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Run npx skillmds@latest add dromlakhani/endo-igf1-atypical-with-comorbidities 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 Igf1 Atypical With Comorbidities by dromlakhani

Name: Endo Igf1 Atypical With Comorbidities
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Igf1 Atypical With Comorbidities

This skill suggests measuring serum IGF-1 in patients who lack typical acromegaly features but present with associated comorbidities such as sleep apnea, type 2 diabetes, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, or hypertension. It is triggered when a clinician encounters a patient with these conditions without classic signs of acromegaly.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Measure IGF-1 in atypical presentation with comorbidities

STEP 1 — Gather Information

Collect history for the presence of sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension; simultaneously assess for typical acromegaly features (acral enlargement, coarse facial features, prognathism) to confirm their absence.

STEP 2 — Rule In / Rule Out

If the patient has two or more of the listed comorbidities AND lacks typical acromegaly features, proceed to measure IGF-1; otherwise, do not measure IGF-1 and consider alternative explanations for the comorbidities.

STEP 3 — Classify or Stratify

Interpret the IGF-1 result using age‑adjusted normal ranges for the specific assay: an elevated IGF-1 suggests possible acromegaly, while a normal IGF-1 makes acromegaly unlikely.

STEP 4 — Decide

If IGF-1 is elevated, proceed to confirm diagnosis with an oral glucose tolerance test (GH suppression) and pituitary MRI; if IGF-1 is normal, pursue other etiologies for the comorbidities and reconsider acromegaly only if new typical features emerge.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on random GH alone for diagnosis; IGF-1 assays show inter‑laboratory variability, so use the same assay consistently; avoid IGF-1 testing in pregnancy, renal or hepatic failure, or malnutrition without adjusting for known confounders; normal IGF-1 does not exclude acromegaly if assay is inappropriate or if there is assay interference.

Concrete Clinical Example

A 48‑year‑old woman presents with newly diagnosed hypertension, type 2 diabetes, and bilateral carpal tunnel syndrome; she notes no change in ring or shoe size and her facial appearance is unchanged. IGF-1 is measured and found elevated above the age‑adjusted norm. An oral glucose tolerance test shows failure to suppress GH below 1 µg/L, and a pituitary MRI reveals a 12 mm macroadenoma, leading to a diagnosis of acromegaly.

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

---name: endo-igf1-atypical-with-comorbiditiesdescription: This skill suggests measuring serum IGF-1 in patients who lack typical acromegaly features but present with associated comorbidities such as sleep apnea, type 2 diabetes, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, or hypertension. It is triggered when a clinician encounters a patient with these conditions without classic signs of acromegaly.---# Measure IGF-1 in atypical presentation with comorbidities## STEP 1 — Gather InformationCollect history for the presence of sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension; simultaneously assess for typical acromegaly features (acral enlargement, coarse facial features, prognathism) to confirm their absence.## STEP 2 — Rule In / Rule OutIf the patient has two or more of the listed comorbidities AND lacks typical acromegaly features, proceed to measure IGF-1; otherwise, do not measure IGF-1 and consider alternative explanations for the comorbidities.## STEP 3 — Classify or StratifyInterpret the IGF-1 result using age‑adjusted normal ranges for the specific assay: an elevated IGF-1 suggests possible acromegaly, while a normal IGF-1 makes acromegaly unlikely.## STEP 4 — DecideIf IGF-1 is elevated, proceed to confirm diagnosis with an oral glucose tolerance test (GH suppression) and pituitary MRI; if IGF-1 is normal, pursue other etiologies for the comorbidities and reconsider acromegaly only if new typical features emerge.## Clinical Guardrails / Mimics / PitfallsDo not rely on random GH alone for diagnosis; IGF-1 assays show inter‑laboratory variability, so use the same assay consistently; avoid IGF-1 testing in pregnancy, renal or hepatic failure, or malnutrition without adjusting for known confounders; normal IGF-1 does not exclude acromegaly if assay is inappropriate or if there is assay interference.## Concrete Clinical ExampleA 48‑year‑old woman presents with newly diagnosed hypertension, type 2 diabetes, and bilateral carpal tunnel syndrome; she notes no change in ring or shoe size and her facial appearance is unchanged. IGF-1 is measured and found elevated above the age‑adjusted norm. An oral glucose tolerance test shows failure to suppress GH below 1 µg/L, and a pituitary MRI reveals a 12 mm macroadenoma, leading to a diagnosis of acromegaly.**Source:** Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700

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