How do I install the Ata Prolactinoma Axis Reassess skill?

Run npx skillmds@latest add dromlakhani/ata-prolactinoma-axis-reassess 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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Who published Ata Prolactinoma Axis Reassess?

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

Ata Prolactinoma Axis Reassess by dromlakhani

Name: Ata Prolactinoma Axis Reassess
Rating: 4.2 (5 reviews)
Author: dromlakhani

Ata Prolactinoma Axis Reassess

Recommends reassessing all pituitary axes in patients with macroprolactinoma and central hypogonadism who have had successful dopamine agonist treatment. Use when managing a macroprolactinoma patient after dopamine agonist treatment with normalized prolactin and tumor shrinkage.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Reassess pituitary axes after dopamine agonist treatment in macroprolactinoma

STEP 1 — Gather Information

Confirm macroprolactinoma diagnosis (MRI >10mm), central hypogonadism (low testosterone/E2 with inappropriately low LH/FSH), and successful dopamine agonist treatment (normoprolactinemia, tumor shrinkage ≥30%, symptom improvement). Collect baseline pituitary hormones (cortisol, fT4, TSH, IGF-1, gonadotropins, sex steroids) and current symptoms.

STEP 2 — Rule In / Rule Out

Is there evidence of successful dopamine agonist treatment? If yes, proceed to axis reassessment; if no, optimize dopamine agonist dose or consider surgery/radiation before reassessment.

STEP 3 — Classify or Stratify

Assess each pituitary axis: adrenal (AM cortisol or ACTH stim), thyroid (fT4/TSH), gonadal (testosterone/E2, LH/FSH), GH (IGF-1), and DI (serum/urine osmolarity if polyuria). Classify each as sufficient, borderline, or deficient based on age-adjusted reference ranges.

STEP 4 — Decide

For any deficient axis, initiate appropriate hormone replacement per endocrine guidelines; for borderline, repeat testing in 3-6 months; for sufficient, continue surveillance with annual clinical review and pituitary MRI.

Clinical Guardrails / Mimics / Pitfalls

Do not assume normalization of prolactin implies recovery of other axes; do not discontinue dopamine agonist without confirming tumor stability; avoid empiric hormone replacement without biochemical confirmation; consider macroprolactinoma regrowth if symptoms worsen despite biochemical control.

Concrete Clinical Example

A 42-year-old man with macroprolactinoma (12mm) and central hypogonadism (testosterone 150 ng/dL, LH 1.2 IU/L) achieved normoprolactinemia (<20 ng/mL) and 50% tumor shrinkage after 6 months of cabergoline. Reassessment revealed low IGF-1 (80 ng/mL) and low testosterone (120 ng/dL); he started testosterone gel and GH replacement.

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

---name: ata-prolactinoma-axis-reassessdescription: Recommends reassessing all pituitary axes in patients with macroprolactinoma and central hypogonadism who have had successful dopamine agonist treatment. Use when managing a macroprolactinoma patient after dopamine agonist treatment with normalized prolactin and tumor shrinkage.---# Reassess pituitary axes after dopamine agonist treatment in macroprolactinoma## STEP 1 — Gather InformationConfirm macroprolactinoma diagnosis (MRI >10mm), central hypogonadism (low testosterone/E2 with inappropriately low LH/FSH), and successful dopamine agonist treatment (normoprolactinemia, tumor shrinkage ≥30%, symptom improvement). Collect baseline pituitary hormones (cortisol, fT4, TSH, IGF-1, gonadotropins, sex steroids) and current symptoms.## STEP 2 — Rule In / Rule OutIs there evidence of successful dopamine agonist treatment? If yes, proceed to axis reassessment; if no, optimize dopamine agonist dose or consider surgery/radiation before reassessment.## STEP 3 — Classify or StratifyAssess each pituitary axis: adrenal (AM cortisol or ACTH stim), thyroid (fT4/TSH), gonadal (testosterone/E2, LH/FSH), GH (IGF-1), and DI (serum/urine osmolarity if polyuria). Classify each as sufficient, borderline, or deficient based on age-adjusted reference ranges.## STEP 4 — DecideFor any deficient axis, initiate appropriate hormone replacement per endocrine guidelines; for borderline, repeat testing in 3-6 months; for sufficient, continue surveillance with annual clinical review and pituitary MRI.## Clinical Guardrails / Mimics / PitfallsDo not assume normalization of prolactin implies recovery of other axes; do not discontinue dopamine agonist without confirming tumor stability; avoid empiric hormone replacement without biochemical confirmation; consider macroprolactinoma regrowth if symptoms worsen despite biochemical control.## Concrete Clinical ExampleA 42-year-old man with macroprolactinoma (12mm) and central hypogonadism (testosterone 150 ng/dL, LH 1.2 IU/L) achieved normoprolactinemia (<20 ng/mL) and 50% tumor shrinkage after 6 months of cabergoline. Reassessment revealed low IGF-1 (80 ng/mL) and low testosterone (120 ng/dL); he started testosterone gel and GH replacement.**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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