本文へ移動
cccskills
無料GitHub で公開

es-cushing-individualized-management-postop-cortisol-categorization

This skill guides postoperative management after Cushing's syndrome surgery by classifying patients into hypocortisolism, hypercortisolism, or eucortisolism based on serum cortisol levels. Use when postoperative cortisol is <5 µg/dL (hypocortisolism), >20 µg/dL (hypercortisolism), or 5-20 µg/dL (eucortisolism) to direct glucocorticoid replacement, further treatment, or monitoring.

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。

Individualized Management Approach Based on Postoperative Serum Cortisol Categorization

STEP 1 — Gather Information

Collect postoperative morning serum cortisol (drawn before any glucocorticoid dose, preferably postoperative day 1), assess for symptoms of hypocortisolism (fatigue, nausea, hypotension) or hypercortisolism (hypertension, hyperglycemia), and note any exogenous glucocorticoid administration. Proceed to cortisol threshold evaluation.

STEP 2 — Rule In / Rule Out

Is postoperative morning serum cortisol <5 µg/dL? If yes, classify as hypocortisolism; if no, proceed to evaluate for hypercortisolism.

STEP 3 — Classify or Stratify

For cortisol ≥5 µg/dL, determine if >20 µg/dL; if yes, classify as hypercortisolism; if 5–20 µg/dL, classify as eucortisolism.

STEP 4 — Decide

For hypocortisolism: initiate physiologic glucocorticoid replacement (hydrocortisone 10–12 mg/m²/d in divided doses) and educate on stress dosing; taper based on HPA recovery. For hypercortisolism: consider additional definitive therapy (repeat surgery, medical therapy, bilateral adrenalectomy, or radiation) based on persistence and patient factors. For eucortisolism: if on glucocorticoids, attempt taper; monitor with late-night salivary cortisol or UFC every 3–6 months to detect recurrence.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on a single random cortisol; ensure fasting AM sample; avoid interpreting cortisol while on exogenous glucocorticoids. Do not taper replacement prematurely before HPA axis recovery. Recognize assay variability and stress can shift values. Use late-night salivary cortisol or UFC to confirm eucortisolism. Watch for adrenal crisis in hypocortisolism.

Concrete Clinical Example

A 48-year-old man with Cushing disease underwent transsphenoidal adenomaectomy. POD1 morning cortisol was 4 µg/dL (<5 µg/dL). He reported mild fatigue and hypotension. He was started on hydrocortisone 10 mg/m²/d in divided doses, given stress-dosing education, and tapered over 8 months as morning cortisol rose to 12 µg/dL and ACTH stimulation test normalized.

Source: Treatment of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline, Nieman et al., 2015, https://doi.org/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