How do I install the Endo Igf1 Typical Manifestations skill?

Run npx skillmds@latest add dromlakhani/endo-igf1-typical-manifestations 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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Is Endo Igf1 Typical Manifestations free to use?

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Who published Endo Igf1 Typical Manifestations?

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

Endo Igf1 Typical Manifestations by dromlakhani

Name: Endo Igf1 Typical Manifestations
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Igf1 Typical Manifestations

Recommends measuring serum IGF-1 to screen for acromegaly in patients presenting with typical acral and facial manifestations such as enlarging ring or shoe size, macroglossia, or frontal bossing. Trigger phrases include “acral enlargement,” “facial coarsening,” “prognathism,” or “spade‑like hands” prompting IGF-1 measurement.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Measure IGF-1 in typical acromegaly manifestations

STEP 1 — Gather Information

Ask about progressive acral changes (ring, shoe, glove size), facial changes (coarsening, prognathism, forehead prominence), symptoms (headache, visual field changes, arthralgia, fatigue), and screen for comorbidities (sleep apnea, diabetes, hypertension, carpal tunnel syndrome). If typical features are present, proceed to IGF-1 measurement.

STEP 2 — Rule In / Rule Out

Are typical acromegaly manifestations (acral/facial features) present?

Yes: Measure serum IGF-1 using an age‑adjusted assay.
No: Consider alternative diagnoses; IGF-1 measurement is not routinely indicated unless atypical presentation with associated conditions (e.g., unexplained diabetes, sleep apnea).

STEP 3 — Classify or Stratify

Interpret IGF-1 against age‑adjusted normal limits for the specific assay.

Elevated (> upper limit of normal): Proceed to confirmatory testing (GH suppression).
Normal or low: Acromegaly unlikely; reassess clinically, consider assay pitfalls, and monitor for symptom progression.

STEP 4 — Decide

If IGF-1 is elevated, order an oral glucose tolerance test for GH suppression and obtain a pituitary MRI.
If IGF-1 is normal, pursue other diagnoses, repeat IGF-1 only if clinical suspicion remains high or if confounding factors (renal/hepatic failure, hypothyroidism) are suspected.

Clinical Guardrails / Mimics / Pitfalls

IGF-1 assays show inter‑laboratory variability; always use age‑adjusted norms. False‑low results may occur in renal or hepatic failure, untreated hypothyroidism, malnutrition, or pregnancy. Do not rely on random GH alone for screening. Avoid delaying MRI when IGF-1 is clearly elevated. Beware of assay interference from heterophilic antibodies or rheumatoid factor.

Concrete Clinical Example

A 45‑year‑old woman notes her ring size increased from 6 to 8 over 18 months, shoe size increased, and she reports new‑onset jaw protrusion and frontal bossing with snoring and morning headaches. Serum IGF-1 is 2.5 × the age‑adjusted upper limit of normal. Proceed to OGTT for GH suppression and pituitary MRI.

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

---name: endo-igf1-typical-manifestationsdescription: Recommends measuring serum IGF-1 to screen for acromegaly in patients presenting with typical acral and facial manifestations such as enlarging ring or shoe size, macroglossia, or frontal bossing. Trigger phrases include “acral enlargement,” “facial coarsening,” “prognathism,” or “spade‑like hands” prompting IGF-1 measurement.---# Measure IGF-1 in typical acromegaly manifestations## STEP 1 — Gather InformationAsk about progressive acral changes (ring, shoe, glove size), facial changes (coarsening, prognathism, forehead prominence), symptoms (headache, visual field changes, arthralgia, fatigue), and screen for comorbidities (sleep apnea, diabetes, hypertension, carpal tunnel syndrome). If typical features are present, proceed to IGF-1 measurement.## STEP 2 — Rule In / Rule OutAre typical acromegaly manifestations (acral/facial features) present? - **Yes:** Measure serum IGF-1 using an age‑adjusted assay. - **No:** Consider alternative diagnoses; IGF-1 measurement is not routinely indicated unless atypical presentation with associated conditions (e.g., unexplained diabetes, sleep apnea).## STEP 3 — Classify or StratifyInterpret IGF-1 against age‑adjusted normal limits for the specific assay. - **Elevated (> upper limit of normal):** Proceed to confirmatory testing (GH suppression). - **Normal or low:** Acromegaly unlikely; reassess clinically, consider assay pitfalls, and monitor for symptom progression.## STEP 4 — DecideIf IGF-1 is elevated, order an oral glucose tolerance test for GH suppression and obtain a pituitary MRI. If IGF-1 is normal, pursue other diagnoses, repeat IGF-1 only if clinical suspicion remains high or if confounding factors (renal/hepatic failure, hypothyroidism) are suspected.## Clinical Guardrails / Mimics / PitfallsIGF-1 assays show inter‑laboratory variability; always use age‑adjusted norms. False‑low results may occur in renal or hepatic failure, untreated hypothyroidism, malnutrition, or pregnancy. Do not rely on random GH alone for screening. Avoid delaying MRI when IGF-1 is clearly elevated. Beware of assay interference from heterophilic antibodies or rheumatoid factor.## Concrete Clinical ExampleA 45‑year‑old woman notes her ring size increased from 6 to 8 over 18 months, shoe size increased, and she reports new‑onset jaw protrusion and frontal bossing with snoring and morning headaches. Serum IGF-1 is 2.5 × the age‑adjusted upper limit of normal. Proceed to OGTT for GH suppression and pituitary MRI.**Source:** Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, doi:10.1210/jc.2014-2700

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