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.
- severe hypercalcaemia usually corrected serum calcium ≥ 3.0 mmol/l with concerning features:
- weight loss
- delirium or cognitive impairment
- acute renal function impairment
- acute pancreatitis
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
- severe hypercalcaemia corrected serum calcium ≥ 3.0 mmol/l
Category 2 — appointment clinically indicated within 90 days
- asymptomatic hypercalcaemia corrected serum calcium less than 3 mmol/L
- recurrent renal calculi
- non-parathyroid hormone (PTH)-mediated hypercalcaemia
Category 3 — appointment clinically indicated within 365 days
- asymptomatic hyperparathyroidism with normal calcium and vitamin D levels
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
- bone mineral density (BMD) if minimal trauma fracture or loss of height including forearm, spine and hip - dual-energy X-ray absorptiometry (DXA) scan
- relevant diagnostic/imaging reports, including location of company and accession number
- plasma calcium (total and corrected) – repeat fasting if borderline
- serum parathyroid hormone (PTH)
- phosphate (PO4)
- magnesium (Mg)
- alkaline Phosphatase (ALP)
- vitamin D 25-OH
- urea, electrolyte, and creatinine (UEC)
- erythrocyte sedimentation rate (ESR)
- calcium-to-creatinine ratio fasting morning spot urine (2nd void)
Suspected primary hyperparathyroidism
- 24-hour urine calcium paired with serum calcium and creatinine
Additional information to assist triage categorisation
- ultrasound (us) kidneys and urinary tract
Clinical management advice
Parathyroid imaging (ultrasound, nuclear medicine scanning, computerised tomography) should not be performed – these tests are insensitive, do not aid diagnosis and are only useful in guiding the type of surgery once a decision has been made to operate.
Secondary hyperparathyroidism i.e. elevated parathyroid hormone level in the setting of normal serum calcium level can be due to chronic kidney disease, vitamin D deficiency, or hypocalcaemia (malabsorption or drug induced such as Denosumab).
Ensure hypercalcaemia is real by using corrected serum calcium
- cease potential exacerbating drugs e.g. thiazides, calcitriol or lithium if safe to do so
- maintain hydration
- correct vitamin D deficiency using a vitamin D3 preparation
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.