How do I install the Es Acthd Screening Criteria skill?

Run npx skillmds@latest add dromlakhani/es-acthd-screening-criteria 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 Screening Criteria 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 Screening Criteria?

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 Screening Criteria free to use?

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

Who published Es Acthd Screening Criteria?

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

Es Acthd Screening Criteria by dromlakhani

Name: Es Acthd Screening Criteria
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Acthd Screening Criteria

This skill determines whether screening for adrenocorticotropic hormone deficiency (ACTHD) is indicated in childhood cancer survivors with hypothalamic‑pituitary axis radiation exposure between 24‑30 Gy. Screening is recommended when the survivor is >10 years post‑radiation or presents with clinical symptoms suggestive of adrenal insufficiency (e.g., fatigue, hypotension), triggered by questions such as “Should I screen for ACTHD in this survivor with 25 Gy radiation 12 years ago?” or “Does symptomatic adrenal insufficiency warrant ACTHD testing post‑moderate radiation?”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Assess ACTHD screening need based on radiation history

STEP 1 — Gather Information

Collect radiation dose to hypothalamic‑pituitary axis (Gy), years since radiation, and presence of symptoms suggestive of ACTHD (fatigue, hypotension, hyponatremia, hyperkalemia, unexplained weight loss, etc.).

STEP 2 — Rule In / Rule Out

Is the radiation dose between 24 Gy and 30 Gy (inclusive)? If no, screening for ACTHD is not indicated per this guideline (consider other etiologies). If yes, proceed to Step 3.

STEP 3 — Classify or Stratify

Is the survivor >10 years post‑radiation OR reporting clinical symptoms suggestive of ACTHD? If yes, screening is indicated. If no, routine screening per this guideline is not indicated; reassess if symptoms develop or time passes.

STEP 4 — Decide

If screening indicated, order a dynamic test for ACTHD (e.g., insulin tolerance test, low‑ or standard‑dose ACTH stimulation test) per guideline 6.3 (same as non‑cancer population). If not indicated, continue routine surveillance and re‑evaluate at next visit or if symptoms emerge.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on basal cortisol or ACTH levels alone; dynamic testing is required. Oral estrogen can raise cortisol‑binding globulin, elevating total cortisol while free cortisol remains normal. Consider mimics of fatigue/hypotension such as sepsis, dehydration, anemia, or other pituitary deficiencies (TSHD, GH deficiency). Avoid screening before 10 years post‑radiation unless symptoms appear, as ACTHD rarely manifests earlier.

Concrete Clinical Example

A 16‑year‑old survivor of medulloblastoma received 25 Gy craniospinal radiation 12 years ago and now reports fatigue and orthostatic hypotension. Since dose is 25 Gy (within (within 24‑30 Gy) and >10 years post‑radiation, screening for ACTHD is indicated; an insulin tolerance test is ordered.

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

TODO: consider adding scripts/calc.py for the es-acthd-screening-criteria calculator

---name: es-acthd-screening-criteriadescription: This skill determines whether screening for adrenocorticotropic hormone deficiency (ACTHD) is indicated in childhood cancer survivors with hypothalamic‑pituitary axis radiation exposure between 24‑30 Gy. Screening is recommended when the survivor is >10 years post‑radiation or presents with clinical symptoms suggestive of adrenal insufficiency (e.g., fatigue, hypotension), triggered by questions such as “Should I screen for ACTHD in this survivor with 25 Gy radiation 12 years ago?” or “Does symptomatic adrenal insufficiency warrant ACTHD testing post‑moderate radiation?”---# Assess ACTHD screening need based on radiation history## STEP 1 — Gather InformationCollect radiation dose to hypothalamic‑pituitary axis (Gy), years since radiation, and presence of symptoms suggestive of ACTHD (fatigue, hypotension, hyponatremia, hyperkalemia, unexplained weight loss, etc.).## STEP 2 — Rule In / Rule OutIs the radiation dose between 24 Gy and 30 Gy (inclusive)? If no, screening for ACTHD is not indicated per this guideline (consider other etiologies). If yes, proceed to Step 3.## STEP 3 — Classify or StratifyIs the survivor >10 years post‑radiation OR reporting clinical symptoms suggestive of ACTHD? If yes, screening is indicated. If no, routine screening per this guideline is not indicated; reassess if symptoms develop or time passes.## STEP 4 — DecideIf screening indicated, order a dynamic test for ACTHD (e.g., insulin tolerance test, low‑ or standard‑dose ACTH stimulation test) per guideline 6.3 (same as non‑cancer population). If not indicated, continue routine surveillance and re‑evaluate at next visit or if symptoms emerge.## Clinical Guardrails / Mimics / PitfallsDo not rely on basal cortisol or ACTH levels alone; dynamic testing is required. Oral estrogen can raise cortisol‑binding globulin, elevating total cortisol while free cortisol remains normal. Consider mimics of fatigue/hypotension such as sepsis, dehydration, anemia, or other pituitary deficiencies (TSHD, GH deficiency). Avoid screening before 10 years post‑radiation unless symptoms appear, as ACTHD rarely manifests earlier.## Concrete Clinical ExampleA 16‑year‑old survivor of medulloblastoma received 25 Gy craniospinal radiation 12 years ago and now reports fatigue and orthostatic hypotension. Since dose is 25 Gy (within (within 24‑30 Gy) and >10 years post‑radiation, screening for ACTHD is indicated; an insulin tolerance test is ordered.**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> **TODO:** consider adding scripts/calc.py for the es-acthd-screening-criteria calculator

Frequently asked questions