How do I install the Es Gh Treatment Timing skill?

Run npx skillmds@latest add dromlakhani/es-gh-treatment-timing 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 Treatment Timing 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 Gh Treatment Timing?

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 Treatment Timing free to use?

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

Who published Es Gh Treatment Timing?

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

Es Gh Treatment Timing by dromlakhani

Name: Es Gh Treatment Timing
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Es Gh Treatment Timing

This skill determines the appropriate timing for initiating growth hormone (GH) therapy in childhood cancer survivors, recommending to wait until 1 year disease‑free after completion of malignant disease treatment to minimize risks. Triggers include clinician questions such as “When can I start GH therapy after cancer treatment completion?” or “How long should I wait to initiate growth hormone post‑remission?”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Time GH initiation post‑malignant disease

STEP 1 — Gather Information

Record the date of malignant disease therapy completion, verify current disease‑free status (no evidence of disease on imaging/labs), and confirm GH deficiency status via provocative testing or IGF‑1 if appropriate; if any data are missing, obtain oncology follow‑up results before proceeding.

STEP 2 — Rule In / Rule Out

Is the patient disease‑free for at least 12 months?

Yes → Rule in for GH initiation consideration.
No → Rule out immediate GH initiation; recommend continued oncology surveillance and reassess disease‑free interval.

STEP 3 — Classify or Stratify

Among patients disease‑free ≥12 months, classify by GH deficiency status:

GH deficient (positive provocative test) → Proceed to decide GH therapy.
Not GH deficient → Advise against GH therapy for short stature and monitor growth.

STEP 4 — Decide

For GH‑deficient patients with disease‑free ≥12 months, decide to initiate GH therapy using standard pediatric weight‑based regimens; for non‑GH‑deficient patients, decide to withhold GH and continue routine growth monitoring.

Clinical Guardrails / Mimics / Pitfalls

Do not start GH therapy while active malignancy or within 12 months of therapy completion; avoid GH in patients receiving tyrosine kinase inhibitors; do not rely solely on IGF‑1 levels to diagnose GH deficiency; counsel against GH use in spinal radiation‑associated disproportionate growth without discussing risks of worsening scoliosis or slipped capital femoral epiphysis.

Concrete Clinical Example

A 12‑year‑old medulloblastoma survivor completed craniospinal irradiation 14 months ago, remains disease‑free, and has a low IGF‑1 with a failed insulin tolerance test confirming GH deficiency; GH therapy is initiated after confirming the disease‑free interval exceeds 12 months.

Source: Hypothalamic Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline, Sklar et al., 2018, DOI:10.1210/jc.2018-01175

TODO: consider adding scripts/calc.py for the es-gh-treatment-timing calculator

---name: es-gh-treatment-timingdescription: This skill determines the appropriate timing for initiating growth hormone (GH) therapy in childhood cancer survivors, recommending to wait until 1 year disease‑free after completion of malignant disease treatment to minimize risks. Triggers include clinician questions such as “When can I start GH therapy after cancer treatment completion?” or “How long should I wait to initiate growth hormone post‑remission?”---# Time GH initiation post‑malignant disease## STEP 1 — Gather InformationRecord the date of malignant disease therapy completion, verify current disease‑free status (no evidence of disease on imaging/labs), and confirm GH deficiency status via provocative testing or IGF‑1 if appropriate; if any data are missing, obtain oncology follow‑up results before proceeding.## STEP 2 — Rule In / Rule OutIs the patient disease‑free for at least 12 months? - **Yes** → Rule in for GH initiation consideration. - **No** → Rule out immediate GH initiation; recommend continued oncology surveillance and reassess disease‑free interval.## STEP 3 — Classify or StratifyAmong patients disease‑free ≥12 months, classify by GH deficiency status: - **GH deficient** (positive provocative test) → Proceed to decide GH therapy. - **Not GH deficient** → Advise against GH therapy for short stature and monitor growth.## STEP 4 — DecideFor GH‑deficient patients with disease‑free ≥12 months, decide to initiate GH therapy using standard pediatric weight‑based regimens; for non‑GH‑deficient patients, decide to withhold GH and continue routine growth monitoring.## Clinical Guardrails / Mimics / PitfallsDo not start GH therapy while active malignancy or within 12 months of therapy completion; avoid GH in patients receiving tyrosine kinase inhibitors; do not rely solely on IGF‑1 levels to diagnose GH deficiency; counsel against GH use in spinal radiation‑associated disproportionate growth without discussing risks of worsening scoliosis or slipped capital femoral epiphysis.## Concrete Clinical ExampleA 12‑year‑old medulloblastoma survivor completed craniospinal irradiation 14 months ago, remains disease‑free, and has a low IGF‑1 with a failed insulin tolerance test confirming GH deficiency; GH therapy is initiated after confirming the disease‑free interval exceeds 12 months.**Source:** Hypothalamic Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline, Sklar et al., 2018, DOI:10.1210/jc.2018-01175> **TODO:** consider adding scripts/calc.py for the es-gh-treatment-timing calculator

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