How do I install the Es Cushing Free T4 Prolactin Assessment Post Surgery skill?

Run npx skillmds@latest add dromlakhani/es-cushing-free-t4-prolactin-assessment-post-surgery 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 Cushing Free T4 Prolactin Assessment Post Surgery 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 Cushing Free T4 Prolactin Assessment Post Surgery?

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 Cushing Free T4 Prolactin Assessment Post Surgery free to use?

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

Who published Es Cushing Free T4 Prolactin Assessment Post Surgery?

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

Es Cushing Free T4 Prolactin Assessment Post Surgery by dromlakhani

Name: Es Cushing Free T4 Prolactin Assessment Post Surgery
Rating: 4.5 (4 reviews)
Author: dromlakhani

Es Cushing Free T4 Prolactin Assessment Post Surgery

This skill recommends obtaining serum free T4 and prolactin levels within 1–2 weeks after transsphenoidal surgery (TSS) for Cushing's syndrome to screen for overt hypopituitarism. Use in postoperative Cushing's syndrome patients during the early recovery window when evaluating for new pituitary hormone deficiencies.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Assessing Free T4 and Prolactin Within 1-2 Weeks Post-Surgery for Hypopituitarism Evaluation

STEP 1 — Gather Information

Confirm transsphenoidal surgery for Cushing's syndrome, note operative date, review postoperative symptoms (fatigue, hypotension, hypoglycemia), and document current glucocorticoid replacement dose.

STEP 2 — Rule In / Rule Out

If the patient is within 1–2 weeks post-TSS for Cushing's syndrome, proceed to step 3; if outside this window, defer routine free T4/prolactin assessment per this skill and follow standard postoperative follow‑up.

STEP 3 — Classify or Stratify

Interpret results: low free T4 suggests central hypothyroidism; low prolactin suggests prolactin deficiency; both low raise concern for overt hypopituitarism; normal levels make overt hypopituitarism less likely but require clinical correlation.

STEP 4 — Decide

If free T4 and/or prolactin are low, initiate appropriate hormone replacement (e.g., levothyroxine for central hypothyroidism) and stress‑dose glucocorticoids pending ACTH stimulation test; if results are normal, continue routine postoperative monitoring and reassess if symptoms develop.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on these labs to exclude hypopituitarism; clinical assessment is essential. Avoid delaying glucocorticoid replacement in suspected adrenal insufficiency. Do not interpret isolated low prolactin without context (stress, medications can affect levels). This skill applies only to the 1–2‑week window; later assessment may be needed.

Concrete Clinical Example

A 48‑year‑old woman undergoes transsphenoidal resection of an ACTH‑secreting pituitary adenoma for Cushing's disease. On postoperative day 12 she notes fatigue and mild hypotension. Free T4 is 0.55 ng/dL (low) and prolactin is 1.8 ng/mL (low). Decision: start levothyroxine 25 µg daily and stress‑dose hydrocortisone 20 mg morning/10 mg evening pending ACTH stimulation test.

Source: Treatment of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline, Nieman et al., 2015, DOI: 10.1210/jc.2015-1818

---name: es-cushing-free-t4-prolactin-assessment-post-surgerydescription: This skill recommends obtaining serum free T4 and prolactin levels within 1–2 weeks after transsphenoidal surgery (TSS) for Cushing's syndrome to screen for overt hypopituitarism. Use in postoperative Cushing's syndrome patients during the early recovery window when evaluating for new pituitary hormone deficiencies.---# Assessing Free T4 and Prolactin Within 1-2 Weeks Post-Surgery for Hypopituitarism Evaluation## STEP 1 — Gather InformationConfirm transsphenoidal surgery for Cushing's syndrome, note operative date, review postoperative symptoms (fatigue, hypotension, hypoglycemia), and document current glucocorticoid replacement dose.## STEP 2 — Rule In / Rule OutIf the patient is within 1–2 weeks post-TSS for Cushing's syndrome, proceed to step 3; if outside this window, defer routine free T4/prolactin assessment per this skill and follow standard postoperative follow‑up.## STEP 3 — Classify or StratifyInterpret results: low free T4 suggests central hypothyroidism; low prolactin suggests prolactin deficiency; both low raise concern for overt hypopituitarism; normal levels make overt hypopituitarism less likely but require clinical correlation.## STEP 4 — DecideIf free T4 and/or prolactin are low, initiate appropriate hormone replacement (e.g., levothyroxine for central hypothyroidism) and stress‑dose glucocorticoids pending ACTH stimulation test; if results are normal, continue routine postoperative monitoring and reassess if symptoms develop.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on these labs to exclude hypopituitarism; clinical assessment is essential. Avoid delaying glucocorticoid replacement in suspected adrenal insufficiency. Do not interpret isolated low prolactin without context (stress, medications can affect levels). This skill applies only to the 1–2‑week window; later assessment may be needed.## Concrete Clinical ExampleA 48‑year‑old woman undergoes transsphenoidal resection of an ACTH‑secreting pituitary adenoma for Cushing's disease. On postoperative day 12 she notes fatigue and mild hypotension. Free T4 is 0.55 ng/dL (low) and prolactin is 1.8 ng/mL (low). Decision: start levothyroxine 25 µg daily and stress‑dose hydrocortisone 20 mg morning/10 mg evening pending ACTH stimulation test.**Source:** Treatment of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline, Nieman et al., 2015, DOI: 10.1210/jc.2015-1818

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