How do I install the Ata Postop Pituitary Axis Surveillance skill?

Run npx skillmds@latest add dromlakhani/ata-postop-pituitary-axis-surveillance 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.

Is Ata Postop Pituitary Axis Surveillance safe to use?

This skill has not completed SkillMD's automated safety review yet. Independent scanners report: SkillSpector: PASS, Skill Scanner: PASS. Capability flags: makes network calls. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Ata Postop Pituitary Axis Surveillance?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Ata Postop Pituitary Axis Surveillance free to use?

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Who published Ata Postop Pituitary Axis Surveillance?

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

Ata Postop Pituitary Axis Surveillance by dromlakhani

Name: Ata Postop Pituitary Axis Surveillance
Rating: 4.2 (5 reviews)
Author: dromlakhani

Ata Postop Pituitary Axis Surveillance

Recommends retesting all pituitary axes starting at 6 weeks after pituitary surgery and periodically to monitor development or resolution of pituitary deficiencies. Use when managing postoperative pituitary surgery patient; triggers include postoperative pituitary surgery patient needing longitudinal hormone monitoring.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Conduct periodic pituitary axis testing starting 6 weeks post-pituitary surgery

STEP 1 — Gather Information

Collect date of pituitary surgery, type of surgery, preoperative pituitary function if available, current medications (especially glucocorticoids), symptoms of hormone deficiency (fatigue, hypotension, polyuria, cold intolerance, menstrual changes, etc.), and any prior postoperative hormone results. If surgery date is <6 weeks ago, defer testing and schedule reassessment at 6 weeks post-op.

STEP 2 — Rule In / Rule Out

Is the patient at least 6 weeks post-pituitary surgery? If yes, proceed to step 3; if no, delay testing until the 6-week mark and reevaluate then.

STEP 3 — Classify or Stratify

Determine which pituitary axes to assess based on surgical extent and preoperative deficits: order basal morning cortisol (or ACTH stim if on glucocorticoids), free T4 and TSH, IGF-1, gonadotropins (LH, FSH, estradiol/testosterone), prolactin, and consider serum/urine osmolarity if polyuria present. Action: Obtain the indicated hormone panel.

STEP 4 — Decide

If any axis reveals deficiency, initiate appropriate hormone replacement and schedule repeat testing in 3–6 months; if all axes are normal, repeat testing annually or as clinically indicated based on symptoms.

Clinical Guardrails / Mimics / Pitfalls

Do not interpret cortisol while patient is on glucocorticoids without adequate washout (at least 18–24h after last HC dose or longer for synthetic GCs); avoid testing during acute illness or stress; do not rely solely on TSH to diagnose central hypothyroidism; recognize that transient diabetes insipidus may resolve postoperatively and avoid unnecessary DDAVP; consider that estrogen therapy can elevate total cortisol via CBG, masking AI.

Concrete Clinical Example

A 45-year-old woman 8 weeks post-transsphenoidal resection of a nonfunctioning adenoma presents with fatigue and mild polyuria. Morning cortisol 8 µg/dL (low), free T4 low-normal with normal TSH, IGF-1 low, LH/FSH low with low estradiol. Diagnosed with central AI, CH, GHD, and hypogonadism; started on hydrocortisone, levothyroxine, GH replacement, and estrogen. Repeat testing scheduled in 3 months.

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

---name: ata-postop-pituitary-axis-surveillancedescription: Recommends retesting all pituitary axes starting at 6 weeks after pituitary surgery and periodically to monitor development or resolution of pituitary deficiencies. Use when managing postoperative pituitary surgery patient; triggers include postoperative pituitary surgery patient needing longitudinal hormone monitoring.---# Conduct periodic pituitary axis testing starting 6 weeks post-pituitary surgery## STEP 1 — Gather InformationCollect date of pituitary surgery, type of surgery, preoperative pituitary function if available, current medications (especially glucocorticoids), symptoms of hormone deficiency (fatigue, hypotension, polyuria, cold intolerance, menstrual changes, etc.), and any prior postoperative hormone results. If surgery date is <6 weeks ago, defer testing and schedule reassessment at 6 weeks post-op.## STEP 2 — Rule In / Rule OutIs the patient at least 6 weeks post-pituitary surgery? If yes, proceed to step 3; if no, delay testing until the 6-week mark and reevaluate then.## STEP 3 — Classify or StratifyDetermine which pituitary axes to assess based on surgical extent and preoperative deficits: order basal morning cortisol (or ACTH stim if on glucocorticoids), free T4 and TSH, IGF-1, gonadotropins (LH, FSH, estradiol/testosterone), prolactin, and consider serum/urine osmolarity if polyuria present. Action: Obtain the indicated hormone panel.## STEP 4 — DecideIf any axis reveals deficiency, initiate appropriate hormone replacement and schedule repeat testing in 3–6 months; if all axes are normal, repeat testing annually or as clinically indicated based on symptoms.## Clinical Guardrails / Mimics / PitfallsDo not interpret cortisol while patient is on glucocorticoids without adequate washout (at least 18–24h after last HC dose or longer for synthetic GCs); avoid testing during acute illness or stress; do not rely solely on TSH to diagnose central hypothyroidism; recognize that transient diabetes insipidus may resolve postoperatively and avoid unnecessary DDAVP; consider that estrogen therapy can elevate total cortisol via CBG, masking AI.## Concrete Clinical ExampleA 45-year-old woman 8 weeks post-transsphenoidal resection of a nonfunctioning adenoma presents with fatigue and mild polyuria. Morning cortisol 8 µg/dL (low), free T4 low-normal with normal TSH, IGF-1 low, LH/FSH low with low estradiol. Diagnosed with central AI, CH, GHD, and hypogonadism; started on hydrocortisone, levothyroxine, GH replacement, and estrogen. Repeat testing scheduled in 3 months.**Source:** Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, https://doi.org/10.1210/jc.2016-2118

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