本文へ移動
cccskills
無料GitHub で公開

ata-estrogen-cortisol-effect

Accounts for estrogen-induced elevation of total serum cortisol via increased corticosteroid-binding globulin (CBG) when evaluating adrenal reserve or hydrocortisone replacement adequacy. Triggered when assessing glucocorticoid adequacy in patients receiving estrogen therapy (e.g., oral estrogen replacement) or interpreting cortisol levels in estrogen-exposed individuals.

インストール方法を見る

含まれるファイル(1)

  • SKILL.md2.3 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。

Account for estrogen effect on cortisol when assessing adrenal reserve

STEP 1 — Gather Information

Collect patient's estrogen status (type, route, dose), total serum cortisol level, time of draw, and note if estrogen is oral (which increases CBG) vs transdermal (no effect) or pregnancy/OCP.

STEP 2 — Rule In / Rule Out

If the patient is on oral estrogen (or other estrogen known to increase CBG), proceed to Step 3; otherwise, interpret total cortisol using standard reference ranges and proceed to Step 4.

STEP 3 — Classify or Stratify

Measure free cortisol or 24-hour urinary free cortisol to assess true adrenal cortical activity.

STEP 4 — Decide

Base decisions on adrenal reserve or HC adequacy on free cortisol or urinary cortisol results; do not adjust HC dose based solely on elevated total cortisol in estrogen-exposed patients.

Clinical Guardrails / Mimics / Pitfalls

  • Do not assume elevated total cortisol indicates Cushing's syndrome or glucocorticoid over-replacement in estrogen-treated patients.
  • Avoid reducing hydrocortisone dose based solely on high total cortisol when CBG is elevated.
  • Remember that transdermal estrogen does not increase CBG; only oral estrogen (and pregnancy) produce this effect.
  • Consider that free cortisol or urinary cortisol reflects bioactive fraction and is unaffected by CBG changes.

Concrete Clinical Example

A 45-year-old woman on oral estradiol 2 mg daily for hypopituitarism has a morning total cortisol of 22 µg/dL (above normal range). Her free cortisol is normal. She is on stable hydrocortisone 15 mg daily. Decision: maintain current hydrocortisone dose; the elevated total cortisol is due to CBG increase from oral estrogen.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118

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。

同じリポジトリのスキル

概要と使いどころ

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

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

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

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

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

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