Claude Skills by dromlakhani

This skill guides evaluation for malignancy using imaging in patients with a history of adrenal adenoma (post‑adrenalectomy Cushing’s syndrome) when the adenoma demonstrates a CT density of ≥10 Hounsfield units or when pathology is consistent with possible carcinoma. Trigger phrases include “CT density ≥10 HU”, “possible carcinoma on pathology”, and “post‑adrenalectomy CS patient with adrenal adenoma history”.

This skill suggests follow-up tests for specific comorbidities associated with Cushing's syndrome in patients with adrenal adenoma when CT density is less than 10 Hounsfield units. Use when managing a post-adrenalectomy Cushing's syndrome patient with confirmed adrenal adenoma pathology and low-density imaging (<10 HU).

This skill recommends obtaining serum free T4 and prolactin levels within 1–2 weeks after transsphenoidal surgery (TSS) for Cushing's syndrome to screen for overt hypopituitarism. Use in postoperative Cushing's syndrome patients during the early recovery window when evaluating for new pituitary hormone deficiencies.

This skill suggests administering a glucocorticoid antagonist (e.g., mifepristone) in patients with Cushing's disease who have diabetes or glucose intolerance and are not surgical candidates or have persistent disease after transsphenoidal surgery. Consider when encountering persistent hypercortisolism after TSS, contraindications to surgery, or comorbid diabetes/glucose intolerance requiring medical control.

This skill recommends glucocorticoid replacement and patient education for hypocortisolemic patients after surgical remission of Cushing's syndrome. Use when a postoperative Cushing's patient exhibits low cortisol (e.g., morning cortisol <5 µg/dL) or symptoms of adrenal insufficiency.

This skill recommends follow-up morning cortisol and/or ACTH stimulation tests or insulin-induced hypoglycemia to assess HPA axis recovery in postoperative Cushing's syndrome patients with at least one intact adrenal gland. Triggers include postoperative remission (morning cortisol <5 µg/dL or UFC <28–56 nmol/d) and the need to evaluate HPA recovery before glucocorticoid discontinuation.

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.

Recommends initial surgical resection of the primary lesion(s) causing Cushing's syndrome when surgery is feasible and likely to significantly reduce glucocorticoid excess. Trigger phrases include overt Cushing's syndrome, ACTH-dependent CS, ectopic ACTH secretion, adrenal adenoma, bilateral macronodular adrenal hyperplasia, and persistent hypercortisolism.

This skill recommends measuring late-night salivary or serum cortisol to screen for Cushing's disease recurrence in patients with eucortisolism after transsphenoidal surgery, including cases where eucortisolism was established by medical treatment prior to surgery. Use when postoperative follow-up shows eucortisolism (normal morning cortisol/UFC) but concern for recurrence exists.

This skill recommends lifelong follow-up tests for cardiac myxoma and associated disease (testicular tumors, acromegaly, thyroid lesions) in patients with Carney complex. Use when managing a Cushing’s syndrome patient with a confirmed or suspected Carney complex diagnosis (e.g., spotty skin lentigines, cardiac myxoma, endocrine tumors).

This skill recommends localizing and resecting ectopic ACTH-secreting tumors with node dissection when ectopic ACTH secretion is suspected or confirmed. Clinical triggers include unexplained persistent hypercortisolism after pituitary surgery, elevated ACTH with negative pituitary MRI, or identification of occult ectopic ACTH syndrome (EAS) on biochemical testing.

This skill recommends measuring serum cortisol or urine free cortisol off-medication at 6- to 12-month intervals to assess radiation therapy effect in patients with Cushing's syndrome undergoing or post-radiotherapy. It is also indicated when patients on stable medical therapy develop new adrenal insufficiency symptoms such as fatigue, weight loss, or hypotension.

This skill suggests medical therapy to block aberrant hormone receptors for bilateral macronodular adrenal hyperplasia (BMAH) when surgery is not preferred or feasible. Consider this approach in patients with confirmed BMAH and evidence of aberrant hormone receptor expression (e.g., GIP, LH/hCG, serotonin) driving cortisol excess.

This skill recommends that a multidisciplinary team, including an experienced endocrinologist, incorporates patient values and preferences while providing education about treatment options for Cushing’s syndrome. Use when planning treatment for a CS patient requiring coordinated care; triggers include persistent hypercortisolism after transsphenoidal surgery, consideration of bilateral adrenalectomy, radiotherapy, or medical therapy, and need for shared decision‑making.

This skill provides structured education to patients and families about Cushing's syndrome pathophysiology, treatment options, and post-remission expectations. It is triggered when a clinician encounters a new Cushing's syndrome patient or family needing disease information, such as at initial diagnosis or before treatment initiation.

This skill suggests perioperative prophylaxis for venous thromboembolism in patients with Cushing's syndrome undergoing surgery. Use when preparing a CS patient for any surgical procedure; triggers include "CS patient pre-op", "Cushing's syndrome surgery", "perioperative VTE prophylaxis CS".

This skill suggests pituitary-directed medical treatments (e.g., cabergoline, pasireotide) for patients with Cushing's disease who are not surgical candidates or have persistent disease after transsphenoidal surgery. Use when a CD patient cannot undergo surgery or has residual disease post-TSS; triggers include "not a surgical candidate", "persistent disease after TSS", "ongoing hypercortisolism despite prior surgery".

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.

This skill recommends re-evaluating the need for treatment of other pituitary hormone deficiencies in the postoperative period following surgical intervention for Cushing's syndrome. It is triggered when assessing a post-op CS patient for ongoing pituitary function, evaluating for hypopituitarism, or checking HPA axis recovery with morning cortisol/ACTH stimulation tests and pituitary MRI within 1–3 months.

This skill recommends regularly evaluating for corticotroph tumor progression using pituitary MRIs and ACTH levels in patients with known Cushing's disease who underwent bilateral adrenalectomy and in patients undergoing this procedure for presumed occult ectopic ACTH secretion. Triggers include postoperative follow‑up after bilateral adrenalectomy, rising ACTH levels, or new pituitary lesion on MRI suggestive of tumor progression.

This skill recommends using biochemical tests to screen for hypercortisolism to detect recurrence in patients with ACTH-dependent Cushing's syndrome after surgical remission. It is triggered during postoperative follow-up when the HPA axis has recovered, annually, or sooner if clinical signs of hypercortisolism (e.g., weight gain, hypertension, glucose intolerance) or abnormal late-night salivary cortisol/UFC appear.

This skill recommends measuring serum sodium several times during the first 5–14 days after transsphenoidal surgery to detect and manage electrolyte disturbances such as postoperative hyponatremia and diabetes insipidus. Use when managing a post-TSS Cushing’s syndrome patient in the early recovery phase; triggers include postoperative day 5–10 hyponatremia, polyuria, fluid intake‑output imbalance, or suspected diabetes insipidus.

This skill provides a shared decision-making framework for selecting second-line therapies in patients with ACTH-dependent Cushing's syndrome who have persistent hypercortisolism after transsphenoidal surgery or for whom surgery is not feasible. Clinical triggers include "failed TSS", "non-curative pituitary surgery", "persistent UFC elevation post-op", and "surgery contraindicated".

Recommends steroidogenesis inhibitors as second-line treatment after transsphenoidal surgery (TSS) in Cushing's disease, as primary therapy for occult or metastatic ectopic ACTH syndrome (EAS), and as adjunctive cortisol reduction in adrenocortical carcinoma. Use when evaluating CS patients post‑TSS, with occult/metastatic EAS, or ACC; triggers include “persistent hypercortisolism after TSS,” “occult EAS,” and “adjunctive for ACC.”

Suggests repeat transsphenoidal surgery for patients with persistent hypercortisolism after initial transsphenoidal surgery when imaging shows evidence of incomplete resection or a pituitary lesion. Clinical triggers include postoperative MRI revealing residual adenoma, persistent elevated UFC or late-night salivary cortisol, and visible pituitary lesion on imaging.

This skill suggests radiation therapy or radiosurgery for adult patients with Cushing's disease who have failed transsphenoidal surgery (TSS) or have recurrent disease after initial remission. Consider when postoperative urinary free cortisol or late-night salivary cortisol remains elevated, or when clinical recurrence is suspected.

This skill recommends bilateral adrenalectomy for patients with Cushing's syndrome when bilateral adrenal pathology is confirmed as the source of hypercortisolism. Clinical triggers include bilateral macronodular adrenal hyperplasia (BMAH), bilateral adrenal adenomas, or bilateral adrenal carcinoma identified by imaging.

This skill suggests targeted therapies (somatostatin analogs or tyrosine kinase inhibitors) to treat ectopic ACTH syndrome when ectopic ACTH secretion is confirmed or strongly suspected. Use when triggers include occult or metastatic ectopic ACTH secretion, very severe ACTH‑dependent disease uncontrolled by medical therapy, or when surgery is not possible or noncurative.

This skill recommends lifelong biochemical testing for recurrence in all patients with Cushing's syndrome after adrenalectomy, except those with resected adrenal adenoma showing CT density <10 Hounsfield units. Use when determining long‑term follow‑up strategy for a post‑adrenalectomy CS patient; triggers include “post‑adrenalectomy Cushing’s syndrome”, “CT density <10 HU”, and “adrenal adenoma resection”.

This skill directs lifelong treatment of cardiovascular risk factors, osteoporosis, and psychiatric symptoms in all patients with Cushing's syndrome until biochemical resolution of hypercortisolism. Use when managing any CS patient for long‑term comorbidity control; triggers include persistent hypertension, dyslipidemia, low bone density, depression, anxiety, or cognitive changes in the setting of known or suspected CS.

This skill defines the treatment goals for patients with overt Cushing's syndrome, focusing on normalizing cortisol levels or action to eliminate symptoms and treat comorbidities. Use when a clinician asks about treatment objectives for a newly diagnosed overt Cushing's syndrome patient; triggers include "overt CS," "treatment goals for overt Cushing's," and "normalize cortisol in overt CS."

This skill recommends transsphenoidal selective adenomectomy (TSS) by an experienced pituitary surgeon as the optimal treatment for Cushing's disease in pediatric and adult patients. Use when a patient with ACTH-dependent Cushing syndrome is a surgical candidate; triggers include overt Cushing's syndrome, elevated UFC or late-night salivary cortisol, and pituitary MRI showing an adenoma.

This skill recommends unilateral resection by an experienced adrenal surgeon for all cases of benign unilateral disease causing Cushing's syndrome. Trigger when a CS patient has a unilateral adrenal lesion confirmed benign via imaging and biochemical assessment.

This skill recommends urgent treatment (within 24–72 hours) of hypercortisolism when life‑threatening complications of Cushing's syndrome such as infection, pulmonary thromboembolism, cardiovascular events, or acute psychosis are present. Trigger phrases include sepsis, PE, chest pain with hemodynamic instability, new‑onset psychosis, or delirium in a patient with known or suspected Cushing's.

This skill recommends using radiation therapy for corticotroph adenomas in Cushing's disease when imaging shows invasive features or mass‑effect concerns such as cavernous sinus invasion, suprasellar extension, or knobby protrusion. Consider RT when postoperative medical therapy has normalized cortisol but tumor progression or residual invasive disease is suspected.

This skill guides evaluation of venous thromboembolism (VTE) risk factors in Cushing's syndrome patients to prevent thrombotic complications. Use when assessing a CS patient for thrombotic risk, especially perioperatively; triggers include preoperative assessment, postoperative period (within 4-6 weeks), or presence of CS with additional risk factors such as prior VTE, immobilization, malignancy, or estrogen use.

Guidance for clinicians managing pregnant individuals with preexisting diabetes mellitus (PDM) who are evaluating daily carbohydrate intake; consider a carbohydrate-restricted diet (<175 g/day) or usual diet (>175 g/day) based on patient factors. Trigger when assessing nutrition in pregnancy for PDM, especially when discussing glycemic targets, weight gain, or fetal growth concerns.

This skill advises against using a single 24-hour CGM target <140 mg/dL when managing glucose in pregnancy for patients with preexisting diabetes. Trigger when a clinician is determining CGM-based glucose targets for pregnant individuals with type 1 or type 2 diabetes.

Recommends contraception when pregnancy is not desired for individuals with diabetes who could become pregnant. Triggered by discussions about pregnancy planning, contraception needs, or when pregnancy is not desired.

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.

Recommends discontinuation of GLP-1RA before conception rather than between start of pregnancy and end of first trimester for individuals with type 2 diabetes who are planning pregnancy. Trigger when clinician considers stopping GLP-1RA therapy in a patient with type 2 diabetes who is planning pregnancy or seeking preconception care.

Suggests either continuous glucose monitor (CGM) or self-monitoring of blood glucose (SMBG) for pregnant individuals with type 2 diabetes. Triggers include decisions about glucose monitoring methods for pregnant patients with T2DM needing a monitoring strategy.

Recommends use of hybrid closed-loop pump rather than insulin pump with CGM (without algorithm) or multiple daily injections with CGM for pregnant individuals with type 1 diabetes. Triggered when deciding on insulin delivery methods for pregnant patients with type 1 diabetes.

Recommends against routine addition of metformin to insulin for pregnant individuals with type 2 diabetes already on insulin. Triggered when considering adding metformin to an insulin regimen in pregnancy for patients with type 2 diabetes.

Recommends postpartum endocrine care (diabetes management) in addition to usual obstetric care for individuals with preexisting diabetes (including those with pregnancy loss or termination). Triggered by postpartum care planning for patients with diabetes after delivery.

This skill screens for pregnancy intention in individuals with preexisting diabetes at every reproductive, diabetes, primary care, and urgent care/ER visit when clinically appropriate. Trigger phrases include reproductive planning, preconception care, or pregnancy intention discussion.

Guide pump setting adjustments for the MiniMed 780G system based on CareLink data, using Medtronic's 3-step follow-up workflow. Use when a clinician has CareLink data for a 780G patient and wants to know what to change — which setting, by how much, and how to program it. Triggers include: "what do I adjust", "how to fix high TIR", "how to reduce hypos", "adjust ICR/ISF/basal", "SmartGuard settings", "780G pump settings review", or any question about optimising 780G therapy after reviewing a d...

Systematically interpret a Medtronic CareLink or MiniMed 780G Daily Review download in a structured 6-step clinical workflow — covering Time in Range, insulin delivery, day/night patterns, hypo and hyperglycemia root causes, and a prioritised action plan. Trigger when a clinician uploads or shares a CareLink report, MiniMed download, 780G Daily Review, pump download, or asks to review a patient's CGM or insulin pump data.

Reassesses annually the patient’s CGM sensor site health and care practices, including skin integrity, rotation, and hygiene. Triggered by phrases such as 'Yearly sensor site inspection' or 'Annual review of CGM insertion site rotation and hygiene'.

Reassesses annually the patient’s use of self-monitoring blood glucose to calibrate the CGM system. Triggered by ‘Yearly calibration practice review’ or ‘Annual check of SMBG calibration adherence’.