How do I install the Es Acthd Diagnostic Procedure skill?

Run npx skillmds@latest add dromlakhani/es-acthd-diagnostic-procedure 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 Es Acthd Diagnostic Procedure safe to use?

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Which AI agents work with Es Acthd Diagnostic Procedure?

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 Es Acthd Diagnostic Procedure free to use?

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

Who published Es Acthd Diagnostic Procedure?

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

Es Acthd Diagnostic Procedure by dromlakhani

Name: Es Acthd Diagnostic Procedure
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Es Acthd Diagnostic Procedure

This skill determines the appropriate screening and dynamic testing procedures (e.g., insulin tolerance test, standard or high-dose ACTH stimulation) for diagnosing adrenocorticotropic hormone deficiency in childhood cancer survivors, recommending the same methods used in the noncancer population. Triggers include clinician questions such as “How should I test for ACTHD in this survivor?” or “What dynamic test is appropriate for adrenal insufficiency evaluation?”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Select ACTHD diagnostic method

STEP 1 — Gather Information

Collect history of hypothalamic–pituitary radiation dose ≥30 Gy, tumor/surgery involving the HP region, presence of other pituitary hormone deficits, and clinical symptoms suggestive of ACTHD (e.g., chronic fatigue, hypotension, hyponatremia, hypoglycemia, weight loss). Also verify prior annual screening results if available.

STEP 2 — Rule In / Rule Out

If the survivor has risk factors and/or symptoms, proceed to dynamic testing; if no risk factors and asymptomatic, routine annual screening suffices and no further testing is needed.

STEP 3 — Classify or Stratify

Choose the insulin tolerance test (ITT) as the preferred dynamic test when safe; if ITT is contraindicated (e.g., seizure disorder, ischemic heart disease), use a standard- or high-dose ACTH stimulation test instead.

STEP 4 — Decide

Perform the selected test and interpret using established cutoffs (ITT: peak cortisol <5 µg/dL indicates ACTHD; ACTH stimulation: peak cortisol <18 µg/dL after 250 µg cosyntropin indicates deficiency). Confirm diagnosis and initiate glucocorticoid replacement education and stress‑dose planning.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on basal cortisol or low‑dose ACTH stimulation to rule out ACTHD; be aware that oral estrogen raises total cortisol‑binding globulin, potentially masking free cortisol deficiency; avoid CRH or glucagon stimulation as primary tests; ITT is contraindicated in uncontrolled epilepsy or significant coronary artery disease.

Concrete Clinical Example

A 16‑year‑old survivor of craniopharyngioma treated with 35 Gy cranial radiation reports fatigue and mild hyponatremia. Annual screening shows a low morning cortisol. An ITT is performed; cortisol fails to rise above 4 µg/dL, confirming ACTHD. The patient receives glucocorticoid replacement instructions and an emergency card.

Source: Hypothalamic Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, DOI:10.1210/jc.2018-01175

---name: es-acthd-diagnostic-proceduredescription: This skill determines the appropriate screening and dynamic testing procedures (e.g., insulin tolerance test, standard or high-dose ACTH stimulation) for diagnosing adrenocorticotropic hormone deficiency in childhood cancer survivors, recommending the same methods used in the noncancer population. Triggers include clinician questions such as “How should I test for ACTHD in this survivor?” or “What dynamic test is appropriate for adrenal insufficiency evaluation?”---# Select ACTHD diagnostic method## STEP 1 — Gather InformationCollect history of hypothalamic–pituitary radiation dose ≥30 Gy, tumor/surgery involving the HP region, presence of other pituitary hormone deficits, and clinical symptoms suggestive of ACTHD (e.g., chronic fatigue, hypotension, hyponatremia, hypoglycemia, weight loss). Also verify prior annual screening results if available.## STEP 2 — Rule In / Rule OutIf the survivor has risk factors and/or symptoms, proceed to dynamic testing; if no risk factors and asymptomatic, routine annual screening suffices and no further testing is needed.## STEP 3 — Classify or StratifyChoose the insulin tolerance test (ITT) as the preferred dynamic test when safe; if ITT is contraindicated (e.g., seizure disorder, ischemic heart disease), use a standard- or high-dose ACTH stimulation test instead.## STEP 4 — DecidePerform the selected test and interpret using established cutoffs (ITT: peak cortisol <5 µg/dL indicates ACTHD; ACTH stimulation: peak cortisol <18 µg/dL after 250 µg cosyntropin indicates deficiency). Confirm diagnosis and initiate glucocorticoid replacement education and stress‑dose planning.## Clinical Guardrails / Mimics / PitfallsDo not rely on basal cortisol or low‑dose ACTH stimulation to rule out ACTHD; be aware that oral estrogen raises total cortisol‑binding globulin, potentially masking free cortisol deficiency; avoid CRH or glucagon stimulation as primary tests; ITT is contraindicated in uncontrolled epilepsy or significant coronary artery disease.## Concrete Clinical ExampleA 16‑year‑old survivor of craniopharyngioma treated with 35 Gy cranial radiation reports fatigue and mild hyponatremia. Annual screening shows a low morning cortisol. An ITT is performed; cortisol fails to rise above 4 µg/dL, confirming ACTHD. The patient receives glucocorticoid replacement instructions and an emergency card.**Source:** Hypothalamic Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, DOI:10.1210/jc.2018-01175

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