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Endocrine outpatient services

The Central Adelaide endocrine service provides inpatient and outpatient services for patients living in the Central Adelaide Local Area Health Network with endocrine disorders.Priority service is provided to disorders which cause severe metabolic derangement or are potentially life threatening, if untreated.

The Central Adelaide endocrine service also provides services to patients referred from rural and remote areas, including the Northern Territory, South West NSW and the Victorian Riverland.

Please Note: a separate document has been prepared for the Central Adelaide Diabetes Service.

Contact details

Royal Adelaide Hospital
Clinic fax (for referrals): (08) 8222 5908
For all appointments: enquiries and new case appointments: (08) 8222 5586
Review / change of appointments: (08) 8222 5586

Note: Endocrine surgical clinic 
Phone: (08) 8222 2923 fax: (08) 8222 5928

The Queen Elizabeth Hospital
Clinic fax (for referrals): (08) 8222 7188
Appointment enquiries, changes, reviews and treatment: (08) 8222 7030
Review / change of appointments: (08) 8222 7030 / (08) 8222 7010

Appointment location

Royal Adelaide Hospital

Endocrine
Location: Level 8, outpatient block, North Terrace Adelaide SA 5000

The Queen Elizabeth Hospital

Outpatients area 
Location: 1 & 2, 28 Woodville Road, Woodville SA 5011

Diabetes house
Location: 8 Woodville Road, Woodville SA 5011

Surgical endocrine outpatients 
Location: 8th Floor, 28 Woodville Road, Woodville SA 5011

Endocrine outpatients

Some endocrine conditions require supervision from an endocrinologist long term such as disorders associated with pituitary or adrenal hypo or hyperfunction. 

However where possible, the objective of an endocrinology outpatient appointment is to provide an assessment of the patient, an opinion regarding the key clinical issues and advice to the patient and the referring practitioner over several visits followed by formal discharge from the clinic.

This particularly applies to lesser priority conditions which may have a longer waiting time for an appointment and for which specialised drug therapies and/or disease monitoring are not indicated.

At the Royal Adelaide Hospital (RAH), in addition general endocrine clinics, a variety of “themed” clinics are held including pituitary, thyroid and osteoporosis. At the The Queen Elizabeth Hospital, patients all these disorders can be referred to General Endocrine clinics, where patients with diabetes are also seen.

Patients are generally seen by a Consultant Medical Officer, either directly or in an overseeing role following inputs from a Registrar.

Staff and clinic days

Royal Adelaide Hospital (RAH)

Day Doctors attending Clinic Conditions seen
Monday (am) Dr Tony Roberts
Dr Jui Ho
Dr Lucy Gagliardi
Dr Mitra Guha
Dr Devika Thomas
Level 8, Outpatient Block Endocrine disorders



Osteoporosis
Monday (pm) Prof David Torpy
Dr Natalie Giles
Prof Peter Clifton
Prof David Torpy
Dr Nicola Poplawski
Level 8, Outpatient Block Endocrine / acute endocrine / pituitary
Endocrine
Endocrine genetics every two months
Tuesday (am) Prof Michael Horowitz
Prof Gary Wittert
Dr Tony Roberts
Registrar clinic
Level 8, Outpatient Block  
Tuesday (pm) No clinics    
Wednesday (am) Dr David Jesudason
Professor Ian Chapman
Level 8, Outpatient Block Osteoporosis
Wednesday (pm) Prof Michael Horowitz
Dr Penny Coates
Registrar clinic
Level 8, Outpatient Block

Endocrine

Pituitary

Thursday (am) Dr Campbell Thompson Level 8, Outpatient Block Obesity multidisciplinary clinic
Thursday (pm) No clinics    
Friday (am) Prof Ian Chapman (W)
Registrar Clinic (W)
Dr Janice Fletcher (with Dietician)
Dr Penny Coates
Level 8, Outpatient Block Endocrine metabolic disorders and general endocrine
Endocrine genetics
Osteoporosis
Friday (pm) No clinics    

Bulk bill clinics: (named referral required)

Dr Campbell Thompson - Obesity multidisciplinary clinic

The Queen Elizabeth Hospital (TQEH)

Day Doctors attending Clinic Conditions seen
Monday Dr David Jesudason
Registrar Junior
Outpatient area 2 General endocrine disorders
Tuesday Dr David Jesudason
Dr Narsing Laddipeerla
(bi-weekly)
RMO
Dr Kirsten Campbell
Dr Narsing Laddipeerla (bi-weekly)
Outpatient area 2
Diabetes house

Outpatient area 1
General endocrine disorders
Wednesday No clinics    
Thursday Registrar junior Outpatient area 2 General endocrine disorders
Friday Dr Lucia Gagliardi
Dr Narsing Laddipeerla
Registrar Junior
Registrar Senior
Dr Kirsten Campbell
Outpatient area 2



8th floor
General endocrine disorders

Bulk bill clinics: (named referral required)

Dr David Jesudason
Dr Narsing Laddipeerla
Dr Kirsten Campbell
Dr Lucia Gagliardi

Referral process

Immediate referral process

Where consultation is “same day” urgent, the endocrine registrar on call should be contacted via the Royal Adelaide Hospital Switchboard (08) 8222 4000 or The Queen Elizabeth Switchboard (08) 82226000 to discuss the patient.A written referral marked URGENT should then be faxed to (08) 8222 5908 (RAH) OR 8222 7188 (TQEH) or sent with the patient if urgent assessment arranged.If the condition is life-threatening, the patient should be sent to the nearest Emergency Department.

Less urgent referrals

All referrals including those urgently requiring consultation must be in writing.Preferred method of referral is by fax or letter.

Fax number: (08) 8222 5908 (RAH) OR 8222.7188 (TQEH)

Non-urgent referrals will be allocated to the next available appointment. Non-urgent referrals will incur a wait. The waiting time for appointment will vary and be dependent on the capacity of the clinic to meet the demand for the service and the medical urgency of the patient’s condition.

Should changes occur to a patient’s medical condition during the waiting time for an appointment, referrers should send an updated referral containing the relevant clinical information.

Referrals unlikely to be offered an appointment

  • fatigue (except where endocrinopathy suspected)
  • uncomplicated hypothyroidism.

Post OPD discharge guidelines and information

Patients whose endocrine disorder has stabilised or resolved and for whom no further appointment has been made will be formally discharged. If there is a deterioration in the clinical state requiring further specialist input, a new referral should be faxed to the Endocrine Department of the RAH or TQEH.

Endocrine priorities are based on clinical urgency as displayed below:

Immediate priority Endocrine examples
(not an exhaustive list)
Endocrine emergencies causing severe metabolic derangement
Endocrine emergencies which are potentially life threatening if untreated.

Acute monoarthritis where sepsis cannot be excluded.

Acute ill-health where patient is clinically unstable.

For example, giant cell arteritis, systemic vasculitis, acutely unwell SLE.

Rheumatological drug complications (for example, methotrexate pneumonitis).

Referral process: must be discussed with the rheumatology registrar or the on call medical registrar if after hours, via RAH switchboard on (08) 8222 4000. 

A written referral marked URGENT should then be faxed to (08) 8222 5895 or sent with the patient if urgent assessment arranged.If the condition is life-threatening, the patient should be sent to the nearest Emergency Department.

Urgent priority Endocrine examples
(not an exhaustive list)

Rapidly evolving or unstable

  • Likely clinical compromise if delay in management
  • “Crisis” presentation for known endocrine problem.

Rapidly evolving or unstable

  • Likely clinical compromise if delay in management
  • “ Crisis” presentation for known endocrine problem 
  • Severe hyper or hypothyroidism
  • Acute symptomatic hypercalcemia  (e.g. serum calcium > 3.0 mmol/l).
  • Symptomatic hypocalcemia.
  • Pituitary tumours especially macroadenomas or if hypersecreting or associated hypopituitarism or visual compromise.
  • Suspected diabetes insipidus Must be discussed with the endocrine registrar or consultant on call on 08 8222 4000 (RAH) OR 8222 6000 (TQEH) to obtain appropriate prioritisation and then a referral letter marked URGENT referrals should be faxed to (08) 8222 5908 (RAH) OR 8222 7188 (TQEH).
Referral process: must be discussed with the endocrine registrar or consultant on call on 08 8222 4000 (RAH) OR 8222 6000 (TQEH) to obtain appropriate prioritisation and then a referral letter marked URGENT referrals should be faxed to (08) 8222 5908 (RAH) OR 8222 7188 (TQEH)
Semi urgent priority Endocrine examples
(not an exhaustive list)

Endocrine abnormality causing slowly progressive deterioration in health. 

Endocrine abnormality causing progressive biochemical deterioration.

Episodic hypoglycaemia.

  • Pituitary dysfunction
  • Adrenal dysfunction (e.g. Cushing’s)
  • Hyperthyroidism not associated with significant compromise.
  • Endocrine Hypertension
  • Hyperprolactinemia.
Referral process: referrals should be faxed to (08) 8222 5908 (RAH) OR 8222 7188 (TQEH).
Routine Endocrine examples
(not an exhaustive list)

Condition is unlikely to deteriorate quickly.

Condition is unlikely to require more complex care if assessment is delayed.

 

  • Osteoporosis and Metabolic Bone Disease
  • Paget’s Disease
  • Hirsuitism
  • Hypogonadism
  • Goitre without airway compromise.
Referral process: referrals should be faxed  to (08) 8222 5908 (RAH) OR (08) 8222 7188 (TQEH).
Non urgent priority Endocrine examples
(not an exhaustive list)
 

Do not usually need to see a specialist unless there are atypical features.

  • Uncomplicated Hypothyroidism
  • Fatigue (except where endocrinopathy suspected).
Referral process: referrals should be faxed to (08) 8222 5895. Low priority for appointment.

Note: It is important to note these guidelines indicate what is clinically desirable, not what is always feasible in terms of delivery which is dependent on size and staffing of the hospital department.

Endocrine clinical information sheets

The following information sheets about presentations commonly seen in Endocrine outpatients provide the minimum information required for assessing a referral under the headings of: eligibility, priority, differential diagnosis, clinical information and investigations required, pre-referral management strategies and discharge criteria.

Alternate care options/health information for low priority conditions while waiting for an appointment or if no appointment is made:

Not all patients referred to Endocrinology can be offered appointments in the Central Adelaide Local Health Network (CALHN) Endocrinology clinics due to limited resources. In many cases, this triaging will be based on the history and investigations provided which suggest that a treatable endocrine condition is either unlikely to be present or could be reasonably managed at primary care level.

In most cases, the key to appropriate management is a detailed history and examination. If there is a worsening in the clinical or biochemical state then an updated referral could be sent. Alternatively a verbal discussion with the Endocrine service may clarify options for management.

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