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.

  • nil

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

  • concerning features of virilisation (masculine physical characteristics):
    • male-pattern baldness
    • deepening of voice
    • clitoromegaly
    • abnormal glucose metabolism
    • cardiovascular disease
    • non-alcoholic fatty liver disease
  • endometrial carcinoma

Category 2 — appointment clinically indicated within 90 days

  • nil

Category 3 — appointment clinically indicated within 365 days

  • biochemical hyperandrogenism
    • and/or related clinical signs of acne
    • and/or hirsutism without concerning features
  • PCOS

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/reproductive history, including:
    • family history of delayed puberty or hypogonadism
    • history of chronic ill health or any medications
    • reproductive features (hirsutism, infertility and pregnancy complications)
    • metabolic implications (insulin resistance, metabolic syndrome, impaired glucose tolerance, type 2 diabetes and potentially cardiovascular disease)
  • current medications and dosages
  • use/frequency of alcohol, tobacco, and other drugs, including:
    • history of marijuana use (including partner)
    • other relevant medications that contribute to infertility e.g. illicit drugs, steroids, chemotherapy
  • allergies and sensitivities
  • onset, duration, and progression of symptoms
  • management history including treatments trialled/implemented prior to referral
  • height/weight
  • body mass index (BMI)
  • abdominal/pelvic examination
  • transvaginal ultrasound (US) between days 1 to 4 menstrual cycle
    • pelvic US in females that are not sexually active
  • relevant diagnostic/imaging reports including location of company and accession number
    • if clinical suspicion of obstructive sleep apnoea (OSA)
      • sleep study

Pathology

  • testosterone
  • glycated haemoglobin test (HbA1c) (diabetic)
  • fasting blood glucose
  • lipids
  • androgen studies
  • oestradiol
  • progesterone
  • prolactin
  • luteinizing hormone (LH)
  • follicle-stimulating hormone (FSH)
  • sex hormone-binding globulin (SHBG)
  • thyroid function test (TFT)
  • thyroid stimulating hormone (TSH)
  • dehydroepiandrosterone sulphate (DHEAS)
  • 17-hydroxyprogesterone (17-OHP)
  • oral glucose tolerance test (OGTT), non-diabetic

Clinical management advice

PCOS is a common condition, present in 12 to 21% of women in their reproductive years. A diagnosis of PCOS can be made if 2 of the 3 following criteria are met:

  • excess androgen (clinical or biochemical)
  • menstrual disturbance (oligomenorrhoea/amenorrhoea)
  • polycystic appearance of ovaries on ultrasound.

The treatment of PCOS aims to address the symptoms and long-term health risks arising from abnormal ovarian androgen production, anovulatory menstrual cycles, obesity and insulin resistance. Most aspects of PCOS can be managed in general practice, but specialist referral is appropriate if:

  • diagnosis is uncertain
  • hirsutism is not responding to antiandrogen therapy after 6 to 12 months
  • seeking fertility treatment, refer to reproductive physicians.

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.

Clinical resources

Consumer resources