How do I install the Enda Increase Hc Pregnancy Third Trimester skill?

Run npx skillmds@latest add dromlakhani/enda-increase-hc-pregnancy-third-trimester 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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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 Enda Increase Hc Pregnancy Third Trimester free to use?

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Who published Enda Increase Hc Pregnancy Third Trimester?

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

Enda Increase Hc Pregnancy Third Trimester by dromlakhani

Name: Enda Increase Hc Pregnancy Third Trimester
Rating: 4.5 (4 reviews)
Author: dromlakhani

Enda Increase Hc Pregnancy Third Trimester

Recommends increasing hydrocortisone dose in pregnant patients with primary adrenal insufficiency based on individual clinical course, especially during the third trimester. Trigger phrases include "fatigue, postural hypotension, weight loss, or hyperglycemia in pregnant PAI patient" and "need for glucocorticoid dose adjustment in third trimester."

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Increase Hydrocortisone Dose in Pregnancy, Particularly During Third Trimester

STEP 1 — Gather Information

Collect gestational age, current hydrocortisone dose and schedule, maternal symptoms (fatigue, nausea, vomiting, postural hypotension or hypertension, weight changes, hyperglycemia), weight, blood pressure, and any signs of over- or under-replacement; end with assessment of symptom pattern.

STEP 2 — Rule In / Rule Out

Is the patient pregnant with confirmed PAI and at ≥28 weeks gestation? If yes, proceed to symptom classification; if no, continue routine trimester‑based monitoring and do not apply this specific increase algorithm.

STEP 3 — Classify or Stratify

Classify symptom pattern: under‑replacement (fatigue, nausea, hypotension, weight loss, hyponatremia); over‑replacement (weight gain, hyperglycemia, insomnia, edema, hypertension); or stable (no concerning signs); end with a classification decision.

STEP 4 — Decide

If under‑replacement signs are present, increase hydrocortisone dose by 20‑40% (e.g., from 20 mg to 25 mg daily) divided into two or three doses; if over‑replacement, maintain current dose or consider reduction after obstetric review; if stable, maintain current dose; end with dosing adjustment order.

Clinical Guardrails / Mimics / Pitfalls

Avoid glucocorticoid over‑replacement that can cause Cushingoid features, maternal hyperglycemia, hypertension, or fetal growth restriction; do not use dexamethasone in pregnancy due to lack of placental inactivation; avoid abrupt dose changes without maternal‑fetal monitoring; ensure mineralocorticoid adequacy when increasing hydrocortisone.

Concrete Clinical Example

A 32‑year‑on‑known PAI at 30 weeks gestation reports fatigue, postural hypotension, and 2 kg weight loss despite hydrocortisone 20 mg daily. Assessment indicates glucocorticoid under‑replacement. Increase hydrocortisone to 25 mg daily in divided doses, reassess symptoms and weight in 1‑2 weeks.

Source: Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2015-1710

---name: enda-increase-hc-pregnancy-third-trimesterdescription: Recommends increasing hydrocortisone dose in pregnant patients with primary adrenal insufficiency based on individual clinical course, especially during the third trimester. Trigger phrases include "fatigue, postural hypotension, weight loss, or hyperglycemia in pregnant PAI patient" and "need for glucocorticoid dose adjustment in third trimester."---# Increase Hydrocortisone Dose in Pregnancy, Particularly During Third Trimester## STEP 1 — Gather InformationCollect gestational age, current hydrocortisone dose and schedule, maternal symptoms (fatigue, nausea, vomiting, postural hypotension or hypertension, weight changes, hyperglycemia), weight, blood pressure, and any signs of over- or under-replacement; end with assessment of symptom pattern.## STEP 2 — Rule In / Rule OutIs the patient pregnant with confirmed PAI and at ≥28 weeks gestation? If yes, proceed to symptom classification; if no, continue routine trimester‑based monitoring and do not apply this specific increase algorithm.## STEP 3 — Classify or StratifyClassify symptom pattern: under‑replacement (fatigue, nausea, hypotension, weight loss, hyponatremia); over‑replacement (weight gain, hyperglycemia, insomnia, edema, hypertension); or stable (no concerning signs); end with a classification decision.## STEP 4 — DecideIf under‑replacement signs are present, increase hydrocortisone dose by 20‑40% (e.g., from 20 mg to 25 mg daily) divided into two or three doses; if over‑replacement, maintain current dose or consider reduction after obstetric review; if stable, maintain current dose; end with dosing adjustment order.## Clinical Guardrails / Mimics / PitfallsAvoid glucocorticoid over‑replacement that can cause Cushingoid features, maternal hyperglycemia, hypertension, or fetal growth restriction; do not use dexamethasone in pregnancy due to lack of placental inactivation; avoid abrupt dose changes without maternal‑fetal monitoring; ensure mineralocorticoid adequacy when increasing hydrocortisone.## Concrete Clinical ExampleA 32‑year‑on‑known PAI at 30 weeks gestation reports fatigue, postural hypotension, and 2 kg weight loss despite hydrocortisone 20 mg daily. Assessment indicates glucocorticoid under‑replacement. Increase hydrocortisone to 25 mg daily in divided doses, reassess symptoms and weight in 1‑2 weeks.**Source:** Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2015-1710

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