How do I install the Es Ghd Retest Indication skill?

Run npx skillmds@latest add dromlakhani/es-ghd-retest-indication 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.

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Is Es Ghd Retest Indication free to use?

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Who published Es Ghd Retest Indication?

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

Es Ghd Retest Indication by dromlakhani

Name: Es Ghd Retest Indication
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Ghd Retest Indication

This skill identifies adult childhood cancer survivors with isolated growth hormone deficiency and prior hypothalamic‑pituitary axis radiation exposure who require retesting to confirm persistence of GHD. Triggers include clinician questions such as “Should I retest for GHD in this adult survivor with childhood GHD and radiation history?” or “Is repeat GHD evaluation indicated in this patient?”

dromlakhani Updated Aug 19, 2026 10 repo stars

File contents

Determine GHD retest need in adult survivors

STEP 1 — Gather Information

Collect patient’s age, cancer treatment history (specifically hypothalamic‑pituitary axis radiation exposure), childhood diagnosis of isolated GHD (confirm no other anterior pituitary hormone deficits), current GH therapy status, and timing since last GHD assessment.

STEP 2 — Rule In / Rule Out

If the patient is an adult survivor of childhood cancer, received hypothalamic‑pituitary axis radiation, and had a diagnosis of isolated GHD in childhood → proceed to retest; otherwise, retesting is not indicated per guideline.

STEP 3 — Classify or Stratify

No further stratification needed; all patients meeting the criteria above are candidates for retesting regardless of radiation dose or time since exposure.

STEP 4 — Decide

Order provocative GHD testing (e.g., insulin tolerance test, glucagon stimulation test, or GHRH‑arginine if available) per guideline 2.3, ensuring appropriate pretest precautions (e.g., discontinuation of GH therapy, consideration of obesity‑related cut‑offs).

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on serum IGF‑I levels; avoid GHRH‑alone or GHRH‑plus‑arginine testing; avoid spontaneous GH sampling; be aware that obesity, estrogen exposure, or hypothyroidism can blunt GH response and require lower cut‑off values; do not retest if three or more other pituitary hormone deficiencies are present (per 2.6); ensure GH therapy has been discontinued for adequate washout before testing.

Concrete Clinical Example

A 23‑year‑old male survivor of childhood acute lymphoblastic leukemia who received 18 Gy cranial radiation at age 4, was diagnosed with isolated GHD at age 10 based on a subnormal ITT, and has been off GH therapy for 18 months. He presents for routine endocrine follow‑up. The clinician gathers history of isolated GHD and HP axis radiation, confirms no other pituitary deficits, and orders an insulin tolerance test to retest for GHD persistence.

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-ghd-retest-indicationdescription: This skill identifies adult childhood cancer survivors with isolated growth hormone deficiency and prior hypothalamic‑pituitary axis radiation exposure who require retesting to confirm persistence of GHD. Triggers include clinician questions such as “Should I retest for GHD in this adult survivor with childhood GHD and radiation history?” or “Is repeat GHD evaluation indicated in this patient?”---# Determine GHD retest need in adult survivors## STEP 1 — Gather InformationCollect patient’s age, cancer treatment history (specifically hypothalamic‑pituitary axis radiation exposure), childhood diagnosis of isolated GHD (confirm no other anterior pituitary hormone deficits), current GH therapy status, and timing since last GHD assessment.## STEP 2 — Rule In / Rule OutIf the patient is an adult survivor of childhood cancer, received hypothalamic‑pituitary axis radiation, and had a diagnosis of isolated GHD in childhood → proceed to retest; otherwise, retesting is not indicated per guideline.## STEP 3 — Classify or StratifyNo further stratification needed; all patients meeting the criteria above are candidates for retesting regardless of radiation dose or time since exposure.## STEP 4 — DecideOrder provocative GHD testing (e.g., insulin tolerance test, glucagon stimulation test, or GHRH‑arginine if available) per guideline 2.3, ensuring appropriate pretest precautions (e.g., discontinuation of GH therapy, consideration of obesity‑related cut‑offs).## Clinical Guardrails / Mimics / PitfallsDo not rely solely on serum IGF‑I levels; avoid GHRH‑alone or GHRH‑plus‑arginine testing; avoid spontaneous GH sampling; be aware that obesity, estrogen exposure, or hypothyroidism can blunt GH response and require lower cut‑off values; do not retest if three or more other pituitary hormone deficiencies are present (per 2.6); ensure GH therapy has been discontinued for adequate washout before testing.## Concrete Clinical ExampleA 23‑year‑old male survivor of childhood acute lymphoblastic leukemia who received 18 Gy cranial radiation at age 4, was diagnosed with isolated GHD at age 10 based on a subnormal ITT, and has been off GH therapy for 18 months. He presents for routine endocrine follow‑up. The clinician gathers history of isolated GHD and HP axis radiation, confirms no other pituitary deficits, and orders an insulin tolerance test to retest for GHD persistence.**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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