How do I install the Es Acthd Screening Indication skill?

Run npx skillmds@latest add dromlakhani/es-acthd-screening-indication 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 Indication 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 Indication?

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 Indication 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 Indication?

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

Es Acthd Screening Indication by dromlakhani

Name: Es Acthd Screening Indication
Rating: 4.5 (4 reviews)
Author: dromlakhani

Es Acthd Screening Indication

This skill identifies childhood cancer survivors who require lifelong annual screening for adrenocorticotropic hormone deficiency (ACTHD) based on hypothalamic-pituitary tumor history or radiation exposure ≥30 Gy. It is triggered by clinician questions such as “Does this survivor need yearly ACTH/cortisol testing?” or “Is annual adrenal function screening indicated post‑HP radiation?”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Screen for ACTHD indication

STEP 1 — Gather Information

Collect history of childhood cancer focusing on tumor location (hypothalamic‑pituitary region) and radiation dose to the hypothalamic‑pituitary axis (HP radiation). Also note any prior surgery involving the HP region.

STEP 2 — Rule In / Rule Out

Is there a history of tumor involving the hypothalamic‑pituitary region OR HP radiation ≥30 Gy? If yes, proceed to screening; if no, routine annual ACTHD screening is not indicated per this guideline (consider other risk factors elsewhere).

STEP 3 — Classify or Stratify

If the criterion is met, classify the survivor as requiring lifelong annual ACTH/cortisol screening.

STEP 4 — Decide

Order annual provocative testing for adrenal function (e.g., insulin tolerance test or low‑dose ACTH stimulation test) and measure morning cortisol. Provide education on adrenal insufficiency signs and stress‑dose glucocorticoid administration.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on random or basal cortisol/ACTH alone; dynamic testing is required to rule in/out ACTHD. Avoid screening if HP radiation <30 Gy without documented HP tumor/surgery. Remember that oral estrogen can raise cortisol‑binding globulin, affecting total cortisol interpretation. Do not miss coexisting pituitary deficiencies (TSH, LH/FSH, GH) that also need surveillance.

Concrete Clinical Example

A 25‑year‑old survivor of childhood craniopharyngioma received surgical resection followed by 35 Gy HP radiation. They are asymptomatic. Applying the skill, they undergo annual insulin tolerance testing; a subnormal cortisol response confirms ACTHD, leading to hydrocortisone replacement and stress‑dose education.

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-indication calculator

---name: es-acthd-screening-indicationdescription: This skill identifies childhood cancer survivors who require lifelong annual screening for adrenocorticotropic hormone deficiency (ACTHD) based on hypothalamic-pituitary tumor history or radiation exposure ≥30 Gy. It is triggered by clinician questions such as “Does this survivor need yearly ACTH/cortisol testing?” or “Is annual adrenal function screening indicated post‑HP radiation?”---# Screen for ACTHD indication## STEP 1 — Gather InformationCollect history of childhood cancer focusing on tumor location (hypothalamic‑pituitary region) and radiation dose to the hypothalamic‑pituitary axis (HP radiation). Also note any prior surgery involving the HP region.## STEP 2 — Rule In / Rule OutIs there a history of tumor involving the hypothalamic‑pituitary region OR HP radiation ≥30 Gy? If **yes**, proceed to screening; if **no**, routine annual ACTHD screening is not indicated per this guideline (consider other risk factors elsewhere).## STEP 3 — Classify or StratifyIf the criterion is met, classify the survivor as **requiring lifelong annual ACTH/cortisol screening**.## STEP 4 — DecideOrder annual provocative testing for adrenal function (e.g., insulin tolerance test or low‑dose ACTH stimulation test) and measure morning cortisol. Provide education on adrenal insufficiency signs and stress‑dose glucocorticoid administration.## Clinical Guardrails / Mimics / PitfallsDo not rely on random or basal cortisol/ACTH alone; dynamic testing is required to rule in/out ACTHD. Avoid screening if HP radiation <30 Gy without documented HP tumor/surgery. Remember that oral estrogen can raise cortisol‑binding globulin, affecting total cortisol interpretation. Do not miss coexisting pituitary deficiencies (TSH, LH/FSH, GH) that also need surveillance.## Concrete Clinical ExampleA 25‑year‑old survivor of childhood craniopharyngioma received surgical resection followed by 35 Gy HP radiation. They are asymptomatic. Applying the skill, they undergo annual insulin tolerance testing; a subnormal cortisol response confirms ACTHD, leading to hydrocortisone replacement and stress‑dose education.**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-indication calculator

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