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This page contains information for general practitioners on how to refer patients aged 16 years and over to Diabetes and Endocrine services at Mater Hospital Brisbane
The Queensland Diabetes and Endocrine Centre (QDEC) at Mater Health is an accrediated NADC Tertiary Care Diabetes Service. Offering a comprehensive approach to diabetes and endocrine care, patients are cared for by a variety of health care professionals including doctors, nurses (clinical nurses, nurse educators and nurse practitioners), psychologists and podiatrists.
QDEC also offers specialised services for young adults aged 16 - 25 years, through the Young Diabetes Transition Clinic and the Young Adult Endocrine Clinic at the Mater Young Adult Health Centre Brisbane. These clinics offers a number of clinical services and programs that have been developed with young people in mind.
The Diabetes and Endocrine service is also the referral point for the Multidisciplinary High Risk Foot Service, which comprises of medical specialists (from Diabetes and Endocrine, Orthopaedics and Vascular), wound nurses, podiatrists and clinical nurses who collaboarate at a fortnightly clinic to develop individualised plans of care.
This service provides care to adult patients with diabetes who have been diagnosed as being at "High Risk" of developing foot complications such as:
Please note: All women who are currently pregnant should be referred to the Fetal Maternal Medicine Clinic at the Mater Mother's Hospital and not to the Diabetes and Endocrine Department.
Emergency
Urgent cases – (refer to key below) A – client to present to emergency department immediately B – client to present to diabetes specialist service within 24 hours. If no specialist service is available, present to an emergency department.
Essential information (Referral will be declined without this)
Additional referral information (useful for processing the referral)
Other useful information for management (not an exhaustive list)
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – urgent
Clinically recommended timeframe for initial appointment is 30 days
Category 2 - Priority
Clinically recommended timeframe for initial appointment is 90 days
Category 3 - Routine
Clinically recommended timeframe for initial appointment is 365 days
Suspected or confirmed primary or secondary adrenal insufficiency. For optimum care patient should be seen within 1 week
Routine review of stable treated glucocorticoid insufficiency
No category 3 criteria
Adrenal tumour with suspicious features for malignancy and / or > 4 cm
Adrenal tumour with evidence that it is functional
Adrenal incidentaloma with no suspicious features for malignancy or production of excess cortisol, aldosterone, catecholamines or androgens
Within 7 days Pregnancy in patient with existing diabetes – newly diagnosed GDM / REFER MMH – Obs Med clinic
Pregnancy in patient with existing diabetes. For optimum care, patient should be seen within 1 week.
Newly diagnosed GDM. For optimum care, patient should be seen within 1 week.
Poorly controlled diabetes with recent deterioration despite escalation of therapy (HbA1c >86mmol/mol or 10%)
Major hypoglycaemic episode (assistance has been required by a third party) or multiple episodes of hypoglycaemia
Existing type 1 diabetes with newly diagnosed coeliac disease
Existing diabetes with recent unintentional weight loss (> 5% of body weight over a month period)
Diabetes requiring optimisation in the presence of severe vascular complications, for example stage 3 CKD, proliferative retinopathy, gastroparesis
Diabetes with disordered eating
Diabetic foot ulcer – refer to high-risk foot criteria
Post DKA admission. For optimum care, face to face or telephone review should be seen within 1 week.
*The following category 2 cases can be referred to local / regional general physician if endocrinologist access is not locally available
Diabetes requiring optimisation in the presence of uncontrolled risk factors for chronic vascular disease (CVD)*
Unsatisfactorily controlled diabetes with recent deterioration despite escalation of therapy (HbA1c 64-86mmol/mol or 8-10%)*
High-risk (but currently not ulcerated) foot in client with diabetes*
Pre-pregnancy planning
Private or commercial driver’s licence who require a new or renewal of conditional licence
Stable type 1 diabetes
For consideration or commencement of continuous glucose monitoring or continuous subcutaneous insulin infusion pump
Self-management education or difficulties in managing diabetes in the absence of adequate community resources
Suspected or confirmed diabetes insipidus with normal electrolytes
Asymptomatic hyper or hyponatraemia
Suspected or confirmed Cushing’s syndrome
Low risk of Cushing's syndrome
No Category 3 criteria
Urgent cases – (refer to key below) A – client to present to emergency department immediately B – client to present to diabetes specialist service within 24 hours. If no specialist service is available, consult with a specialist service via telehealth, or present to an emergency department.
*High-risk foot has 2 or more of the following:
or a history of:
All other symptomatic hypercalcaemia
All non-PTH mediated hypercalcaemia
Mild asymptomatic hypercalcaemia e.g. <3 mmol/L
Mild asymptomatic hyperparathyroidism with normal calcium levels
Confirmed phaeochromocytoma or suspected with uncontrolled hypertension
Suspected phaeochromocytoma
Primary hyperaldosteronism (Conn’s syndrome)
Resistant hypertension
Severe thyroid eye disease
Newly diagnosed symptomatic thyrotoxicosis with T4 and/or T3 >2x normal
Inadequate response to anti-thyroid medication or intolerant of medication
Hyperthyroidism that is stable with GP initiated therapy or T4 and/or T3 <2x normal
Symptomatic hypocalcaemia
Asymptomatic hypocalcaemia
*PBS subsidised testosterone treatment must be prescribed initially by an endocrinologist and patients must have two morning testosterone levels < 6 with established pituitary or gonadal disease
Arrested puberty (16 years and over)
Suspected hypopituitarism
Delayed puberty (16 years and over)
Male infertility
Confirmed hypogonadism with two morning testosterone levels under 6
Azoospermia
Symptoms of androgen deficiency with testosterone levels over 6*
Suspected or confirmed secondary hypothyroidism (low T4 without a raised TSH)
Hypothyroidism with difficulty normalising TFTs despite thyroxine therapy
Hypothyroidism within 12 months of delivery of a child
Pre-pregnancy counselling
NB Category 2 cases can be referred to local / regional general physician if endocrinologist access is not locally available
Problems with management of primary or secondary hypothyroidism
Hypoglycaemia or significant suspicion of hypoglycaemia
No category 2 criteria
Total cholesterol > 10 mmol/l and triglyceride < 10 mmol/l in patient having had cardiovascular event in the preceding 3 months
Total triglyceride > 20mmol/l in patient having had episode of pancreatitis in the previous 3 months
The following conditions not responsive to maximal tolerated therapy or statin intolerance
Mater Hospital Brisbane does not currently accept referrals where obesity is the primary reason for referral.
Complex obesity services are available through Metro South Health.
Infertility include
Polycystic ovarian disease include
Hirsutism include
Amenorrhea include
Delayed Puberty
Infertility
Hirsutism
Diagnostic criteria for Rotterdam diagnosis of polycystic ovary syndrome: Monash International evidence-based guideline for the assessment and management of Polycystic Ovary Syndrome (PCOS) 2018
Amenorrhea in children or adolescents:
New onset virilisation in a female (hirsutism, acne, balding)
Serum testosterone >5nmol/l in a female
Primary or secondary oligo/amenorrhoea. For optimum care, patient should be seen within 6 months.
Biochemical hyperandrogenism and/or related clinical signs of acne and/or hirsutism without evidence of severe androgen excess
Polycystic ovarian syndrome as per Rotterdam criteria in the absence of any other explanation
All referrals for infertility (definition: - infertility is the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse)
Clinical Resources
Recurrent fractures despite initiation of treatment for osteoporosis
Pagets disease
Fibrous dysplasia
Osteomalacia
Low trauma fracture, in individuals in whom there are contraindications/concerns regarding conventional osteoporosis management
Long term glucocorticoids with BMD t-score <-1.5, in individuals in whom there are contraindications/concerns regarding conventional osteoporosis management
Post-transplant osteoporotic (BMD t-score <-2.5) and/or fracturing and/or using glucocorticoids
Osteoporosis where PBS thresholds are not met for e.g. Inflammatory bowel disease)
Unexplained osteoporosis
Osteoporosis on BMD without fracture
Other (suspected) metabolic bone disease eg. Osteogenesis imperfecta
Newly diagnosed pituitary tumour
Suspected pituitary failure
If any obvious hormonal excess or deficiency
Known pituitary dysfunction or hyperfunction, or pituitary tumours on therapy
Pathological headaches with pituitary mass
Serum prolactin >x10 upper limit of normal range
All other cases of hyperprolactinaemia
Abormal thyroid function
The following conditions are to be referred if accompanied with normal thyroid function to Mater General Surgery Service
Diffuse goitre, multi-nodular goitre or solitary nodule (<4cm in size)
Essential information
Additional information
Other useful information for management
Turner Syndrome with complex and urgent needs
Turner Syndrome review
Mater Health offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed clinic, please provide a named referral to one of the specialists listed above.
If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200
We provide up to date data on how long patients are waiting for their first appointment by specialty here
These Mater Referral Guidelines align with standardised best practice tools for referral to publicly funded specialist outpatient services developed in Queensland through the Clinical Prioritisation Criteria project.
Content Last Reviewed: 12 February 2024
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