How do I install the Es Acthd Treatment Regimen skill?

Run npx skillmds@latest add dromlakhani/es-acthd-treatment-regimen 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 Treatment Regimen safe to use?

This skill has not completed SkillMD's automated safety review yet. Independent scanners report: SkillSpector: PASS, Skill Scanner: PASS. Capability flags: makes network calls. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Es Acthd Treatment Regimen?

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 Treatment Regimen free to use?

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

Who published Es Acthd Treatment Regimen?

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

Es Acthd Treatment Regimen by dromlakhani

Name: Es Acthd Treatment Regimen
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Acthd Treatment Regimen

This skill identifies the appropriate glucocorticoid replacement regimen for childhood cancer survivors with adrenocorticotropic hormone deficiency (ACTHD), recommending hydrocortisone dosing and stress coverage strategies identical to those used in the noncancer population. Triggers include clinician questions such as “What steroid dose should I use for ACTHD replacement?” or “How do I determine glucocorticoid therapy for adrenal insufficiency?”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Select glucocorticoid regimen for ACTHD

STEP 1 — Gather Information

Confirm ACTHD diagnosis via appropriate dynamic testing (e.g., insulin tolerance test or low-/high-dose ACTH stimulation test) per guideline 6.3; obtain baseline weight, height, and body surface area; assess for concurrent illnesses or planned procedures requiring stress dosing; review current medications that may affect cortisol metabolism (e.g., enzyme-inducing antiepileptics).

STEP 2 — Rule In / Rule Out

Is ACTHD biochemically confirmed? If yes, proceed to glucocorticoid replacement planning; if no, reconsider diagnosis and evaluate for other causes of fatigue, hypotension, or hyponatremia (e.g., primary adrenal insufficiency, sepsis, medication effect) before initiating steroids.

STEP 3 — Classify or Stratify

Calculate physiologic hydrocortisone dose based on body surface area: typical pediatric replacement is 8–10 mg/m²/day divided into two or three doses (e.g., higher dose in the morning). Adjust for age/weight if BSA unavailable: approximate 0.15–0.2 mg/kg/dose TID.

STEP 4 — Decide

Prescribe calculated hydrocortisone regimen with standard stress coverage: double or triple the daily dose during mild illness, fever, or minor stress; administer parenteral hydrocortisone (50–100 mg/m² bolus then continuous infusion or q6h dosing) for major stress, surgery, or adrenal crisis; provide emergency injectable kit and medical alert identification.

Clinical Guardrails / Mimics / Pitfalls

Do not confuse ACTHD with primary adrenal insufficiency (which requires mineralocorticoid replacement); avoid over-replacement to prevent iatrogenic Cushingoid features, weight gain, or bone loss; remember that enzyme-inducing antiepileptics may increase hydrocortisone clearance, necessitating higher doses; never abruptly discontinue glucocorticoids without taper; stress dosing is essential during illness, surgery, or trauma to prevent adrenal crisis.

Concrete Clinical Example

A 12-year-old female survivor of craniopharyngioma treated with 36 Gy cranial radiation presents with fatigue and hypotension; ACTHD confirmed by low-dose ACTH stimulation test. Weight 38 kg, BSA ~1.2 m². Prescribe hydrocortisone 10 mg/m²/day = 12 mg total daily, divided as 6 mg AM, 3 mg early afternoon, 3 mg late afternoon. For fever >38°C, double dose to 24 mg/day divided TID. Provide emergency hydrocortisone injection card.

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

---name: es-acthd-treatment-regimendescription: This skill identifies the appropriate glucocorticoid replacement regimen for childhood cancer survivors with adrenocorticotropic hormone deficiency (ACTHD), recommending hydrocortisone dosing and stress coverage strategies identical to those used in the noncancer population. Triggers include clinician questions such as “What steroid dose should I use for ACTHD replacement?” or “How do I determine glucocorticoid therapy for adrenal insufficiency?”---# Select glucocorticoid regimen for ACTHD## STEP 1 — Gather InformationConfirm ACTHD diagnosis via appropriate dynamic testing (e.g., insulin tolerance test or low-/high-dose ACTH stimulation test) per guideline 6.3; obtain baseline weight, height, and body surface area; assess for concurrent illnesses or planned procedures requiring stress dosing; review current medications that may affect cortisol metabolism (e.g., enzyme-inducing antiepileptics).## STEP 2 — Rule In / Rule OutIs ACTHD biochemically confirmed? If yes, proceed to glucocorticoid replacement planning; if no, reconsider diagnosis and evaluate for other causes of fatigue, hypotension, or hyponatremia (e.g., primary adrenal insufficiency, sepsis, medication effect) before initiating steroids.## STEP 3 — Classify or StratifyCalculate physiologic hydrocortisone dose based on body surface area: typical pediatric replacement is 8–10 mg/m²/day divided into two or three doses (e.g., higher dose in the morning). Adjust for age/weight if BSA unavailable: approximate 0.15–0.2 mg/kg/dose TID.## STEP 4 — DecidePrescribe calculated hydrocortisone regimen with standard stress coverage: double or triple the daily dose during mild illness, fever, or minor stress; administer parenteral hydrocortisone (50–100 mg/m² bolus then continuous infusion or q6h dosing) for major stress, surgery, or adrenal crisis; provide emergency injectable kit and medical alert identification.## Clinical Guardrails / Mimics / PitfallsDo not confuse ACTHD with primary adrenal insufficiency (which requires mineralocorticoid replacement); avoid over-replacement to prevent iatrogenic Cushingoid features, weight gain, or bone loss; remember that enzyme-inducing antiepileptics may increase hydrocortisone clearance, necessitating higher doses; never abruptly discontinue glucocorticoids without taper; stress dosing is essential during illness, surgery, or trauma to prevent adrenal crisis.## Concrete Clinical ExampleA 12-year-old female survivor of craniopharyngioma treated with 36 Gy cranial radiation presents with fatigue and hypotension; ACTHD confirmed by low-dose ACTH stimulation test. Weight 38 kg, BSA ~1.2 m². Prescribe hydrocortisone 10 mg/m²/day = 12 mg total daily, divided as 6 mg AM, 3 mg early afternoon, 3 mg late afternoon. For fever >38°C, double dose to 24 mg/day divided TID. Provide emergency hydrocortisone injection card.**Source:** Hypothalamic Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, https://doi.org/10.1210/jc.2018-01175

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