How do I install the Endo Gigantism Standard Approaches skill?

Run npx skillmds@latest add dromlakhani/endo-gigantism-standard-approaches 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 Endo Gigantism Standard Approaches safe to use?

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

Which AI agents work with Endo Gigantism Standard Approaches?

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 Endo Gigantism Standard Approaches free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Endo Gigantism Standard Approaches?

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

Endo Gigantism Standard Approaches by dromlakhani

Name: Endo Gigantism Standard Approaches
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Endo Gigantism Standard Approaches

Recommends applying standard acromegaly treatment approaches to normalize GH and IGF-1 in patients with pituitary gigantism. Use when evaluating a child or adolescent with excessive linear growth prior to epiphyseal closure, elevated IGF-1, and nonsuppressed GH after glucose load.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Apply standard approaches to normalize GH and IGF-1 in gigantism

STEP 1 — Gather Information

Collect clinical history (growth velocity, pubertal stage), physical exam (acral enlargement, facial changes), labs (age‑adjusted serum IGF‑1, GH suppression after 75 g oral glucose tolerance test), and pituitary MRI with contrast to assess tumor size, cavernous sinus invasion, and chiasmal proximity.

STEP 2 — Rule In / Rule Out

If IGF‑1 exceeds the age‑adjusted upper limit and GH fails to suppress to <0.4 µg/L after OGTT, with MRI confirming a GH‑secreting adenoma → rule in gigantism; otherwise rule out and consider alternative causes of overgrowth (e.g., genetic syndromes, precocious puberty).

STEP 3 — Classify or Stratify

Stratify by surgical resectability: tumor confined to sella with minimal cavernous sinus invasion → primary transsphenoidal surgery; extensive cavernous sinus invasion or chiasmal compression making gross total resection unlikely → primary medical therapy.

STEP 4 — Decide

For resectable tumors, perform transsphenoidal surgery; for unresectable disease or as adjuvant post‑surgery, initiate medical therapy (first‑line somatostatin receptor ligand, add pegvisomant if inadequate, consider dopamine agonist for mild IGF‑1 elevation) targeting age‑adjusted IGF‑1 normalization and random GH <1 µg/L.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on random GH alone for diagnosis; avoid long‑acting SRLs or pegvisomant in pregnancy without specialist input; do not delay surgery in rapidly progressive cases due to irreversible skeletal overgrowth; use age‑adjusted IGF‑1 norms; avoid radiotherapy as first‑line in children because of neurocognitive risk.

Concrete Clinical Example

A 14‑year‑old presents with 10 cm/year growth, coarse facial features, and enlarged hands. IGF‑1 is 2× the upper limit for age, GH 2 µg/L after OGTT. MRI shows a 12 mm pituitary macroadenoma touching the cavernous sinus. Transsphenoidal surgery reduces tumor size but IGF‑1 remains elevated; monthly lanreotide 120 mg normalizes IGF‑1 at 6 months.

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

---name: endo-gigantism-standard-approachesdescription: Recommends applying standard acromegaly treatment approaches to normalize GH and IGF-1 in patients with pituitary gigantism. Use when evaluating a child or adolescent with excessive linear growth prior to epiphyseal closure, elevated IGF-1, and nonsuppressed GH after glucose load.---# Apply standard approaches to normalize GH and IGF-1 in gigantism## STEP 1 — Gather InformationCollect clinical history (growth velocity, pubertal stage), physical exam (acral enlargement, facial changes), labs (age‑adjusted serum IGF‑1, GH suppression after 75 g oral glucose tolerance test), and pituitary MRI with contrast to assess tumor size, cavernous sinus invasion, and chiasmal proximity.## STEP 2 — Rule In / Rule OutIf IGF‑1 exceeds the age‑adjusted upper limit and GH fails to suppress to <0.4 µg/L after OGTT, with MRI confirming a GH‑secreting adenoma → rule in gigantism; otherwise rule out and consider alternative causes of overgrowth (e.g., genetic syndromes, precocious puberty).## STEP 3 — Classify or StratifyStratify by surgical resectability: tumor confined to sella with minimal cavernous sinus invasion → primary transsphenoidal surgery; extensive cavernous sinus invasion or chiasmal compression making gross total resection unlikely → primary medical therapy.## STEP 4 — DecideFor resectable tumors, perform transsphenoidal surgery; for unresectable disease or as adjuvant post‑surgery, initiate medical therapy (first‑line somatostatin receptor ligand, add pegvisomant if inadequate, consider dopamine agonist for mild IGF‑1 elevation) targeting age‑adjusted IGF‑1 normalization and random GH <1 µg/L.## Clinical Guardrails / Mimics / PitfallsDo not rely on random GH alone for diagnosis; avoid long‑acting SRLs or pegvisomant in pregnancy without specialist input; do not delay surgery in rapidly progressive cases due to irreversible skeletal overgrowth; use age‑adjusted IGF‑1 norms; avoid radiotherapy as first‑line in children because of neurocognitive risk.## Concrete Clinical ExampleA 14‑year‑old presents with 10 cm/year growth, coarse facial features, and enlarged hands. IGF‑1 is 2× the upper limit for age, GH 2 µg/L after OGTT. MRI shows a 12 mm pituitary macroadenoma touching the cavernous sinus. Transsphenoidal surgery reduces tumor size but IGF‑1 remains elevated; monthly lanreotide 120 mg normalizes IGF‑1 at 6 months.**Source:** Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700

Frequently asked questions