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:
    • nausea/vomiting
    • dehydration
    • weight loss
    • delirium or cognitive impairment
  • acute renal function impairment
  • acute pancreatitis

For clinical advice, please telephone 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

  • 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

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.

  • 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

Pathology

  • plasma calcium (total and corrected) – repeat fasting if borderline
  • serum parathyroid hormone (PTH)
  • phosphate (PO4)
  • magnesium (Mg)
  • alkaline Phosphatase (ALP)
  • vitamin D 25-OH
  • albumin
  • 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.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.