本文へ移動
cccskills
無料GitHub で公開

es-cushing-against-treatment-borderline-hpa

This skill recommends against initiating treatments aimed at normalizing cortisol or its action when only borderline biochemical abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis are present without specific signs of Cushing's syndrome. Use when encountering borderline urinary free cortisol, late-night salivary cortisol, or dexamethasone suppression test results without classic Cushingoid features; triggers include borderline UFC (1-2× ULN), equivocal late-night salivary cortisol, or nondiagnostic low-dose DST.

dromlakhani/MD2SKILL
インストール方法を見る

含まれるファイル（1）

  • SKILL.md3.2 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。

Against Treatment for Borderline HPA Axis Abnormality Without Specific CS Signs

STEP 1 — Gather Information

Obtain detailed history for weight gain, facial plethora, proximal muscle weakness, easy bruising, striae, hypertension, diabetes; perform physical exam for CS signs; collect baseline biochemical tests: 24‑h urinary free cortisol (UFC), late‑night salivary cortisol (LNSC), and low‑dose dexamethasone suppression test (LDDST); note medications, alcohol intake, depressive symptoms, obesity that can cause pseudo‑Cushing; consider imaging only if biochemical abnormality persists and signs develop.

STEP 2 — Rule In / Rule Out

Are any specific signs or symptoms of Cushing's syndrome present? If yes → consider further evaluation for possible CS and potential treatment; if no → proceed to evaluate biochemical borderline status.

STEP 3 — Classify or Stratify

Classify the biochemical abnormality as borderline if UFC is 1–2× upper limit of normal, LNSC is mildly elevated but below diagnostic cutoff, or LDDST shows nonsuppression without clear diagnostic threshold; exclude values clearly normal or frankly elevated (>2× ULN) which would warrant different pathways.

STEP 4 — Decide

Recommend against initiating cortisol‑lowering medications, adrenal‑directed surgery, or radiotherapy; instead, repeat biochemical testing in 3–6 months, address modifiable pseudo‑Cushing factors (weight loss, alcohol reduction, treat depression), and manage any comorbidities (hypertension, diabetes) with standard therapies.

Clinical Guardrails / Mimics / Pitfalls

Do not treat based solely on borderline labs; avoid unnecessary steroidogenesis inhibitors or glucocorticoid receptor antagonists due to risk of adrenal insufficiency and side effects; consider common mimics such as chronic stress, depression, alcohol excess, obesity, and medications (e.g., glucocorticoids, psychoactive drugs); monitor for emergence of overt CS signs; missing early treatment is less harmful than overtreating biochemical noise.

Concrete Clinical Example

A 45‑year‑old woman with mild weight gain and irregular menses has UFC 1.4× ULN, LNSC at the upper limit of normal, and LDDST showing 30% suppression; physical exam shows no facial plethora, proximal weakness, or wide striae. Following this skill, clinicians refrain from ketoconazole, repeat testing in 4 months while counseling on weight control, and her UFC normalizes to 0.9× ULN without intervention.

Source: Treatment of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline, Nieman et al., 2015, DOI: 10.1210/jc.2015-1818

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