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Run npx skillmds@latest add dromlakhani/endo-hirsutism-screen-nccah-amenorrhea 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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dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Endo Hirsutism Screen Nccah Amenorrhea by dromlakhani

Name: Endo Hirsutism Screen Nccah Amenorrhea
Rating: 4.5 (4 reviews)
Author: dromlakhani

Endo Hirsutism Screen Nccah Amenorrhea

Orders early morning 17‑hydroxyprogesterone to screen for nonclassic congenital adrenal hyperplasia due to 21‑hydroxylase deficiency in hyperandrogenemic women with amenorrhea or infrequent menses. Triggered by menstrual irregularity with hirsutism and a clinical request to rule out adrenal hyperplasia.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Screen for NCCAH in amenorrheic or infrequent menses women

STEP 1 — Gather Information

Collect menstrual history (amenorrhea or <6 cycles/year), hirsutism assessment (Ferriman‑Gallwey score ≥8), signs of hyperandrogenism, family history of congenital adrenal hyperplasia, and ethnicity; order early morning (08:00–10:00) 17‑hydroxyprogesterone (17‑OHP) level.

STEP 2 — Rule In / Rule Out

Is the early morning 17‑OHP ≥ .170 ng/dL (5.15 nmol/L)?

Yes → proceed to Step 3 (possible NCCAH).
No → rule out NCCAH; consider other causes of hyperandrogenism.

STEP 3 — Classify or Stratify

Classify 17‑OHP:

.170–200 ng/dL (5.15–6.0 nmol/L): borderline positive (≈95% sensitive, 90% specific).
≥1000 ng/dL (30–45 nmol/L): diagnostic for NCCAH.
< .170 ng/dL: negative.

STEP 4 — Decide

If 17‑OHP ≥1000 ng/dL: refer for CYP21A2 genetic testing and consider low‑dose glucocorticoid therapy.
If 17‑OHP .170–200 ng/dL: perform ACTH stimulation test; if peak 17‑OHP ≥1000 ng/dL, proceed to genetic testing.
If 17‑OHP < .170 ng/dL: reassess for PCOS or idiopathic hirsutism; no further NCCAH work‑up.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on random‑time 17‑OHP or DHEAS as primary screen; avoid testing in eumenorrheic women without hirsutism; false positives may occur with acute illness or stress; false negatives if sample not drawn in early morning; do not initiate glucocorticoids without confirmed diagnosis.

Concrete Clinical Example

A 28‑year‑old woman reports 6 months of amenorrhea, mild hirsutism (FG score 12), and requests evaluation for adrenal hyperplasia. Early morning 17‑OHP is 180 ng/dL (borderline). She has no family history. An ACTH stimulation test yields a peak 17‑OHP of 1200 ng/dL; genetic testing confirms a pathogenic CYP21A2 variant, establishing NCCAH diagnosis.

Source: Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, DOI: 10.1210/jc.2018-00241

TODO: consider adding scripts/calc.py for the endo-hirsutism-screen-nccah-amenorrhea calculator

---name: endo-hirsutism-screen-nccah-amenorrheadescription: Orders early morning 17‑hydroxyprogesterone to screen for nonclassic congenital adrenal hyperplasia due to 21‑hydroxylase deficiency in hyperandrogenemic women with amenorrhea or infrequent menses. Triggered by menstrual irregularity with hirsutism and a clinical request to rule out adrenal hyperplasia.---# Screen for NCCAH in amenorrheic or infrequent menses women## STEP 1 — Gather InformationCollect menstrual history (amenorrhea or <6 cycles/year), hirsutism assessment (Ferriman‑Gallwey score ≥8), signs of hyperandrogenism, family history of congenital adrenal hyperplasia, and ethnicity; order early morning (08:00–10:00) 17‑hydroxyprogesterone (17‑OHP) level.## STEP 2 — Rule In / Rule OutIs the early morning 17‑OHP ≥ .170 ng/dL (5.15 nmol/L)? - Yes → proceed to Step 3 (possible NCCAH). - No → rule out NCCAH; consider other causes of hyperandrogenism.## STEP 3 — Classify or StratifyClassify 17‑OHP: - .170–200 ng/dL (5.15–6.0 nmol/L): borderline positive (≈95% sensitive, 90% specific). - ≥1000 ng/dL (30–45 nmol/L): diagnostic for NCCAH. - < .170 ng/dL: negative.## STEP 4 — DecideIf 17‑OHP ≥1000 ng/dL: refer for CYP21A2 genetic testing and consider low‑dose glucocorticoid therapy. If 17‑OHP .170–200 ng/dL: perform ACTH stimulation test; if peak 17‑OHP ≥1000 ng/dL, proceed to genetic testing. If 17‑OHP < .170 ng/dL: reassess for PCOS or idiopathic hirsutism; no further NCCAH work‑up.## Clinical Guardrails / Mimics / PitfallsDo not rely on random‑time 17‑OHP or DHEAS as primary screen; avoid testing in eumenorrheic women without hirsutism; false positives may occur with acute illness or stress; false negatives if sample not drawn in early morning; do not initiate glucocorticoids without confirmed diagnosis.## Concrete Clinical ExampleA 28‑year‑old woman reports 6 months of amenorrhea, mild hirsutism (FG score 12), and requests evaluation for adrenal hyperplasia. Early morning 17‑OHP is 180 ng/dL (borderline). She has no family history. An ACTH stimulation test yields a peak 17‑OHP of 1200 ng/dL; genetic testing confirms a pathogenic CYP21A2 variant, establishing NCCAH diagnosis.**Source:** Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, DOI: 10.1210/jc.2018-00241 > **TODO:** consider adding scripts/calc.py for the endo-hirsutism-screen-nccah-amenorrhea calculator

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