# Endo Discontinue Longacting Srl Pegvisomant Preconception

> This skill guides discontinuation of long-acting somatostatin receptor ligands (SRLs) and pegvisomant approximately two months before conception attempts in patients with acromegaly, substituting short-acting octreotide as needed for disease control. Trigger phrases include "preconception planning," "patient planning pregnancy," or "about to attempt conception."

- Skill: `dromlakhani/endo-discontinue-longacting-srl-pegvisomant-preconception` (Agent Skill)
- Install (CLI): `npx skillmds@latest add dromlakhani/endo-discontinue-longacting-srl-pegvisomant-preconception`
- Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/endo-discontinue-longacting-srl-pegvisomant-preconception/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-discontinue-longacting-srl-pegvisomant-preconception

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# Discontinue long-acting SRL and pegvisomant approximately 2 months before conception attempts

## STEP 1 — Gather Information
Confirm diagnosis of acromegaly, current medical therapy (long-acting SRL such as octreotide LAR or lanreotide autogel, or pegvisomant), pregnancy intent, and desired conception timeline.

## STEP 2 — Rule In / Rule Out
Is the patient currently receiving a long-acting SRL or pegvisomant and actively planning pregnancy or attempting conception? If yes, proceed to Step 3; if not on these agents or not pursuing conception, no discontinuation is needed.

## STEP 3 — Classify or Stratify
Determine the approximate discontinuation date: calculate 2 months prior to the intended conception date; if within this window, classify as ready for transition.

## STEP 4 — Decide
Discontinue the long-acting SRL and pegvisomant; initiate short-acting octreotide (e.g., 50–100 mcg subcutaneously every 8 hours as needed) to maintain biochemical control until conception is confirmed, then reassess therapy.

## Clinical Guardrails / Mimics / Pitfalls
Do not continue long-acting SRL or pegvisomant during pregnancy due to insufficient safety data; avoid relying on depot formulations for contraception; monitor IGF-1 and symptoms frequently during transition; short-acting octreotide crosses the placenta—use lowest effective dose.

## Concrete Clinical Example
A 32-year-old woman on octreotide LAR 30 mg monthly planning pregnancy stops the depot two months before her target conception date and uses short-acting octreotide 50 mcg SC TID as needed to keep IGF-1 <1.3× ULN until pregnancy test is positive.

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