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Run npx skillmds@latest add dromlakhani/endo-serial-visual-field-pregnancy-macroadenoma 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 Serial Visual Field Pregnancy Macroadenoma by dromlakhani

Name: Endo Serial Visual Field Pregnancy Macroadenoma
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Serial Visual Field Pregnancy Macroadenoma

Recommends serial visual field testing during pregnancy for patients with acromegaly who harbor a macroadenoma to monitor for neurologic deterioration. Trigger when a pregnant acromegaly patient has a known pituitary macroadenoma.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Suggest serial visual field testing in pregnant patients with macroadenomas

STEP 1 — Gather Information

Confirm pregnancy, verify acromegaly diagnosis (elevated IGF-1 with lack of GH suppression to <1 µg/L after oral glucose load), document macroadenoma on pituitary MRI (size ≥10 mm), obtain baseline visual field testing and assess for headache or visual symptoms.
Action: Proceed to assess need for serial visual field testing.

STEP 2 — Rule In / Rule Out

Is a pituitary macroadenoma present on imaging?

Yes: Proceed to classification.
No: Do not recommend serial visual field testing; manage per routine prenatal care.
Action: Branch based on macroadenoma presence.

STEP 3 — Classify or Stratify

Assess for visual symptoms (headache, visual field defects) or known chiasmal abutment/compression on MRI.

High risk: Visual symptoms or chiasmal involvement.
Moderate risk: Asymptomatic macroadenoma without chiasmal signs.
Action: Assign risk category.

STEP 4 — Decide

High risk: Perform visual field testing at baseline and each trimester (or every 3 months) throughout pregnancy.
Moderate risk: Perform baseline visual field testing and repeat each trimester or if new neurologic symptoms arise.
Action: Implement scheduled visual field monitoring.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on GH or IGF-1 monitoring during pregnancy (per guideline 7.5) to assess tumor activity. Avoid delaying testing until symptomatic worsening; macroadenoma growth can be asymptomatic. Do not substitute CT for MRI when MRI is contraindicated without neurosurgical input. Remember to discontinue long-acting SRLs ≈2 months before conception per guideline 7.2.

Concrete Clinical Example

A 32‑year‑old woman with known acromegaly and a 12 mm macroadenoma becomes pregnant; baseline visual field is normal. At 16 weeks she reports mild bilateral temporal blurring. Repeat testing shows emerging bitemporal hemianopia, prompting neurosurgical consultation for tumor debulking.

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

---name: endo-serial-visual-field-pregnancy-macroadenomadescription: Recommends serial visual field testing during pregnancy for patients with acromegaly who harbor a macroadenoma to monitor for neurologic deterioration. Trigger when a pregnant acromegaly patient has a known pituitary macroadenoma.---# Suggest serial visual field testing in pregnant patients with macroadenomas## STEP 1 — Gather InformationConfirm pregnancy, verify acromegaly diagnosis (elevated IGF-1 with lack of GH suppression to <1 µg/L after oral glucose load), document macroadenoma on pituitary MRI (size ≥10 mm), obtain baseline visual field testing and assess for headache or visual symptoms. **Action:** Proceed to assess need for serial visual field testing.## STEP 2 — Rule In / Rule OutIs a pituitary macroadenoma present on imaging? - **Yes:** Proceed to classification. - **No:** Do not recommend serial visual field testing; manage per routine prenatal care. **Action:** Branch based on macroadenoma presence.## STEP 3 — Classify or StratifyAssess for visual symptoms (headache, visual field defects) or known chiasmal abutment/compression on MRI. - **High risk:** Visual symptoms or chiasmal involvement. - **Moderate risk:** Asymptomatic macroadenoma without chiasmal signs. **Action:** Assign risk category.## STEP 4 — Decide- **High risk:** Perform visual field testing at baseline and each trimester (or every 3 months) throughout pregnancy. - **Moderate risk:** Perform baseline visual field testing and repeat each trimester or if new neurologic symptoms arise. **Action:** Implement scheduled visual field monitoring.## Clinical Guardrails / Mimics / PitfallsDo not rely on GH or IGF-1 monitoring during pregnancy (per guideline 7.5) to assess tumor activity. Avoid delaying testing until symptomatic worsening; macroadenoma growth can be asymptomatic. Do not substitute CT for MRI when MRI is contraindicated without neurosurgical input. Remember to discontinue long-acting SRLs ≈2 months before conception per guideline 7.2.## Concrete Clinical ExampleA 32‑year‑old woman with known acromegaly and a 12 mm macroadenoma becomes pregnant; baseline visual field is normal. At 16 weeks she reports mild bilateral temporal blurring. Repeat testing shows emerging bitemporal hemianopia, prompting neurosurgical consultation for tumor debulking.**Source:** Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, doi:10.1210/jc.2014-2700

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