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Suggests either continuous glucose monitor (CGM) or self-monitoring of blood glucose (SMBG) for pregnant individuals with type 2 diabetes. Triggers include decisions about glucose monitoring methods for pregnant patients with T2DM needing a monitoring strategy.

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This skill recommends using radiation therapy for corticotroph adenomas in Cushing's disease when imaging shows invasive features or mass‑effect concerns such as cavernous sinus invasion, suprasellar extension, or knobby protrusion. Consider RT when postoperative medical therapy has normalized cortisol but tumor progression or residual invasive disease is suspected.

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This skill recommends urgent treatment (within 24–72 hours) of hypercortisolism when life‑threatening complications of Cushing's syndrome such as infection, pulmonary thromboembolism, cardiovascular events, or acute psychosis are present. Trigger phrases include sepsis, PE, chest pain with hemodynamic instability, new‑onset psychosis, or delirium in a patient with known or suspected Cushing's.

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This skill recommends unilateral resection by an experienced adrenal surgeon for all cases of benign unilateral disease causing Cushing's syndrome. Trigger when a CS patient has a unilateral adrenal lesion confirmed benign via imaging and biochemical assessment.

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This skill recommends transsphenoidal selective adenomectomy (TSS) by an experienced pituitary surgeon as the optimal treatment for Cushing's disease in pediatric and adult patients. Use when a patient with ACTH-dependent Cushing syndrome is a surgical candidate; triggers include overt Cushing's syndrome, elevated UFC or late-night salivary cortisol, and pituitary MRI showing an adenoma.

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This skill defines the treatment goals for patients with overt Cushing's syndrome, focusing on normalizing cortisol levels or action to eliminate symptoms and treat comorbidities. Use when a clinician asks about treatment objectives for a newly diagnosed overt Cushing's syndrome patient; triggers include "overt CS," "treatment goals for overt Cushing's," and "normalize cortisol in overt CS."

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This skill directs lifelong treatment of cardiovascular risk factors, osteoporosis, and psychiatric symptoms in all patients with Cushing's syndrome until biochemical resolution of hypercortisolism. Use when managing any CS patient for long‑term comorbidity control; triggers include persistent hypertension, dyslipidemia, low bone density, depression, anxiety, or cognitive changes in the setting of known or suspected CS.

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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.

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This skill suggests targeted therapies (somatostatin analogs or tyrosine kinase inhibitors) to treat ectopic ACTH syndrome when ectopic ACTH secretion is confirmed or strongly suspected. Use when triggers include occult or metastatic ectopic ACTH secretion, very severe ACTH‑dependent disease uncontrolled by medical therapy, or when surgery is not possible or noncurative.

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This skill recommends bilateral adrenalectomy for patients with Cushing's syndrome when bilateral adrenal pathology is confirmed as the source of hypercortisolism. Clinical triggers include bilateral macronodular adrenal hyperplasia (BMAH), bilateral adrenal adenomas, or bilateral adrenal carcinoma identified by imaging.

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This skill suggests medical therapy to block aberrant hormone receptors for bilateral macronodular adrenal hyperplasia (BMAH) when surgery is not preferred or feasible. Consider this approach in patients with confirmed BMAH and evidence of aberrant hormone receptor expression (e.g., GIP, LH/hCG, serotonin) driving cortisol excess.

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This skill suggests radiation therapy or radiosurgery for adult patients with Cushing's disease who have failed transsphenoidal surgery (TSS) or have recurrent disease after initial remission. Consider when postoperative urinary free cortisol or late-night salivary cortisol remains elevated, or when clinical recurrence is suspected.

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Suggests repeat transsphenoidal surgery for patients with persistent hypercortisolism after initial transsphenoidal surgery when imaging shows evidence of incomplete resection or a pituitary lesion. Clinical triggers include postoperative MRI revealing residual adenoma, persistent elevated UFC or late-night salivary cortisol, and visible pituitary lesion on imaging.

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Recommends steroidogenesis inhibitors as second-line treatment after transsphenoidal surgery (TSS) in Cushing's disease, as primary therapy for occult or metastatic ectopic ACTH syndrome (EAS), and as adjunctive cortisol reduction in adrenocortical carcinoma. Use when evaluating CS patients post‑TSS, with occult/metastatic EAS, or ACC; triggers include “persistent hypercortisolism after TSS,” “occult EAS,” and “adjunctive for ACC.”

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This skill recommends measuring serum sodium several times during the first 5–14 days after transsphenoidal surgery to detect and manage electrolyte disturbances such as postoperative hyponatremia and diabetes insipidus. Use when managing a post-TSS Cushing’s syndrome patient in the early recovery phase; triggers include postoperative day 5–10 hyponatremia, polyuria, fluid intake‑output imbalance, or suspected diabetes insipidus.

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This skill recommends follow-up morning cortisol and/or ACTH stimulation tests or insulin-induced hypoglycemia to assess HPA axis recovery in postoperative Cushing's syndrome patients with at least one intact adrenal gland. Triggers include postoperative remission (morning cortisol <5 µg/dL or UFC <28–56 nmol/d) and the need to evaluate HPA recovery before glucocorticoid discontinuation.

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This skill provides structured education to patients and families about Cushing's syndrome pathophysiology, treatment options, and post-remission expectations. It is triggered when a clinician encounters a new Cushing's syndrome patient or family needing disease information, such as at initial diagnosis or before treatment initiation.

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This skill provides a shared decision-making framework for selecting second-line therapies in patients with ACTH-dependent Cushing's syndrome who have persistent hypercortisolism after transsphenoidal surgery or for whom surgery is not feasible. Clinical triggers include "failed TSS", "non-curative pituitary surgery", "persistent UFC elevation post-op", and "surgery contraindicated".

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This skill recommends using biochemical tests to screen for hypercortisolism to detect recurrence in patients with ACTH-dependent Cushing's syndrome after surgical remission. It is triggered during postoperative follow-up when the HPA axis has recovered, annually, or sooner if clinical signs of hypercortisolism (e.g., weight gain, hypertension, glucose intolerance) or abnormal late-night salivary cortisol/UFC appear.

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This skill recommends regularly evaluating for corticotroph tumor progression using pituitary MRIs and ACTH levels in patients with known Cushing's disease who underwent bilateral adrenalectomy and in patients undergoing this procedure for presumed occult ectopic ACTH secretion. Triggers include postoperative follow‑up after bilateral adrenalectomy, rising ACTH levels, or new pituitary lesion on MRI suggestive of tumor progression.

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This skill suggests follow-up tests for specific comorbidities associated with Cushing's syndrome in patients with adrenal adenoma when CT density is less than 10 Hounsfield units. Use when managing a post-adrenalectomy Cushing's syndrome patient with confirmed adrenal adenoma pathology and low-density imaging (<10 HU).

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This skill recommends re-evaluating the need for treatment of other pituitary hormone deficiencies in the postoperative period following surgical intervention for Cushing's syndrome. It is triggered when assessing a post-op CS patient for ongoing pituitary function, evaluating for hypopituitarism, or checking HPA axis recovery with morning cortisol/ACTH stimulation tests and pituitary MRI within 1–3 months.

日本語の概要は準備中です。原文の説明を表示しています。

This skill recommends obtaining a postoperative pituitary MRI within 1–3 months after successful transsphenoidal surgery (TSS) to establish a new baseline for future recurrence assessment. Use when a Cushing’s syndrome patient has achieved biochemical remission post‑TSS and is entering routine follow‑up.

日本語の概要は準備中です。原文の説明を表示しています。

This skill recommends that all patients with Cushing’s syndrome receive monitoring and adjunctive treatment for cortisol-dependent comorbidities including psychiatric disorders, diabetes, hypertension, hypokalemia, infections, dyslipidemia, osteoporosis, and poor physical fitness. Apply when managing any CS patient to address associated health issues; triggers include confirmed or suspected hypercortisolism, preoperative evaluation, postoperative follow‑up, or persistent hypercortisolism despite treatment.

日本語の概要は準備中です。原文の説明を表示しています。