How do I install the Es Cushing Initial Resection Recommendation skill?

Run npx skillmds@latest add dromlakhani/es-cushing-initial-resection-recommendation 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 Initial Resection Recommendation 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 Initial Resection Recommendation?

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 Initial Resection Recommendation free to use?

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

Who published Es Cushing Initial Resection Recommendation?

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

Es Cushing Initial Resection Recommendation by dromlakhani

Name: Es Cushing Initial Resection Recommendation
Rating: 4.5 (4 reviews)
Author: dromlakhani

Es Cushing Initial Resection Recommendation

Recommends initial surgical resection of the primary lesion(s) causing Cushing's syndrome when surgery is feasible and likely to significantly reduce glucocorticoid excess. Trigger phrases include overt Cushing's syndrome, ACTH-dependent CS, ectopic ACTH secretion, adrenal adenoma, bilateral macronodular adrenal hyperplasia, and persistent hypercortisolism.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Initial Resection of Primary Lesion(s) for Cushing's Syndrome

STEP 1 — Gather Information

Confirm overt Cushing's syndrome via abnormal cortisol excretion (UFC, late-night salivary cortisol, dexamethasone suppression) and determine etiology: pituitary MRI for ACTH-secreting tumor, chest/abdominal imaging for ectopic source, adrenal CT/MRI for adrenal lesion; assess surgical feasibility and likelihood of significant glucocorticoid reduction.

STEP 2 — Rule In / Rule Out

Is surgery possible and likely to significantly reduce glucocorticoid excess? If no, proceed to second-line therapies (medication, bilateral adrenalectomy, radiation). If yes, move to classification.

STEP 3 — Classify or Stratify

Classify by etiology: pituitary Cushing's disease -> transsphenoidal selective adenomectomy (TSS); ectopic ACTH-secreting tumor -> localization and resection with node dissection; benign unilateral adrenal adenoma/carcinoma -> unilateral adrenalectomy; bilateral macronodular adrenal hyperplasia (BMAH) -> consider bilateral adrenalectomy if aberrant hormone receptors demonstrated, otherwise medical therapy; adrenal carcinoma -> resection if resectable, else consider adjuvant therapy.

STEP 4 — Decide

Perform the indicated primary lesion resection by an experienced surgeon (adrenal, pituitary, or thoracic/abdominal as appropriate) with goal of normalizing cortisol levels or action.

Clinical Guardrails / Mimics / Pitfalls

Do not resort to surgery if it is unlikely to significantly reduce glucocorticoid excess (e.g., diffuse ectopic disease, unresectable carcinoma); avoid mistaking ectopic source for pituitary lesion without proper localization; ensure surgeon expertise to minimize complications; do not proceed with bilateral adrenalectomy for BMAH without evidence of aberrant receptor coupling; monitor for postoperative adrenal insufficiency and provide glucocorticoid replacement as needed.

Concrete Clinical Example

A 48-year-old man presents with overt Cushing's syndrome, elevated UFC and loss of diurnal rhythm; pituitary MRI reveals 8 mm microadenoma, inferior petrosal sinus sampling confirms central ACTH source; he undergoes transsphenoidal selective adenomectomy by an experienced pituitary surgeon; postoperative morning cortisol normalizes within 2 weeks, achieving remission.

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-initial-resection-recommendationdescription: Recommends initial surgical resection of the primary lesion(s) causing Cushing's syndrome when surgery is feasible and likely to significantly reduce glucocorticoid excess. Trigger phrases include overt Cushing's syndrome, ACTH-dependent CS, ectopic ACTH secretion, adrenal adenoma, bilateral macronodular adrenal hyperplasia, and persistent hypercortisolism.---# Initial Resection of Primary Lesion(s) for Cushing's Syndrome## STEP 1 — Gather InformationConfirm overt Cushing's syndrome via abnormal cortisol excretion (UFC, late-night salivary cortisol, dexamethasone suppression) and determine etiology: pituitary MRI for ACTH-secreting tumor, chest/abdominal imaging for ectopic source, adrenal CT/MRI for adrenal lesion; assess surgical feasibility and likelihood of significant glucocorticoid reduction.## STEP 2 — Rule In / Rule OutIs surgery possible and likely to significantly reduce glucocorticoid excess? If no, proceed to second-line therapies (medication, bilateral adrenalectomy, radiation). If yes, move to classification.## STEP 3 — Classify or StratifyClassify by etiology: pituitary Cushing's disease -> transsphenoidal selective adenomectomy (TSS); ectopic ACTH-secreting tumor -> localization and resection with node dissection; benign unilateral adrenal adenoma/carcinoma -> unilateral adrenalectomy; bilateral macronodular adrenal hyperplasia (BMAH) -> consider bilateral adrenalectomy if aberrant hormone receptors demonstrated, otherwise medical therapy; adrenal carcinoma -> resection if resectable, else consider adjuvant therapy.## STEP 4 — DecidePerform the indicated primary lesion resection by an experienced surgeon (adrenal, pituitary, or thoracic/abdominal as appropriate) with goal of normalizing cortisol levels or action.## Clinical Guardrails / Mimics / PitfallsDo not resort to surgery if it is unlikely to significantly reduce glucocorticoid excess (e.g., diffuse ectopic disease, unresectable carcinoma); avoid mistaking ectopic source for pituitary lesion without proper localization; ensure surgeon expertise to minimize complications; do not proceed with bilateral adrenalectomy for BMAH without evidence of aberrant receptor coupling; monitor for postoperative adrenal insufficiency and provide glucocorticoid replacement as needed.## Concrete Clinical ExampleA 48-year-old man presents with overt Cushing's syndrome, elevated UFC and loss of diurnal rhythm; pituitary MRI reveals 8 mm microadenoma, inferior petrosal sinus sampling confirms central ACTH source; he undergoes transsphenoidal selective adenomectomy by an experienced pituitary surgeon; postoperative morning cortisol normalizes within 2 weeks, achieving remission.**Source:** Treatment of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline, Nieman et al., 2015, DOI:10.1210/jc.2015-1818

Frequently asked questions