How do I install the Ata Estrogen Cortisol Effect skill?

Run npx skillmds@latest add dromlakhani/ata-estrogen-cortisol-effect in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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Is Ata Estrogen Cortisol Effect free to use?

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Who published Ata Estrogen Cortisol Effect?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ata Estrogen Cortisol Effect by dromlakhani

Name: Ata Estrogen Cortisol Effect
Rating: 4.5 (4 reviews)
Author: dromlakhani

Ata Estrogen Cortisol Effect

Accounts for estrogen-induced elevation of total serum cortisol via increased corticosteroid-binding globulin (CBG) when evaluating adrenal reserve or hydrocortisone replacement adequacy. Triggered when assessing glucocorticoid adequacy in patients receiving estrogen therapy (e.g., oral estrogen replacement) or interpreting cortisol levels in estrogen-exposed individuals.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Account for estrogen effect on cortisol when assessing adrenal reserve

STEP 1 — Gather Information

Collect patient's estrogen status (type, route, dose), total serum cortisol level, time of draw, and note if estrogen is oral (which increases CBG) vs transdermal (no effect) or pregnancy/OCP.

STEP 2 — Rule In / Rule Out

If the patient is on oral estrogen (or other estrogen known to increase CBG), proceed to Step 3; otherwise, interpret total cortisol using standard reference ranges and proceed to Step 4.

STEP 3 — Classify or Stratify

Measure free cortisol or 24-hour urinary free cortisol to assess true adrenal cortical activity.

STEP 4 — Decide

Base decisions on adrenal reserve or HC adequacy on free cortisol or urinary cortisol results; do not adjust HC dose based solely on elevated total cortisol in estrogen-exposed patients.

Clinical Guardrails / Mimics / Pitfalls

Do not assume elevated total cortisol indicates Cushing's syndrome or glucocorticoid over-replacement in estrogen-treated patients.
Avoid reducing hydrocortisone dose based solely on high total cortisol when CBG is elevated.
Remember that transdermal estrogen does not increase CBG; only oral estrogen (and pregnancy) produce this effect.
Consider that free cortisol or urinary cortisol reflects bioactive fraction and is unaffected by CBG changes.

Concrete Clinical Example

A 45-year-old woman on oral estradiol 2 mg daily for hypopituitarism has a morning total cortisol of 22 µg/dL (above normal range). Her free cortisol is normal. She is on stable hydrocortisone 15 mg daily. Decision: maintain current hydrocortisone dose; the elevated total cortisol is due to CBG increase from oral estrogen.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118

---name: ata-estrogen-cortisol-effectdescription: Accounts for estrogen-induced elevation of total serum cortisol via increased corticosteroid-binding globulin (CBG) when evaluating adrenal reserve or hydrocortisone replacement adequacy. Triggered when assessing glucocorticoid adequacy in patients receiving estrogen therapy (e.g., oral estrogen replacement) or interpreting cortisol levels in estrogen-exposed individuals.---# Account for estrogen effect on cortisol when assessing adrenal reserve## STEP 1 — Gather InformationCollect patient's estrogen status (type, route, dose), total serum cortisol level, time of draw, and note if estrogen is oral (which increases CBG) vs transdermal (no effect) or pregnancy/OCP.## STEP 2 — Rule In / Rule OutIf the patient is on oral estrogen (or other estrogen known to increase CBG), proceed to Step 3; otherwise, interpret total cortisol using standard reference ranges and proceed to Step 4.## STEP 3 — Classify or StratifyMeasure free cortisol or 24-hour urinary free cortisol to assess true adrenal cortical activity.## STEP 4 — DecideBase decisions on adrenal reserve or HC adequacy on free cortisol or urinary cortisol results; do not adjust HC dose based solely on elevated total cortisol in estrogen-exposed patients.## Clinical Guardrails / Mimics / Pitfalls- Do not assume elevated total cortisol indicates Cushing's syndrome or glucocorticoid over-replacement in estrogen-treated patients.- Avoid reducing hydrocortisone dose based solely on high total cortisol when CBG is elevated.- Remember that transdermal estrogen does not increase CBG; only oral estrogen (and pregnancy) produce this effect.- Consider that free cortisol or urinary cortisol reflects bioactive fraction and is unaffected by CBG changes.## Concrete Clinical ExampleA 45-year-old woman on oral estradiol 2 mg daily for hypopituitarism has a morning total cortisol of 22 µg/dL (above normal range). Her free cortisol is normal. She is on stable hydrocortisone 15 mg daily. Decision: maintain current hydrocortisone dose; the elevated total cortisol is due to CBG increase from oral estrogen.**Source:** Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118

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