# Endo Avoid Random Gh Diagnosis

> Recommends against using random GH levels to diagnose acromegaly because of pulsatile secretion. Use when a clinician considers ordering a random GH test to evaluate for acromegaly in a patient with suggestive features.

- Skill: `dromlakhani/endo-avoid-random-gh-diagnosis` (Agent Skill)
- Install (CLI): `npx skillmds@latest add dromlakhani/endo-avoid-random-gh-diagnosis`
- Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/endo-avoid-random-gh-diagnosis/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Coding & Dev Tools
- Author: dromlakhani (https://skillmd.com/u/dromlakhani)
- Updated: 2026-09-08
- Page: https://skillmd.com/skills/dromlakhani/endo-avoid-random-gh-diagnosis

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# Avoid random GH measurement for acromegaly diagnosis

## STEP 1 — Gather Information
Collect clinical features suggestive of acromegaly (e.g., acral enlargement, facial changes, comorbidities such as diabetes, hypertension, sleep apnea, carpal tunnel syndrome) and determine if a random GH test is being considered for diagnosis.

## STEP 2 — Rule In / Rule Out
If a random GH test is being considered to evaluate for acromegaly, proceed to step 3; otherwise, do not order random GH and end evaluation.

## STEP 3 — Classify or Stratify
Classify the scenario as “random GH not recommended for diagnosis” per guideline recommendation against reliance on random GH levels.

## STEP 4 — Decide
Do not order random GH; instead, order serum IGF-1 as the initial screening test for acromegaly.

## Clinical Guardrails / Mimics / Pitfalls
Do not interpret random GH levels as diagnostic or use them to rule in/out acromegaly; avoid relying on single random GH due to pulsatile secretion; use IGF-1 and OGTT with glucose suppression for confirmation.

## Concrete Clinical Example
A 48‑year‑old presents with shoe size increase, jaw protrusion, and fatigue; the clinician considers ordering a random GH test. Following the skill, they order IGF‑1 instead; an elevated IGF‑1 prompts an OGTT to assess GH suppression.

**Source:** Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700