufficiency?”

This skill determines whether screening for adrenocorticotropic hormone deficiency (ACTHD) is indicated in childhood cancer survivors with hypothalamic‑pituitary axis radiation exposure between 24‑30 Gy. Screening is recommended when the survivor is >10 years post‑radiation or presents with clinical symptoms suggestive of adrenal insufficiency (e.g., fatigue, hypotension), triggered by questions such as “Should I screen for ACTHD in this survivor with 25 Gy radiation 12 years ago?” or “Does s...

This skill identifies childhood cancer survivors who require lifelong annual screening for adrenocorticotropic hormone deficiency (ACTHD) based on hypothalamic-pituitary tumor history or radiation exposure ≥30 Gy. It is triggered by clinician questions such as “Does this survivor need yearly ACTH/cortisol testing?” or “Is annual adrenal function screening indicated post‑HP radiation?”

This skill identifies the appropriate glucocorticoid replacement regimen for childhood cancer survivors with adrenocorticotropic hormone deficiency (ACTHD), recommending hydrocortisone dosing and stress coverage strategies identical to those used in the noncancer population. Triggers include clinician questions such as “What steroid dose should I use for ACTHD replacement?” or “How do I determine glucocorticoid therapy for adrenal insufficiency?”

This skill determines if formal diagnostic testing for growth hormone deficiency is required in childhood cancer survivors who already have three or more confirmed anterior pituitary hormone deficiencies, as retesting may not change management. Triggers include: "Do I need to test for GHD if the patient already has TSH, LH/FSH, and ACTH deficiencies?" or "Is formal GHD testing redundant with multiple pituitary deficits?"

This skill determines whether to use growth hormone-releasing hormone (GHRH) alone or with arginine for diagnosing growth hormone deficiency (GHD) after hypothalamic-pituitary axis radiation exposure. It addresses clinician questions such as "Is the GHRH-arginine test valid for GHD diagnosis after cranial radiation?" and "Should I avoid arginine stimulation testing in this post-radiation survivor?"

This skill determines whether serum insulin-like growth factor-1 (IGF-I) levels alone can be used to diagnose growth hormone deficiency (GHD) in childhood cancer survivors exposed to hypothalamic-pituitary axis radiotherapy. Triggers include questions such as “Can I rely on IGF-I alone to diagnose GHD after cranial radiation?” or “Is IGF-I sufficient for GHD assessment post-HP RT?”

This skill guides selection of an appropriate provocative test for growth hormone deficiency (GHD) diagnosis in childhood cancer survivors when clinicians ask, "What test should I use to diagnose GHD in this survivor?" or "Which provocative test is appropriate for GHD evaluation?" It recommends using the same testing modalities as in the noncancer population, tailored to patient-specific contraindications.

This skill identifies adult childhood cancer survivors with isolated growth hormone deficiency and prior hypothalamic‑pituitary axis radiation exposure who require retesting to confirm persistence of GHD. Triggers include clinician questions such as “Should I retest for GHD in this adult survivor with childhood GHD and radiation history?” or “Is repeat GHD evaluation indicated in this patient?”

This skill identifies childhood cancer survivors who require lifelong periodic assessment for growth hormone deficiency based on hypothalamic-pituitary tumor history or cranial/spinal radiation exposure ≥18 Gy. It is triggered by questions such as "Does this survivor need GHD screening?" or "Is this patient at risk for growth hormone deficiency post-radiation?"

This skill determines whether spontaneous growth hormone secretion sampling (e.g., 12-hour overnight) is appropriate for diagnosing growth hormone deficiency in childhood cancer survivors. It is triggered by clinician questions such as "Can I use overnight GH sampling to diagnose GHD?" or "Is spontaneous GH secretion testing reliable in this survivor?"

This skill determines the appropriate diagnostic strategy for luteinizing hormone/follicle-stimulating hormone deficiency (LH/FSHD) in childhood cancer survivors, recommending the use of the same diagnostic methods (e.g., GnRH stimulation test) as in the noncancer population. It is triggered by clinician questions such as "How should I diagnose LH/FSHD in this survivor?" or "What tests are appropriate for gonadotropin deficiency evaluation?"

This skill identifies childhood cancer survivors who require screening for luteinizing hormone/follicle-stimulating hormone deficiency based on hypothalamic-pituitary axis radiation exposure ≥30 Gy or history of tumors/surgery affecting the HP region. Triggers include: “Does this survivor need LH/FSHD screening?” or “Is gonadotropin deficiency evaluation indicated post‑cranial radiation?”

This skill identifies the appropriate treatment approach for luteinizing hormone/follicle-stimulating hormone deficiency (LH/FSHD) in childhood cancer survivors. It is triggered by clinician questions such as "How should I treat LH/FSHD in this survivor?" or "What sex hormone replacement is suitable for gonadotropin deficiency?" and recommends following the same hormone replacement strategies as in the noncancer population.

This skill determines the appropriate biochemical tests (e.g., free T4, TSH) for screening thyroid-stimulating hormone deficiency (TSHD) in childhood cancer survivors. It recommends using the same assays and reference ranges as in the noncancer population when clinicians ask, "What labs should I order to screen for TSHD?" or "Which thyroid tests are appropriate for this survivor?"

This skill determines whether serum triiodothyronine, thyroid-stimulating hormone surge analysis, or thyrotropin-releasing hormone stimulation should be used to diagnose thyroid-stimulating hormone deficiency in childhood cancer survivors. Triggers include: "Can I use T3 levels to diagnose central hypothyroidism?" or "Is TRH stimulation test appropriate for TSHD evaluation?"

This skill identifies childhood cancer survivors who require lifelong annual screening for thyroid-stimulating hormone deficiency (TSHD) based on hypothalamic-pituitary tumor history or radiation exposure ≥30 Gy. It is triggered by clinician questions such as “Does this survivor need yearly TSH testing?” or “Is annual thyroid function monitoring indicated post‑HP radiation?”

This skill determines the appropriate treatment approach for thyroid-stimulating hormone deficiency (TSHD) in childhood cancer survivors. It recommends using the same levothyroxine dosing and monitoring strategies (e.g., target free T4 levels) as in the noncancer population, triggered by questions such as "How should I treat central hypothyroidism in this survivor?" or "What levothyroxine dose is appropriate for TSHD?"

Run a complete vaccination review for a person with diabetes using the ADA 2026 checklist — checks COVID-19, influenza, hepatitis B, pneumococcal, RSV, Tdap, and zoster status and gives a clear give/defer/skip decision for each. Trigger when a clinician asks about vaccines in diabetes, immunisation review, vaccination schedule for a diabetic patient, or "what vaccines does my patient with diabetes need".

Recommends against routine 25(OH)D testing in the general population aged 50 to 74 years. Triggered when a clinician considers ordering 25(OH)D for asymptomatic adults aged 50-74 without established indications such as hypocalcemia, malabsorption, or chronic kidney disease.

The skill recommends against routine 25(OH)D testing in adults with dark complexion. Use when a clinician considers ordering a 25(OH)D test for a patient with dark complexion lacking established indications for vitamin D testing.

The Endocrine Society guideline recommends against routine 25(OH)D testing in asymptomatic adults without established indications for vitamin D assessment. Trigger when a clinician considers ordering a 25(OH)D level for a healthy adult with no symptoms of deficiency and no clinical indications such as hypocalcemia, malabsorption, or osteoporosis.

Recommends against routine screening for 25(OH)D levels in adults with obesity (BMI ≥30 kg/m²). Use when a clinician considers ordering a 25(OH)D test for an obese patient without established indications for vitamin D testing.

Recommends against routine 25(OH)D testing in adults aged 75 years and older. Use when a clinician considers ordering 25(OH)D for asymptomatic adults 75+ without established indications for vitamin D testing.