Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • suspected pituitary tumour with concerning features including:
    • acute new visual field loss (usually temporal and classically bitemporal superior quadrantinopia/hemianopia)
    • hyperprolactinaemia
    • neurological symptoms
    • ophthalmoplegia (pituitary apoplexy)
    • symptomatic cortisol insufficiency
    • thunderclap headache

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 - appointment clinically indicated within 30 days

  • any obvious hormonal excess or deficiency
  • newly diagnosed pituitary tumour
  • suspected hypopituitarism

Category 2 — appointment clinically indicated within 90 days

  • known pituitary dysfunction or hyperfunction, or pituitary tumours on therapy

Category 3 — appointment clinically indicated within 365 days

  • nil

For more on outpatient referrals, see the general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • past medical/surgical history
  • current medications and dosages
  • allergies and sensitivities
  • use/frequency of alcohol, tobacco, and other drugs
  • onset, duration, and progression of symptoms, including:
    • symptoms of raised intracranial pressure
    • neurological deficits, seizures or visual disturbances
    • potential symptoms of hormone excess or hypopituitarism
  • management history including treatments trialled/implemented prior to referral
  • neurological examination
  • examination including evidence of:
    • hormone hypersecretion
    • hypopituitarism
    • compressive signs e.g. visual deficits, cranial nerve deficits
  • height/weight
  • body mass index (BMI)
  • relevant diagnostic/imaging reports including location of company and accession number

Pathology

  • adrenocorticotropic hormone (ACTH)
  • follicle-stimulating hormone (FSH)
  • insulin-like growth factor-1 (IGF1)
  • luteinizing hormone (LH)
  • morning cortisol (8.00 to 9.00 am)
  • prolactin
  • thyroid function test (TFT):
    • >thyroid stimulating hormone (TSH). TSH alone is not sufficient to exclude central hypothyroidism
    • >free thyroxine (FT4)

Male

  • fasting morning testosterone
  • sex hormone binding globulin

Female

  • oestradiol

Suspected of Cushing’s syndrome

  • 1 mg dexamethasone suppression test, late night salivary cortisol, and/or
  • 24-hour urinary free cortisol measurement

Macroadenomas or those complaining of visual symptoms

  • optometrist/ophthalmology report (less than 6 months old)

Additional information to assist triage categorisation

  • pituitary magnetic resonance imaging (MRI) if completed

Clinical management advice

Pituitary adenoma is the most common pituitary lesion, with potential alternate diagnoses comprising Rathke's cleft cyst, craniopharyngioma, meningioma, hypophysitis, and metastasis. Categorically, pituitary adenomas are divided into functioning and non-functioning varieties.

Functioning pituitary adenomas can incite significant symptoms due to hormone overproduction. Both functioning and non-functioning pituitary adenomas can lead to mass effect symptoms like headaches, visual disturbances, and hypopituitarism.

Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.

Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.

Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.

Investigations not helpful

Computerised tomography (CT) imaging  investigations are not helpful in the investigation of pituitary disease.

Clinical resources

Consumer resources