Indications for referral for clinic appointment
Please note: Patients will be offered the model of care that the Endocrinology Team deem to be most appropriate based on the information contained in the referral letter. Possibilities include face to face appointments, telehealth appointments, case conferences and group education sessions.
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Condition
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Referral accepted
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Referral not accepted
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Type 1 Diabetes
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- All patients with Type 1 diabetes >16 y, including patients in transition from paediatric to adult endocrinology care
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Type 2 Diabetes
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- Aged 16 or older with one or more of the following
- Acute symptomatic hyper or hypoglycaemia not fulfilling criteria for ED referral – refer urgently – phone endocrinologist on-call through switch (9926 7111)
- Difficulty attaining individualised glycaemic/HbA1c targets despite maximally tolerated oral therapy and GLP-1RA injectables
- Multiple drug intolerances to glucose-lowering medications, or contraindications
- Recurrent symptomatic hypoglycaemia while on therapy
- Development of diabetes complications where glycaemic targets are not being met (note: patients with diabetic foot complications may be referred to RNSH High Risk Foot Service [hyperlink])
- Hyperglycaemic during hospitalisation
- Co-morbidity impacting management of diabetes (including use of oral corticosteroids)
- Pregnancy planning
- Suspicion of unusual variants, such as LADA, MODY, or secondary diabetes
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- HbA1c at target (individualised, but in general target is <53 mmol/mol [7%] if achievable without undue risk of hypoglycaemia, or <64 mmol/mol [8%] if at high risk of hypoglycaemia)
- Poor quality referral without appropriate information or investigations
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Adrenal Disease
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- Addison’s disease and other causes of primary adrenal insufficiency
- Congenital Adrenal Hyperplasia
- Cushing’s syndrome
- Conn’s syndrome (primary hyperaldosteronism)
- Adrenal tumour/mass lesion – refer urgently – phone endocrinologist on-call through switch (9926 7111)
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Phaeochromocytoma
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Gonadal Disease
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- Turner’s syndrome
- Virilization, including polycystic ovary syndrome
- Unexplained primary or secondary amenorrhoea
- Premature menopause
- Male hypogonadism
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Pituitary disorders
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- Pituitary tumour
- Prolactinoma
- Acromegaly
- Cushing’s disease
- Hypopituitarism
- Diabetes insipidus
- Hypothalamic disorders (tumours, hypophysitis)
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Thyroid disorders
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- Known or suspected carcinoma
- Thyroid nodules (other than clearly benign (Ti-Rads 1 or 2) appearance on Ultrasound)
- Goitre suspicious for obstruction*
- Severe hypothyroidism or not responding as expected to Thyroxine replacement
- Thyrotoxicosis
- Unusual TFT results confirmed on repeat testing with a second laboratory
*Endocrinology and Endocrine Surgery run a multidisciplinary service for these patients
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- Subclinical hypothyroidism
- Positive antibodies in setting of normal thyroid hormone levels
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Calcium, electrolyte and metabolic bone disorders
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- Hypercalcaemia including primary hyperparathyroidism
- Hypocalcaemia
- Paget’s disease
- Osteomalacia
- Hypophosphataemia
- Rare metabolic bone diseases including X-linked hypophosphataemic rickets, tumoral calcinosis, hypophosphatasia, fibrodysplasia ossificans progressiva
- Hyponatraemia
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- Normocalcaemic hyperparathyroidism
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Osteoporosis
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- T-score < -2.5 or absolute ten-year fracture risk >20%, with failure to respond or intolerance to first line treatment with anti-resorptive medication
- Please note: any patient with a recent minimal trauma fracture who has osteoporosis can be referred through Osteoporosis Refracture Prevention Service
- RACF residents will be seen by orthogeriatrics team – please make residential status clear on referral
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- Major trauma fractures
- Pathological fractures
- Known metastatic of myeloma bone disease
- Age less than 16 years old
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Osteoporosis Refracture Prevention (ORP) Service
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- Anyone with a minimal trauma fracture who is
- aged 50 years or older, or
- aged under 50 and post-menopausal
- Anyone who is continuing to fracture despite 1 year of anti-resorptive treatment
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- Major trauma fractures
- Pathological fractures
- Known metastatic of myeloma bone disease
- Nursing home resident
- Age less than 16 years old
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Obesity
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- Age 18-60 years
- BMI > 35kg/m2 with T2DM or BMI >45kg/m2 and 2 obesity related comorbidities known to improve with weight loss
- BMI > 35kg/m2 and Pregnancy planning
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- Age less than 18 or greater than 60 years
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Any endocrine condition in pregnancy
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- These referrals will be sent on to the RNSH Specialist Obstetric Clinic
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Hereditary endocrine disorders
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- Any patient >16 y with Multiple Endocrine Neoplasia Types1 or 2
- Any patient >16 y with Hereditary Phaeochromocytoma, paraganglioma syndromes
- Any patient >16 y with Hereditary Jaw Tumour-Hyperparathyroidism syndrome
- Any patient >16 y with MODY
- Any patient >16 y with Thyroid Hormone Resistance syndromes
- Any patient >16 y with Osteogenesis Imperfecta
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Neuroendocrine Tumours
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- Insulinomas – all patients with recurrent symptomatic hypoglycaemia should be assessed
- Gastrinomas
- Glucagonomas
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Endocrine complications of medical therapies
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- Complications of prolonged corticosteroid use
- Endocrine complications of Lithium treatment
- Amiodarone-induced thyroid disorders
- Endocrine complications of immunotherapies
- Endocrine complications of chemotherapy and radiotherapy
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Indications for urgent referral to local Emergency Department
- Addisonian crisis
- Diabetic foot ulcer with evidence of systemic infection, e.g., fever, hypotension
- Diabetic ketoacidosis, with or without hyperglycaemia (i.e. euglycaemic diabetic ketoacidosis)
- Hyperosmolar hyperglycaemia
- Rapidly enlarging thyroid mass or symptoms of acute airway obstruction
- Sodium < 120 mmol/L or symptomatic hyponatraemia < 130 mmol/L
- Severe symptomatic hypercalcaemia (serum calcium > 2.9 mmol/L)
- Severe symptomatic hypoglycaemia
- Severe symptomatic thyrotoxicosis or hypothyroidism
Exclusion criteria
Out of NSLHD
- Reason must be stated explicitly
- Resident of other LHD that does not provide the clinical service
- Continuing care of existing condition already managed by NSLHD
- Demonstrated complexity requiring services of NSLHD
- Compassionate circumstances, e.g. family, proximity, staff
The following information must be included for referral to be accepted:
- Assessment findings
- History of symptoms, including duration, progression and response to any treatments tried
- Relevant pathology and imaging
Providing more information will aid the triage process and make it more likely that your patient will be seen in the most timely manner possible
Please submit referrals using the eReferral system through HealthLink, which can be accessed through most clinical software systems
Alternatively, address letters to Head of Department A/Prof Sarah Glastras or one of the endocrinologists listed in “Other Information”, below.
Fax (02) 94631045
Email: NSLHD-Endocrinology@health.nsw.gov.au
NSLHD-Diabeteseducation@health.nsw.gov.au
Referrals will be triaged and your patient will be notified of the outcome as soon as possible. This process may take between 1-4 weeks. You will be contacted if more information is needed.
Telehealth services are available, please indicate on the referral if you feel this would be suitable for your patient’s appointment.
