菜单
Suggests a biochemical treatment goal of age-normalized serum IGF-1 value to indicate disease control in acromegaly. Use when setting therapeutic targets after initiating medical therapy or surgery, e.g., post-op IGF-1 at 12 weeks or random GH >1 µg/L.
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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-target-age-normalized-igf1 |
| description | Suggests a biochemical treatment goal of age-normalized serum IGF-1 value to indicate disease control in acromegaly. Use when setting therapeutic targets after initiating medical therapy or surgery, e.g., post-op IGF-1 at 12 weeks or random GH >1 µg/L. |
Collect serum IGF-1 using the same assay throughout, record patient age, and obtain the age-specific median IGF-1 for that assay from laboratory reference tables.
Compute the age-normalized IGF-1 value (patient IGF-1 ÷ age-specific median).
Is the age-normalized IGF-1 ≤1.0 (within age-adjusted normal range)?
Stratify the degree of elevation: mild (1.0–1.5), moderate (1.5–2.5), severe (>2.5).
Assign treatment intensification level based on elevation tier.
For mild elevation, consider optimizing current somatostatin receptor ligand dose; for moderate, add pegvisomant or cabergoline; for severe, evaluate for radiotherapy or repeat surgery.
Implement the selected therapeutic adjustment (dose optimization, add-on agent, or definitive therapy).
Assay variability requires using the same method; age‑specific ranges differ by assay and population. Do not rely on random GH alone when pegvisomant is used, as it interferes with GH assays. Avoid applying adult normal ranges to children or elderly. In pregnancy, hepatic or renal failure, IGF‑1 interpretation is unreliable. Never adjust therapy based on a single IGF‑1 value without confirming assay consistency.
A 48‑year‑old man 3 months after transsphenoidal surgery on lanreotide autogel 90 mg monthly has IGF‑1 720 ng/mL; age‑adjusted median for his assay is 600 ng/mL → ratio 1.20 (mild). Increase lanreotide to 120 mg monthly.
Source: Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, https://doi.org/10.1210/jc.2014-2700
TODO: consider adding scripts/calc.py for the endo-target-age-normalized-igf1 calculator