本文へ移動
cccskills
無料GitHub で公開

enda-acth-measurement-pai

Recommends measurement of plasma ACTH to establish primary adrenal insufficiency (PAI) diagnosis in patients with confirmed cortisol deficiency; a plasma ACTH concentration ≥2-fold the upper limit of the reference range supports PAI. Use when evaluating plasma ACTH in a patient with low morning cortisol or abnormal corticotropin stimulation test.

dromlakhani/MD2SKILL
インストール方法を見る

含まれるファイル（1）

  • SKILL.md2.7 KB

SKILL.md（原文）

インストールする前に、エージェントに与えられる指示の中身を確認できます。

Measure Plasma ACTH to Establish PAI Diagnosis

STEP 1 — Gather Information

Confirm cortisol deficiency via low morning cortisol (<140 nmol/L) or subnormal response to corticotropin stimulation test; obtain paired plasma ACTH sample (preferably with morning cortisol or baseline ACTH stimulation sample) using EDTA-plasma kept on ice and processed promptly.

STEP 2 — Rule In / Rule Out

Calculate whether plasma ACTH is ≥2-fold the assay-specific upper limit of reference range; if yes, rule in primary adrenal insufficiency; if no, rule out PAI and consider secondary adrenal insufficiency or other causes.

STEP 3 — Classify or Stratify

Classify as primary adrenal insufficiency when ACTH ≥2-fold ULN with confirmed cortisol deficiency; classify as secondary/tertiary adrenal insufficiency when ACTH is low or inappropriately normal despite cortisol deficiency.

STEP 4 — Decide

If PAI confirmed, proceed to etiologic workup (e.g., 21-hydroxylase autoantibodies) and initiate glucocorticoid and mineralocorticoid replacement; if secondary adrenal insufficiency suspected, evaluate pituitary/hypothalamic function and consider glucocorticoid replacement alone.

Clinical Guardrails / Mimics / Pitfalls

ACTH assays are subject to pre-analytical variability (hemolysis, delayed processing) and inter-assay differences; always use cold EDTA plasma and refer to assay-specific reference ranges. Do not rely on ACTH alone without confirming cortisol deficiency, and avoid using ACTH levels to adjust glucocorticoid replacement due to loss of negative feedback. Pitfalls include falsely elevated ACTH from stress, illness, or heterophilic antibodies, and falsely normal ACTH in secondary AI.

Concrete Clinical Example

A 48-year-old man presents with weight loss, hypotension, and morning cortisol 90 nmol/L (<140 nmol/L). Plasma ACTH measured at 110 pmol/L (assay ULN 45 pmol/L) is >2-fold ULN (90 pmol/L), supporting PAI; 21-hydroxylase antibodies are positive, and glucocorticoid/mineralocorticoid replacement is started.

Source: Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2015-1710

TODO: consider adding scripts/calc.py for the enda-acth-measurement-pai calculator

レビュー

まだレビューはありません。使ってみた感想をお寄せください。

ログインしてレビューを書く

同じリポジトリのスキル

概要と使いどころ

780g-pump-adjustment

無料

Guide pump setting adjustments for the MiniMed 780G system based on CareLink data, using Medtronic's 3-step follow-up workflow. Use when a clinician has CareLink data for a 780G patient and wants to know what to change — which setting, by how much, and how to program it. Triggers include: "what do I adjust", "how to fix high TIR", "how to reduce hypos", "adjust ICR/ISF/basal", "SmartGuard settings", "780G pump settings review", or any question about optimising 780G therapy after reviewing a download.

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。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-acth-stim-test-interpretation

無料

Performs corticotropin stimulation test to diagnose adrenal insufficiency when morning cortisol is indeterminate (3-15 µg/dL). Triggers include morning cortisol 3-15 µg/dL requiring further AI testing.

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。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-adrenal-crisis-treatment

無料

Administers immediate parenteral injection of 50–100 mg hydrocortisone for suspected adrenal crisis secondary to adrenal insufficiency. Triggers include hypotension, hypoglycemia, or acute illness in a patient with known adrenal insufficiency.

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。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-aed-ai-education

無料

Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.

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。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-aed-lt4-monitoring

無料

In central hypothyroidism patients receiving levothyroxine who initiate enzyme‑inducing antiepileptic drugs, the guideline recommends checking free T4 at least 6 weeks after AED start and increasing the levothyroxine dose if free T4 falls below the target range. Triggers include: central hypothyroidism patient on levothyroxine starting antiepileptic drug such as phenytoin, carbamazepine, or oxcarbazepine.

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。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-cortisol-cutoff-ai-diagnosis

無料

Applies serum cortisol cutoffs (<3 μg/dL indicates central adrenal insufficiency; >15 μg/dL likely excludes it) when evaluating morning cortisol for suspected adrenal insufficiency. Triggers include morning cortisol measurement in suspected AI and use when interpreting morning cortisol levels for adrenal insufficiency workup.

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。

dromlakhani/MD2SKILL132026年10月5日 更新

dromlakhani のスキルをすべて見る

このスキルの問題を報告する