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)
- 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
- Lyell McEwin Hospital
(08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
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
For information on referral forms and how to import them, please view 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
- identify within your referral 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
- compressive signs e.g. visual deficits, cranial nerve deficits
- body mass index (BMI)
- relevant diagnostic/imaging reports including location of company and accession number
- adrenocorticotropic hormone (ACTH)
- follicle-stimulating hormone (FSH)
- insulin-like growth factor-1 (IGF1)
- luteinizing hormone (LH)
- morning cortisol (8.00 to 9.00 am)
- thyroid function test (TFT):
- >thyroid stimulating hormone (TSH). TSH alone is not sufficient to exclude central hypothyroidism
- >free thyroxine (FT4)
- fasting morning testosterone
- sex hormone binding globulin
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.
- Endocrine Society - Clinical Practice Guideline: Pituitary Incidentaloma
- Therapeutic Guidelines - Pituitary Adenomas