Research

This skill recommends obtaining initial screening laboratory tests for functional hypothalamic amenorrhea (FHA) to rule out pregnancy and systemic illness. Use when a clinician states, 'Let’s get basic labs to rule out pregnancy and systemic illness,' or similar phrases such as 'Order a chem panel and pregnancy test' or 'Check CBC and metabolic panel'.

This skill involves administering a progestin challenge (e.g., medroxyprogesterone acetate 5–10 mg daily for 5–10 days) to induce withdrawal bleeding, which indicates adequate estrogen exposure and evaluates outflow tract integrity. Use when a clinician states, “Let’s do a progestin challenge to see if she bleeds,” or gives orders such as “Give 10 mg medroxyprogesterone for 10 days and check for bleed” or “Use progestin challenge to assess endometrial estrogen effect”.

This skill guides clinicians to obtain a detailed personal and family history focusing on diet, eating disorders, exercise, weight, sleep, stressors, mood, menstrual pattern, fractures, substance abuse, and familial endocrine/reproductive disorders when evaluating suspected functional hypothalamic amenorrhea. Use when clinicians state they need to know about her exercise routine, diet, and family history of eating disorders, or when they ask about weight fluctuations, sleep, and stressors, or...

This skill suggests considering a trial of cognitive behavioral therapy (CBT) to restore ovulation and fertility in women with functional hypothalamic amenorrhea (FHA) who desire pregnancy, based on a small study showing efficacy with minimal harm. Clinicians may use this when they hear phrases such as "Try CBT to improve fertility" or "Consider psychotherapy before medical ovulation induction".

This skill recommends against using kisspeptin or leptin to treat infertility in patients with functional hypothalamic amenorrhea (FHA) except within research or closely monitored trials due to limited evidence. Use when a clinician states, “Let’s not prescribe kisspeptin for her infertility,” or encounters triggers such as “Avoid kisspeptin outside trials” or “Do not use leptin for ovulation induction.”

Recommends against routine use of dehydroepiandrosterone in women because indications are inadequate and evidence of efficacy and long-term safety is lacking. Triggers include a clinician considering DHEA supplementation for general well‑being, adrenal insufficiency, or other non‑specific indications.

Recommends against diagnosing androgen deficiency syndrome in healthy women because there is no well-defined syndrome and no data linking androgen levels to specific signs or symptoms. Triggered when a clinician considers diagnosing androgen deficiency in a woman without known pituitary, adrenal, or gonadal disease.

Recommends testosterone replacement for adult males with central hypogonadism and no contraindications to prevent anemia related to T deficiency; reduce fat mass; and improve BMD, libido, sexual function, energy levels, sense of well-being, and muscle mass and strength. Triggers include consideration of testosterone replacement in males with central hypogonadism (e.g., low serum testosterone with symptoms of deficiency).

This skill guides clinicians to inform and counsel individuals seeking gender-affirming medical treatment about fertility preservation options before initiating puberty suppression in adolescents or before starting hormonal therapy in adolescents and adults. It is triggered when a patient is eligible for pubertal suppression or sex hormone treatment and is about to begin such therapy.

Provides a monitoring schedule for patients receiving GnRH agonist therapy for pubertal suppression. Trigger phrases include 'patient undergoing GnRH agonist therapy' or 'initiating pubertal suppression'.

This skill guides individualized prostate cancer screening for transgender females receiving estrogen therapy based on personal risk. Trigger phrase: transgender female receiving estrogens.

Applies standard breast-screening guidelines for transgender females who have been assessed as having no known increased risk of breast cancer. Trigger phrases include transgender female and assessed as no increased breast cancer risk.

Assesses Tanner stage to determine if physical changes of puberty have begun (stage G2/B2 or higher) for considering pubertal suppression. Triggered when a clinician evaluates pubertal development in an adolescent patient.

Determines if patient meets ICD-10 criteria for transsexualism. Triggered when a clinician uses ICD-10 for diagnostic purposes in gender identity assessment.

Recommends continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) for adults with type 1 diabetes who have achieved their A1C goal but experience severe hypoglycemia or high glucose variability, provided the patient and caregivers are willing and able to use the device. Consider CSII when clinicians hear 'A1C is at goal but patient has severe lows or glucose swings' or think 'pump for hypoglycemia-prone controlled T1DM'.

This skill evaluates infusion site health and rotates sites appropriately to prevent lipohypertrophy or infection. It is triggered when clinicians inspect pump sites for irritation or lumps or review site rotation practice at visit.

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.

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.

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 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 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 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.

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 that all patients with Cushing’s syndrome receive monitoring and adjunctive treatment for cortisol-dependent comorbidities including psychiatric disorders, diabetes, hypertension, hypokalemia, infections, dyslipidemia, osteoporosis, and poor physical fitness. Apply when managing any CS patient to address associated health issues; triggers include confirmed or suspected hypercortisolism, preoperative evaluation, postoperative follow‑up, or persistent hypercortisolism desp...