How do I install the Es Acthd Patient Education skill?

Run npx skillmds@latest add dromlakhani/es-acthd-patient-education 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 Patient Education 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 Es Acthd Patient Education?

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 Patient Education free to use?

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

Who published Es Acthd Patient Education?

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

Es Acthd Patient Education by dromlakhani

Name: Es Acthd Patient Education
Rating: 4.5 (4 reviews)
Author: dromlakhani

Es Acthd Patient Education

This skill outlines the essential patient education points for childhood cancer survivors with adrenocorticotropic hormone deficiency (ACTHD), covering stress‑dose glucocorticoid instructions, emergency injectable glucocorticoid administration, and the need for medical alert identification and an emergency kit. It is triggered when a clinician asks, “What should I teach this patient about adrenal crisis management?” or “How do I prepare this survivor for potential adrenal insufficiency?”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Educate on ACTHD emergency management

STEP 1 — Gather Information

Confirm ACTHD diagnosis (e.g., subnormal cortisol on ACTH stimulation test), note patient age, developmental stage, caregiver availability, prior adrenal insufficiency education, current glucocorticoid replacement regimen, and comorbidities that may affect crisis recognition. If ACTHD is confirmed, proceed to rule‑in step; otherwise, provide general follow‑up education.

STEP 2 — Rule In / Rule Out

Determine whether ACTHD is definitively diagnosed. If ACTHD is ruled out (no confirmed deficiency), deliver standard endocrine surveillance counseling and end the skill. If ACTHD is ruled in, advance to stratification.

STEP 3 — Classify or Stratify

Stratify by the patient’s ability to self‑administer emergency glucocorticoid (independent adolescent vs. young child requiring caregiver) and by access to emergency medical services (remote vs. urban). This determines whether to emphasize caregiver training versus self‑administration and the complexity of kit instructions.

STEP 4 — Decide

Deliver tailored education: (a) stress‑dose rules (double oral glucocorticoid for fever > 38 °C or vomiting; triple for severe illness, surgery, or inability to take oral meds); (b) demonstrate how to draw up and inject emergency IM/SC hydrocortisone (e.g., 50 mg/m² or 100 mg for children, 200 mg for adults) and when to give (vomiting, inability to take oral meds, signs of shock); (c) instruct to wear a medical alert bracelet/necklace stating “Adrenal Insufficiency – Requires Stress Dose Steroid”; (d) prescribe an emergency kit with injectable glucocorticoid, syringe, alcohol swabs, and instructions, and advise to check expiration every 6 months.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on oral dose increases during a crisis; delayed injection can be fatal. Avoid confusing stress‑dose with routine dosing. Do not omit caregiver training if the patient is young. Do not forget to renew the emergency kit and verify the patient knows not to use it for non‑emergency situations. Mimics such as hypoglycemia, sepsis, or gastroenteritis can present similarly; if adrenal insufficiency is suspected, give glucocorticoid promptly while seeking emergency care.

Concrete Clinical Example

A 14‑year‑old survivor of a craniopharyngioma treated with 35 Gy hypothalamic‑pituitary radiation presents for routine follow‑up. Laboratory testing shows a subnormal cortisol response to ACTH stimulation, confirming ACTHD. The clinician verifies the diagnosis, notes the patient is independent and lives nearby, then provides stress‑dose instructions (double hydrocortisone for fever > 38 °C, triple for vomiting or inability to take oral meds), demonstrates IM injection of 100 mg hydrocortisone, prescribes a medical alert bracelet, and supplies an emergency kit with instructions to replace the vial annually.

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

---name: es-acthd-patient-educationdescription: This skill outlines the essential patient education points for childhood cancer survivors with adrenocorticotropic hormone deficiency (ACTHD), covering stress‑dose glucocorticoid instructions, emergency injectable glucocorticoid administration, and the need for medical alert identification and an emergency kit. It is triggered when a clinician asks, “What should I teach this patient about adrenal crisis management?” or “How do I prepare this survivor for potential adrenal insufficiency?”---# Educate on ACTHD emergency management## STEP 1 — Gather InformationConfirm ACTHD diagnosis (e.g., subnormal cortisol on ACTH stimulation test), note patient age, developmental stage, caregiver availability, prior adrenal insufficiency education, current glucocorticoid replacement regimen, and comorbidities that may affect crisis recognition. If ACTHD is confirmed, proceed to rule‑in step; otherwise, provide general follow‑up education.## STEP 2 — Rule In / Rule OutDetermine whether ACTHD is definitively diagnosed. If ACTHD is ruled out (no confirmed deficiency), deliver standard endocrine surveillance counseling and end the skill. If ACTHD is ruled in, advance to stratification.## STEP 3 — Classify or StratifyStratify by the patient’s ability to self‑administer emergency glucocorticoid (independent adolescent vs. young child requiring caregiver) and by access to emergency medical services (remote vs. urban). This determines whether to emphasize caregiver training versus self‑administration and the complexity of kit instructions.## STEP 4 — DecideDeliver tailored education: (a) stress‑dose rules (double oral glucocorticoid for fever > 38 °C or vomiting; triple for severe illness, surgery, or inability to take oral meds); (b) demonstrate how to draw up and inject emergency IM/SC hydrocortisone (e.g., 50 mg/m² or 100 mg for children, 200 mg for adults) and when to give (vomiting, inability to take oral meds, signs of shock); (c) instruct to wear a medical alert bracelet/necklace stating “Adrenal Insufficiency – Requires Stress Dose Steroid”; (d) prescribe an emergency kit with injectable glucocorticoid, syringe, alcohol swabs, and instructions, and advise to check expiration every 6 months.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on oral dose increases during a crisis; delayed injection can be fatal. Avoid confusing stress‑dose with routine dosing. Do not omit caregiver training if the patient is young. Do not forget to renew the emergency kit and verify the patient knows not to use it for non‑emergency situations. Mimics such as hypoglycemia, sepsis, or gastroenteritis can present similarly; if adrenal insufficiency is suspected, give glucocorticoid promptly while seeking emergency care.## Concrete Clinical ExampleA 14‑year‑old survivor of a craniopharyngioma treated with 35 Gy hypothalamic‑pituitary radiation presents for routine follow‑up. Laboratory testing shows a subnormal cortisol response to ACTH stimulation, confirming ACTHD. The clinician verifies the diagnosis, notes the patient is independent and lives nearby, then provides stress‑dose instructions (double hydrocortisone for fever > 38 °C, triple for vomiting or inability to take oral meds), demonstrates IM injection of 100 mg hydrocortisone, prescribes a medical alert bracelet, and supplies an emergency kit with instructions to replace the vial annually.**Source:** Endocrine Society Clinical Practice Guideline – Hypothalamic Pituitary and Growth Disorders in Survivors of Childhood Cancer, Endocrine Society, 2018, doi:10.1210/jc.2018-01175

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