How do I install the Es Gh Contraindication Spinal Irradiation skill?

Run npx skillmds@latest add dromlakhani/es-gh-contraindication-spinal-irradiation 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 Gh Contraindication Spinal Irradiation safe to use?

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Which AI agents work with Es Gh Contraindication Spinal Irradiation?

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 Gh Contraindication Spinal Irradiation free to use?

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Who published Es Gh Contraindication Spinal Irradiation?

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

Es Gh Contraindication Spinal Irradiation by dromlakhani

Name: Es Gh Contraindication Spinal Irradiation
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Gh Contraindication Spinal Irradiation

This skill determines whether growth hormone (GH) treatment is contraindicated for short stature in childhood cancer survivors without confirmed growth hormone deficiency (GHD) who have a history of spinal irradiation (e.g., total-body irradiation, craniospinal irradiation). It is triggered by clinician questions such as "Can I use GH for short stature after spinal radiation?" or "Is GH appropriate for growth impairment post-CSI/TBI?"

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Assess GH contraindication post-spinal irradiation

STEP 1 — Gather Information

Collect history of spinal irradiation (total-body irradiation, craniospinal irradiation, or radiation involving the spine), document short stature/poor linear growth (height <-2 SDS or declining growth velocity), confirm absence of GHD via appropriate provocative testing (e.g., insulin tolerance test, glucagon, arginine) per guideline, and verify patient is disease-free for at least 1 year if considering GH.

STEP 2 — Rule In / Rule Out

Determine if GHD is confirmed. If GHD is present, GH may be considered (not contraindicated per this rule); if GHD is not confirmed, proceed to contraindication assessment for spinal irradiation.

STEP 3 — Classify or Stratify

If no GHD and history of spinal irradiation, classify as GH contraindicated for short stature; if GHD present, classify as potential candidate for GH therapy (subject to other guidelines).

STEP 4 — Decide

If contraindicated, refrain from initiating GH for short stature; focus on monitoring growth, evaluating other causes (e.g., spinal foreshortening, nutritional, endocrine), and consider supportive measures. If GHD confirmed, discuss GH initiation with oncology team, ensuring disease-free status and baseline assessments.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on low IGF-I or spontaneous GH secretion to rule out GHD; avoid GH in patients with active malignancy; be aware that GH may worsen disproportionate growth (spinal vs leg) and scoliosis after spinal irradiation; do not use GH to treat short stature without confirming GHD; avoid GH in patients receiving tyrosine kinase inhibitors (per 1.4).

Concrete Clinical Example

A 10-year-old survivor of acute lymphoblastic leukemia who received TBI 12 Gy at age 4 presents with height -2.2 SDS and normal GH stimulation test (peak GH 8 ng/mL). The clinician considers GH for short stature but, per this skill, refrains because GHD is not confirmed and there is a history of spinal irradiation.

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

---name: es-gh-contraindication-spinal-irradiationdescription: This skill determines whether growth hormone (GH) treatment is contraindicated for short stature in childhood cancer survivors without confirmed growth hormone deficiency (GHD) who have a history of spinal irradiation (e.g., total-body irradiation, craniospinal irradiation). It is triggered by clinician questions such as "Can I use GH for short stature after spinal radiation?" or "Is GH appropriate for growth impairment post-CSI/TBI?"---# Assess GH contraindication post-spinal irradiation## STEP 1 — Gather InformationCollect history of spinal irradiation (total-body irradiation, craniospinal irradiation, or radiation involving the spine), document short stature/poor linear growth (height <-2 SDS or declining growth velocity), confirm absence of GHD via appropriate provocative testing (e.g., insulin tolerance test, glucagon, arginine) per guideline, and verify patient is disease-free for at least 1 year if considering GH.## STEP 2 — Rule In / Rule OutDetermine if GHD is confirmed. If GHD is present, GH may be considered (not contraindicated per this rule); if GHD is not confirmed, proceed to contraindication assessment for spinal irradiation.## STEP 3 — Classify or StratifyIf no GHD and history of spinal irradiation, classify as GH contraindicated for short stature; if GHD present, classify as potential candidate for GH therapy (subject to other guidelines).## STEP 4 — DecideIf contraindicated, refrain from initiating GH for short stature; focus on monitoring growth, evaluating other causes (e.g., spinal foreshortening, nutritional, endocrine), and consider supportive measures. If GHD confirmed, discuss GH initiation with oncology team, ensuring disease-free status and baseline assessments.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on low IGF-I or spontaneous GH secretion to rule out GHD; avoid GH in patients with active malignancy; be aware that GH may worsen disproportionate growth (spinal vs leg) and scoliosis after spinal irradiation; do not use GH to treat short stature without confirming GHD; avoid GH in patients receiving tyrosine kinase inhibitors (per 1.4).## Concrete Clinical ExampleA 10-year-old survivor of acute lymphoblastic leukemia who received TBI 12 Gy at age 4 presents with height -2.2 SDS and normal GH stimulation test (peak GH 8 ng/mL). The clinician considers GH for short stature but, per this skill, refrains because GHD is not confirmed and there is a history of spinal irradiation.**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

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