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.
- Addisonian crisis e.g. fatigue, weakness, anorexia, nausea, vomiting, hypotension
- suspected or confirmed acute adrenal insufficiency
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
- suspected/confirmed primary or secondary adrenal insufficiency
- recently treated/resolved Addisonian crisis symptoms may include:
Category 2 — appointment clinically indicated within 90 days
- treated adrenal insufficiency but with persistent symptoms
Category 3 — appointment clinically indicated within 365 days
- review of stable treated glucocorticoid insufficiency
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/cancer history, including osteoporosis
- current medications and dosages
- use/frequency of alcohol, tobacco, and other drugs
- allergies and sensitivities
- onset, duration, and progression of symptoms
- management history including treatments trialled/implemented prior to referral
- physical examination results
- blood pressure
- adrenocorticotropic Hormone (ACTH)
- serum cortisol (0800-0900h)
- thyroid function test (TFT):
- thyroid stimulating hormone (TSH)
- free thyroxine (FT4)
- insulin-like growth factor-1 (IGF-1)
- follicle-stimulating hormone (FSH)
- luteinizing hormone (LH)
- testosterone (male) or oestradiol (female)
- urea, electrolyte, and creatinine (UEC)
- liver function test (LFT)
- random blood glucose level
Additional information to assist triage categorisation
Se cortisol level low, consider short synacthen test.
Clinical management advice
Primary adrenal insufficiency, also referred to as Addison's disease, commonly arises from autoimmune-induced adrenal cortex atrophy; alternative triggers encompass infection and metastatic cancer.
- Key indicators of primary adrenal insufficiency encompass weariness, loss of appetite and weight, postural hypotension, as well as heightened pigmentation of the skin and mucous membranes
- effective management of primary adrenal insufficiency necessitates life-long replacement of both glucocorticoids and mineralocorticoids
- secondary adrenal insufficiency emerges from pituitary or hypothalamic dysfunction, or abrupt discontinuation of glucocorticoid therapy
- in contrast, secondary adrenal insufficiency mandates only glucocorticoid replacement, as the renin–angiotensin–aldosterone axis remains unaffected, obviating the need for mineralocorticoid replacement
- in the event of suspected adrenal insufficiency, it is imperative to promptly engage in discussion with an endocrinologist.
If acutely unwell, commence treatment with intravenous (IV) or intramuscular (IM) hydrocortisone 100mg - pending results of cortisol or short synacthen test.
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.
- Endocrine Society - Primary Adrenal Insufficiency Guideline Resources
- Therapeutic Guidelines - Adrenal Insufficiency