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 adrenal crisis, including unexplained hyponatraemia and hypoglycaemia
- suspected diabetes insipidus with hypernatraemia and dehydration
- suspected pituitary mass including symptoms of (visual field loss/central nervous system (CNS) signs)
- vomiting or altered level of consciousness in a youth with known adrenal insufficiency
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Category 1 - appointment clinically indicated within 30 days
- pituitary mass - consider referral to neurosurgery and ophthalmology
- suspected diabetes insipidus with mild hypernatraemia
- suspected primary adrenal insufficiency
Category 2 — appointment clinically indicated within 90 days
- suspected secondary adrenal insufficiency, or treated adrenal insufficiency
- stable polydipsia
- suspected Cushing syndrome
- septo-optic dysplasia or optic nerve hypoplasia
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
- onset, duration, and progression of symptoms
- current medications and dosages
- allergies and sensitivities
- management history including treatments trialled/implemented prior to referral
- examination findings, including:
- Tanner staging
- presence of hyperpigmentation
- height/weight/body mass index (BMI)
- blood pressure
- urea, electrolyte, and creatinine (UEC)
- if primary adrenal insufficiency suspected:
- serum cortisol, 8.00 am to 9.00 am
- adrenocorticotropic hormone (ACTH)
- 24-hour urine free cortisol (UFC) or midnight salivary cortisol test
- thyroid stimulating hormone (TSH)
- free thyroxine (FT4)
- insulin-like growth factor-1 (IGF-1)
- serum cortisol (0800-0900h)
- If > 9 years of age:
- luteinizing hormone (LH)
- follicle-stimulating hormone (FSH)
- oestrogen or testosterone
Clinical management advice
Examples of paediatric adrenal conditions include:
- primary adrenal insufficiency, e.g Addison disease, congenital adrenal hyperplasia
- secondary adrenal insufficiency, e.g. pituitary or hypothalamic disorder, exogenous glucocorticoids
- glucocorticoid excess, e.g Cushing syndrome
The hallmarks of primary adrenal insufficiency are fatigue, anorexia and weight loss, postural hypotension, and skin and mucosal hyperpigmentation:
- primary adrenal insufficiency requires lifelong glucocorticoid and mineralocorticoid replacement
- secondary adrenal insufficiency only requires glucocorticoid replacement; mineralocorticoid replacement is not required because the renin– angiotensin–aldosterone axis remains intact
- if you suspect adrenal insufficiency, early discussion with endocrinologist is essential.
Examples of paediatric pituitary conditions include:
- congenital and acquired pituitary disorders including prolactinoma
- diabetes insipidus
Contact Women’s and Children’s Hospital (WCH) endocrinology on-call on (08) 8161 7000 for advice or to escalate and discuss any clinical concerns.
Recent pathology results will be required prior to outpatient appointment. Consider providing repeat pathology form to patient at time of referral.
Patients who have previously been seen by a specialist are encouraged to be referred back to their care for further review if required.
Referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but may not fit the criteria provided, you are encouraged to contact the specialist team to discuss your concerns.
- Endocrine Society - Clinical Practice Guideline: Pituitary Incidentaloma
- Royal Children's Hospital Melbourne - Adrenal crisis and acute adrenal insufficiency
- Therapeutic Guidelines - Adrenal Insufficiency
- Therapeutic Guidelines - Pituitary Adenomas