本文へ移動
cccskills
無料GitHub で公開

es-cushing-localize-resect-ectopic-acth-tumors

This skill recommends localizing and resecting ectopic ACTH-secreting tumors with node dissection when ectopic ACTH secretion is suspected or confirmed. Clinical triggers include unexplained persistent hypercortisolism after pituitary surgery, elevated ACTH with negative pituitary MRI, or identification of occult ectopic ACTH syndrome (EAS) on biochemical testing.

dromlakhani/MD2SKILL
インストール方法を見る

含まれるファイル（1）

  • SKILL.md2.9 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。

Localizing and Resecting Ectopic ACTH-Secreting Tumors with Node Dissection

STEP 1 — Gather Information

Confirm biochemical hypercortisolism (elevated UFC or late-night salivary cortisol) and elevated ACTH; obtain pituitary MRI to exclude adenoma; perform inferior petrosal sinus sampling (IPSS) to assess central vs peripheral ACTH source; if peripheral, pursue anatomic imaging (contrast-enhanced CT chest/abdomen/pelvis, somatostatin receptor PET/CT, or Ga-68 DOTATATE) to localize tumor; document size, location, and presence of metastatic nodes.

STEP 2 — Rule In / Rule Out

Is ectopic ACTH secretion confirmed by peripheral IPSS gradient and/or identification of a tumor on imaging? If yes, proceed to localization and resection planning; if no, reconsider Cushing’s disease or adrenal etiology and repeat biochemical testing or pursue alternative diagnostic pathways.

STEP 3 — Classify or Stratify

Classify the ectopic ACTH source as occult (no lesion on conventional CT/MRI but positive functional imaging) versus metastatic (radiographically evident lymph node or distant metastases); this determines extent of surgical dissection needed.

STEP 4 — Decide

For localized occult or resectable metastatic ectopic ACTH tumors, recommend en bloc surgical resection with systematic mediastinal or abdominal lymph node dissection; for unresectable widespread metastasis, consider medical therapy (ketoconazole/metyrapone) or bilateral adrenalectomy as a life-preserving measure while awaiting systemic treatment.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on pituitary MRI; false-negative IPSS can misdirect to pituitary surgery; avoid resection without histologic confirmation when possible; neglecting node dissection increases recurrence risk; proceed to surgery only after multidisciplinary review (endocrinology, thoracic surgery, nuclear medicine); avoid empiric medical therapy without localization in operable disease.

Concrete Clinical Example

A 48‑year‑old with refractory hypertension, hyperglycemia, and hypokalemia had UFC 3× ULN and ACTH 120 pg/mL; pituitary MRI was negative; IPSS showed peripheral gradient; CT chest revealed a 1.5 cm bronchial carcinoid; video‑assisted thoracoscopic resection with mediastinal lymph node dissection yielded normal postoperative UFC and ACTH; patient remained eucortisolemic at 6‑month follow‑up.

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