菜单
The skill evaluates all patients with acromegaly for hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea at initial assessment. It is triggered by a new diagnosis of acromegaly or when a patient presents for baseline endocrine workup.
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
基于 SOC 职业分类
正在显示 SKILL.md
| name | endo-comorbidities-evaluation |
| description | The skill evaluates all patients with acromegaly for hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea at initial assessment. It is triggered by a new diagnosis of acromegaly or when a patient presents for baseline endocrine workup. |
Confirm acromegaly diagnosis (elevated IGF-1 with lack of GH suppression after glucose load). Collect history: blood pressure, diabetic symptoms, cardiovascular symptoms (chest pain, dyspnea), joint pain/stiffness, snoring, daytime somnolence. Perform exam: BP, BMI, joint inspection, neck circumference. Order labs: fasting glucose/HbA1c, lipid panel, basic metabolic panel.
Is acromegaly biochemically confirmed?
Screen results for each comorbidity:
For each identified comorbidity, initiate guideline-directed management:
Do not attribute all symptoms to acromegaly without evaluating comorbidities separately. Manage each comorbidity per disease-specific guidelines; do not delay definitive acromegaly therapy while completing screening. Avoid assuming normal labs exclude disease in early stages.
A 48-year-old with newly diagnosed acromegaly (IGF-1 450 ng/mL, no GH suppression) presents for initial workup. Screening shows BP 152/94 mmHg, HbA1c 7.1%, triglycerides 210 mg/dL, bilateral knee crepitus, and spouse-reported snoring with apneas. Diagnoses: hypertension, type 2 diabetes, hyperlipidemia, osteoarthritis, probable OSA. Treatment: lisinopril, metformin, atorvastatin, NSAID PRN, and sleep study with CPAP if OSA confirmed.
Source: Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700