How do I install the Endo Srl Primary Unresectable Surgery skill?

Run npx skillmds@latest add dromlakhani/endo-srl-primary-unresectable-surgery 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 Srl Primary Unresectable Surgery 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 Srl Primary Unresectable Surgery?

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 Srl Primary Unresectable Surgery free to use?

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

Who published Endo Srl Primary Unresectable Surgery?

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

Endo Srl Primary Unresectable Surgery by dromlakhani

Name: Endo Srl Primary Unresectable Surgery
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Srl Primary Unresectable Surgery

Recommends initiating a somatostatin receptor ligand (SRL) as primary medical therapy for acromegaly when curative surgery is not possible. Consider this approach in patients with extensive cavernous sinus invasion, absence of chiasmal compression, or those deemed poor surgical candidates.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

SRL as primary therapy when surgery not curative

STEP 1 — Gather Information

Confirm biochemical diagnosis of acromegaly (elevated IGF-1, lack of GH suppression). Obtain pituitary MRI to assess tumor size, cavernous sinus invasion, and relationship to optic chiasm. Evaluate surgical candidacy (comorbidities, patient preference, anesthetic risk). Record baseline IGF-1, GH, visual field, and surgical risk assessment.

STEP 2 — Rule In / Rule Out

If MRI shows resectable tumor with low morbidity and the patient is a suitable surgical candidate, proceed to transsphenoidal surgery (outside this skill); otherwise, indicate that curative surgery is not feasible and advance to step 3.

STEP 3 — Classify or Stratify

Classify the patient as having extensive cavernous sinus invasion (MRI grade ≥2), lack of chiasmal compression, or being a poor surgical candidate (ASA ≥3, uncontrolled comorbidities, or patient refusal). This classification confirms eligibility for primary SRL therapy.

STEP 4 — Decide

Initiate long-acting SRL therapy (octreotide LAR 20 mg IM monthly or lanreotide autogel 90 mg SC monthly). Schedule IGF-1 and GH assessment 12 weeks after start to evaluate biochemical response.

Clinical Guardrails / Mimics / Pitfalls

Do not use SRL as primary therapy when there is compressive optic chiasm syndrome requiring urgent decompression. Avoid SRL monotherapy if the patient is a good surgical candidate with low operative risk. Monitor for SRL‑related side effects (gallstones, gastrointestinal disturbances, glucose intolerance) and adjust dose or add pegvisomant if IGF-1 remains elevated after 3‑6 months.

Concrete Clinical Example

A 48‑year‑old woman with acromegaly presents with headaches and acral enlargement. IGF-1 is 2.5 × ULN, GH fails to suppress. MRI shows a 12 mm macroadenoma with bilateral cavernous sinus invasion but no optic chiasm contact. She has poorly controlled type 2 diabetes and declines surgery. Start octreotide LAR 20 mg IM monthly; re‑check IGF-1 at 12 weeks.

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

---name: endo-srl-primary-unresectable-surgerydescription: Recommends initiating a somatostatin receptor ligand (SRL) as primary medical therapy for acromegaly when curative surgery is not possible. Consider this approach in patients with extensive cavernous sinus invasion, absence of chiasmal compression, or those deemed poor surgical candidates.---# SRL as primary therapy when surgery not curative## STEP 1 — Gather InformationConfirm biochemical diagnosis of acromegaly (elevated IGF-1, lack of GH suppression). Obtain pituitary MRI to assess tumor size, cavernous sinus invasion, and relationship to optic chiasm. Evaluate surgical candidacy (comorbidities, patient preference, anesthetic risk). Record baseline IGF-1, GH, visual field, and surgical risk assessment.## STEP 2 — Rule In / Rule OutIf MRI shows resectable tumor with low morbidity and the patient is a suitable surgical candidate, proceed to transsphenoidal surgery (outside this skill); otherwise, indicate that curative surgery is not feasible and advance to step 3.## STEP 3 — Classify or StratifyClassify the patient as having extensive cavernous sinus invasion (MRI grade ≥2), lack of chiasmal compression, or being a poor surgical candidate (ASA ≥3, uncontrolled comorbidities, or patient refusal). This classification confirms eligibility for primary SRL therapy.## STEP 4 — DecideInitiate long-acting SRL therapy (octreotide LAR 20 mg IM monthly or lanreotide autogel 90 mg SC monthly). Schedule IGF-1 and GH assessment 12 weeks after start to evaluate biochemical response.## Clinical Guardrails / Mimics / PitfallsDo not use SRL as primary therapy when there is compressive optic chiasm syndrome requiring urgent decompression. Avoid SRL monotherapy if the patient is a good surgical candidate with low operative risk. Monitor for SRL‑related side effects (gallstones, gastrointestinal disturbances, glucose intolerance) and adjust dose or add pegvisomant if IGF-1 remains elevated after 3‑6 months.## Concrete Clinical ExampleA 48‑year‑old woman with acromegaly presents with headaches and acral enlargement. IGF-1 is 2.5 × ULN, GH fails to suppress. MRI shows a 12 mm macroadenoma with bilateral cavernous sinus invasion but no optic chiasm contact. She has poorly controlled type 2 diabetes and declines surgery. Start octreotide LAR 20 mg IM monthly; re‑check IGF-1 at 12 weeks.**Source:** Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700

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