Mater Specialist Quick Find

Diabetes and Endocrine – public patients 

Purpose

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

Service 

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. 

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.

How to Refer

If referral for care is indicated please list all of the General Referral Information and reason for request, and essential information as indicated below.

To refer, please fill in the Mater Adult Referral Form, available to download and embed into most major Practice Management software applications.

Referrals can be sent by:

Secure messaging  Medical Objects:   HM4101000R8
  HealthLink EDI:    materref   
Fax    07 3163 8548

 

 

 

 

Emergency

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region:

 

View list of conditions:

Pancreatic disease

Present to Emergency Department

  • Diabetes and severe vomiting
  • Diabetic ketoacidosis 
  • Acute severe hyperglycaemia
  • Acute severe hypoglycaemia 
  • Hyperosmolar hyperglycaemic state (HHS)
  • Foot ulcer with infection and systemically unwell or febrile
  • Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm)
  • Acute ischaemia
  • Wet gangrene

High Risk Foot

  • Foot ulcer with infection and systemically unwell or febrile
  • Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm)

Present to Diabetes specialist service within 24 hours (if no specialist service is available, present to an emergency department)

  • Newly diagnosed type 1 diabetes (call registrar or consultant on call)

High Risk Foot

  • Acute ischaemia
  • Wet gangrene
  • Acute or suspected Charcot

Thyroid disorders

  • Hyperthyroidism complicated by cardiac, respiratory compromise or other indications of severe illness (fever, vomiting, labile blood pressure, altered mental state)
  • Neutropenic sepsis in patient taking carbimazole or propylthiouracil
  • Hyperthyroidism with hypokalaemia or paralysis
  • Suspected myxoedema coma (altered consciousness, hypothermia, fluid overload, bradycardia, hyponatraemia)
  • Stridor associated with a thyroid mass
  • Possible tracheal or superior vena cava obstruction from retrosternal thyroid enlargement

Adrenal disease

  • Addisonian crisis
  • Suspected or confirmed acute adrenal insufficiency
  • Phaeochromocytoma in crisis with uncontrolled hypertension
  • Malignant hypertension

Pituitary disorders

  • All patients with visual field loss (usually temporal and classically bitemporal superior quadrantopia / hemianopia)
  • Pituitary tumour with severe headache
  • Pituitary tumour with evidence of symptomatic cortisol insufficiency
  • Hyperprolactinaemia with visual impairment or other neurological signs

Calcium, electrolyte and metabolic bone disorders

  • Acutely symptomatic hypocalcaemia (e.g. tetany) with serum calcium <2.0mmol/L
  • Severe symptomatic hypercalcaemia (usually serum calcium > 3.0 mmol/l)
  • Hypernatraemia or hyponatraemia with acute confusion/delirium
  • Suspected or confirmed diabetes insipidus with hypernatraemia

 

 

Scope of Service

Conditions out of scope

The following conditions are not routinely provided at Mater Hospital Brisbane:

View list of conditions:

  • Pre-diabetes
  • Stable, well-controlled type 2 diabetes
  • Newly diagnosed type 2 diabetes and not acutely unwell
  • Referrals where the primary problem requiring attention is not directly related to the diabetes and should be directed to another specialty service e.g. chest pain for investigation should go to cardiology
  • Dietary advice for weight reduction, high cholesterol, hypertension or CVD in patients with diabetes
  • Newly diagnosed primary hypothyroidism, including subclinical hypothyroidism – Note: in women of child bearing age who are pregnant or wishing to become pregnant or not using contraception, thyroxine should be commenced and titrated, aiming for a TSH less than 2.5
  • Positive thyroid antibodies with normal thyroid function
  • Osteopaenia
  • Routine uncomplicated osteoporosis

 

Conditions in scope

Adrenal Insufficiency

Essential information (Referral will be declined without this)

  • General referral information
  • ELFTs results
  • Glucose results
  • Morning cortisol and ACTH (08:00-09:00) unless acutely unwell then random
  • Renin, aldosterone results
  • Pituitary investigations if evidence of ACTH deficiency

Additional referral information (useful for processing the referral)

  • If low morning cortisol, consider short synacthen tests

Other useful information for management (not an exhaustive list)

  • If suspect adrenal insufficiency, then early discussion with endocrinologist is advised
  • If acutely unwell, treatment with IV or IMI hydrocortisone 50mg should be commenced pending results of cortisol, short synacthen test

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

Routine review of stable treated glucocorticoid insufficiency

No category 3 criteria

 

Adrenal Mass

Essential information (Referral will be declined without this)

  • General referral information
  • Advise presence of hypertension or hypokalaemia
  • For incidental adrenal lesion: ELFT, plasma free metadrenaline and normetadrenaline, morning cortisol and ACTH, aldosterone and renin, DHEAs
  • Current and previous CT or other imaging

Additional referral information (useful for processing the referral)

  • Relevant investigations - any relevant imaging studies
  • If suspicion of Cushing’s syndrome, then 1mg dexamethasone suppression test

Other useful information for management (not an exhaustive list)

  • No other information

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

Adrenal tumour with suspicious features for malignancy and / or > 4 cm

Adrenal tumour with evidence that it is functional

  • excess cortisol (Cushing’s syndrome)
  • excess aldosterone
  • excess catecholamines phaeochromocytoma
  • excess androgens

 

Adrenal incidentaloma with no suspicious features for malignancy or production of excess cortisol, aldosterone, catecholamines or androgens

No category 3 criteria

 

Diabetes Mellitus

Essential information (Referral will be declined without this)

  • General referral information
  • Type of diabetes and duration of disease
  • Details of all treatments offered and efficacy
  • Presence of any complications and details when screening last performed
  • Previous allied health reviews of risk factors
  • Medication history
  • Height, weight, BMI
  • BP
  • History of smoking
  • HbA1c (current and previous results)
  • FBC ELFT fasting lipids – cholesterol LDL HDL Tg results
  • Urine albumin: creatinine results

Additional referral information (useful for processing the referral)

  • Copy of GPMP/TCA
  • Ankle brachial pressure index (ABPI)
  • Licence status
  • Results of depression screening (PHQ-2)
  • over the last 2 weeks, how often have you been bothered by any of the following problems?
  • little interest or pleasure in doing things?
  • feeling down, depressed, or hopeless?
  • If Type 1 diabetes: TSH, anti-transglutaminase antibodies, IgA for coeliac disease within the last 5 years
  • If peripheral neuropathy: B12 folate

Other useful information for management (not an exhaustive list)

Within 7 days Pregnancy in patient with existing diabetes – newly diagnosed GDM / REFER MMH – Obs Med clinic

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

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 hypoglycaemia 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

      

 

Pre-pregnancy planning 

Private or commercial driver’s licence who require a new or renewal of conditional licence

Stable type 1 diabetes

*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*

Self-management education or difficulties in managing diabetes in the absence of adequate community resources

For consideration or commencement of continuous glucose monitoring or continuous subcutaneous insulin infusion pump in the absence of other indications for referral

 

 

Disorders of Salt and Water

Essential information (Referral will be declined without this)

  • General referral information
  • Medication history including non-prescription medications, herbs, supplements
  • ELFTs, glucose and calcium results
  • Paired urine and plasma sodium and osmolality

Additional referral information (useful for processing the referral)

  • Recreational drug use
  • 24-hour urine volume if polyuria
  • If suspected SIADH then perform TFT and morning cortisol, ACTH

Other useful information for management (not an exhaustive list)

  • Consider drugs that may cause hyponatraemia such as diuretics, SSRIs, SNRIs and carbamazepine

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 diabetes insipidus with normal electrolytes

Asymptomatic hyper or hyponatraemia

 

None

 

Glucocorticoid Excess (Cushing's Syndrome)

Essential information (Referral will be declined without this)

  • General referral information
  • Detailed history including: central obesity, hypertension, osteoporosis, muscle weakness, diabetes mellitus, emotional liability
  • ELFTs results
  • Glucose results
  • 24-hour urine free cortisol and/or, 1mg overnight dexamethasone suppression test results

Additional referral information (useful for processing the referral)

  • If confirmed, hypercortisolism and ACTH is suppressed then CT adrenal
  • Mid-night salivary cortisol

Other useful information for management (not an exhaustive list)

  • Cushing’s due to a functional adrenal adenoma will have a suppressed ACTH
  • Women on the OCP can have elevated cortisol levels due to elevation in cortisol binding globulin

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 Cushing’s syndrome

No Category 2 criteria

No Category 3 criteria

 

High Risk Foot

At the Mater Hospital Brisbane this condition is managed by the multidisciplinary High Risk Foot Service. Please refer to their page for referral guidelines and naming specialist. 

Hypercalcaemia

Essential information (Referral will be declined without this)

  • General referral information
  • Serum total and corrected calcium, albumin and/or ionized calcium results
  • ELFTs and phosphate results
  • PTH results
  • FBC, ESR results

Additional referral information (useful for processing the referral)

  • If primary hyperparathyroidism is suspected then perform a 24-hour urine calcium paired with serum calcium and creatinine, USS kidneys and urinary tract, bone mineral density and USS neck/sestamibi scan is useful.

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

All other symptomatic hypercalcaemia

All non-PTH mediated hypercalcaemia

Mild asymptomatic  hypercalcaemia e.g. <3 mmol/L

 

Mild asymptomatic hyperparathyroidism with normal calcium levels

 

 

Hypertension (Endocrine)

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • Many drugs affect renin and aldosterone secretion and may affect interpretation of aldosterone: renin

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

Confirmed phaeochromocytoma or suspected with uncontrolled hypertension

Suspected phaeochromocytoma

Primary hyperaldosteronism (Conn’s syndrome)

 

No category 3 criteria

 

Hyperthyroidism

Essential information (Referral will be declined without this)

  • General referral information
  • Duration of symptoms
  • Associated symptoms
  • Relevant current and previous drug use (e.g. amiodarone, lithium)
  • Concomitant medical problems and family history
  • Recent pregnancy
  • FBC ELFT ESR results
  • TFTs – TSH, T4, T3 results
  • TSH receptor antibodies
  • Recent potential iodine source (e.g. contrast media, kelp and alternative therapies)

Additional referral information (useful for processing the referral)

  • Nuclear technetium thyroid scan if cause of thyrotoxicosis unclear
  • Weight, height, BMI and weight history (weight loss or weight gain) 

Other useful information for management (not an exhaustive list)

  • No USS is required in the routine assessment of hyperthyroidism or hypothyroidism
  • Avoid iodinated contrast agents wherever possible if suspected thyroid disease
  • Consider ß blocker for symptom control
  • Repeat TFTs within a week of clinic appointment
  • If hyperthyroidism is not due to excess exogenous thyroid hormone, transient thyroiditis or iodine load, then start carbimazole (or PTU if pregnancy possible). Note that serious adverse reactions to these drugs are not uncommon and patients must be fully informed

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

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

No Category 3 criteria

 

Hypocalcaemia

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • No other information

Other useful information for management (not an exhaustive list)

  • No other information

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

Symptomatic hypocalcaemia

Asymptomatic hypocalcaemia

No category 3 criteria

 

Hypogonadism & Infertility (Male)

Essential information (Referral will be declined without this)

  • General referral information
  • History
  • age and health
  • reproductive history
  • testicular condition
  • Height, weight, BMI
  • Morning (0700-0900 hours) sample for LH, FSH, total testosterone,
  • SHBG and prolactin results
  • 09:00 Cortisol, ACTH results
  • TSH, T4 results
  • IGF1 and growth hormone results
  • If infertility - seminal analysis (≥4 days of abstinence)
  • repeat in 4-6 weeks if abnormal

Additional referral information (useful for processing the referral)

  • Pituitary investigations if LH, FSH not elevated
  • Bone mineral densitometry
  • History of marijuana use (including partner) or other relevant medications that contribute to infertility e.g. illicit drugs, steroids, chemotherapy – make reference if appropriate

Other useful information for management (not an exhaustive list)

  • Low testosterone levels can be associated with obesity, sleep apnoea, pain killers, alcohol and depression
  • 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

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

Delayed puberty (16 years and over)

Suspected hypopituitarism

 

Male infertility

Confirmed hypogonadism with two morning testosterone levels under 6

Azoospermia

 Symptoms of androgen deficiency with testosterone levels over 6

 

Hypothyroidism

Essential information (Referral will be declined without this)

  • General referral information
  • TSH  free T4 results
  • Thyroid antibodies if primary hypothyroidism
  • Specific thyroid history eg thyroiditis, thyroid disease in pregnancy, mx hyperthyroidism 

Additional referral information (useful for processing the referral)

  • Weight, height, BMI and weight history (weight loss or weight gain) 
  • Family history 

Other useful information for management (not an exhaustive list)

  • Patients with nodular thyroid disease but normal thyroid function are best referred directly to the Breast and Endocrine Surgery Service. Consider a fine needle aspiration biopsy where appropriate prior to referral.
  • All women who are currently pregnant should be referred to the Maternal Fetal Medicine Service at the Mater Mother's Hospital
  • No USS is required in the routine assessment of hyperthyroidism or hypothyroidism
  • Consider other autoimmune glandular conditions if autoimmune hypothyroidism (e.g. pernicious anaemia, coeliac disease and Addison’s)
  • Commence low dose thyroxine and gradually titrate over months if cardiac disease
  • Usually primary hypothyroidism should be able to be managed in general practice
  • Patients with positive thyroid antibodies and normal TFT do not need to be referred to an endocrine service and recommend TSH to be monitored annually
  • Where indicated, cortisol must be replaced before thyroxine
  • TSH cannot be used to guide replacement thyroxine therapy in patients with pituitary dysfunction. Aim to keep T4 in mid-to-upper range of normal

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 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

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

 

 

Insulinoma / Hypoglycaemia unrelated to diabetes

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Concomitant insulin, c-peptide at time of hypoglycaemia
  • Morning cortisol/ACTH results

Other useful information for management (not an exhaustive list)

  • No other information

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

Hypoglycaemia or significant suspicion of hypoglycaemia

 

No category 2 criteria

 

No category 3 criteria

 

Lipids

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • History of medications used to treat the lipid disorder
  • History of cardiovascular disease
  • Any imaging confirming presence of cardiovascular disease
  • Coronary artery calcium score

Other useful information for management (not an exhaustive list)

  • No other information

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

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

  • Hypercholesterolaemia
  • Hypertriglyceridaemia
  • Dyslipidaemia
  • Statin intolerance

 

No category 3 criteria

 

Obesity

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

 

Oligo / Amenorrhea, Hirsutism, Acne, Female Infertility

Essential information (Referral will be declined without this)

  • General referral information
  • History including
  • reproductive features (hirsutism, infertility and pregnancy complications), and
  • metabolic implications (insulin resistance, metabolic syndrome, IGT, DM2 and potentially CVD)

Infertility include

  • History of
  • previous pregnancies, STIs and PID, surgery, endometriosis
  • other medical conditions
  • Include the following information about partner
  • age and health, reproductive history, testicular conditions
  • Weight/ BMI
  • FBC, group and antibodies, rubella IgG, varicella IgG, syphilis serology, Hepatitis BsAg, HBC serology, HIV results
  • FSH, LH (Day 2 - 5), prolactin, TSH results if cycle prolonged and/or irregular
  • Day 21 serum progesterone level results (7 days before the next expected period)
  • Endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • Partner
  • Seminal analysis of partner (≥4 days of abstinence) report
  • Repeat in 4-6 weeks if abnormal

Polycystic ovarian disease include

  • SHBG results
  • Testosterone, DHEA-S results
  • Fasting blood glucose results
  • Lipids, TSH results

Hirsutism include

  • Fasting glucose, lipids results
  • Testosterone, SHBG results

Amenorrhea include

  • Duration of amenorrhoea (i.e. >6 months)
  • Weight/BMI
  • ßeta HCG results
  • FSH, LH, prolactin, oestradiol, TSH results

Additional referral information (useful for processing the referral)

  • Consider pelvic USS (day 1-4 menstrual cycle)(TVS preferable) TVS USS may not be appropriate in virginal young girls
  • If suspected hypopituitarism then check other anterior pituitary hormones e.g. prolactin, TSH, T4, 09:00 cortisol, ACTH, IGF1, growth hormone
  • Consider 08:00 17 (OH) progesterone for Congenital Adrenal Hyperplasia

Infertility

  • History of marijuana use (including partner) or other relevant medications that contribute to infertility e.g. illicit drugs, steroids, chemotherapy

Other useful information for management (not an exhaustive list)

  • Focus of management should be on education and support with a strong emphasis on healthy lifestyle, with targeted medical therapy where indicated
  • Psychological features need to be screened for, acknowledged, discussed and counselling considered, to improve quality of life in PCOS and to facilitate effective and sustainable lifestyle change consideration of depression and/or anxiety and appropriate management
  • IVF not available in public hospitals
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • simple moderate physical activity including structured exercise (at least 30 minutes/day) and optimising incidental exercise assists with weight loss and weight maintenance
  • achieve optimal weight BMI 20 – 30

Infertility

  • Folic acid 0.5mg/day

Hirsutism

  • Self-administered and professional cosmetic therapy are first line (laser recommended)
  • Eflornithine cream can be added and may induce a more rapid response
  • If cosmetic therapy is not adequate, pharmacological therapy can be considered
  • Pharmacological therapy – cyproterone acetate, spironolactone

Diagnostic criteria for Rotterdam diagnosis of polycystic ovary syndrome:
Two of the following three criteria are required:

  • Polycystic ovaries on ultrasound (either 25 or more follicles per ovary or increased ovarian size (>10 cc))
  • Oligo/anovulation
  • Hyperandrogenism
    • clinical (hirsutism or less commonly male pattern alopecia) or
    • biochemical (raised FAI or free testosterone)

Amenorrhea in children or adolescents:

  • In adolescents – consideration needs to be given as to whether the patient should be referred to a paediatric or adult facility. Some general considerations would be:
  • primary amenorrhoea with growth failure and delayed puberty would more likely be best assessed by a paediatric service.
  • secondary amenorrhoea to an adult facility
  • statewide Paediatric and Adolescent Gynaecology Service sees patients up to 18 years of age
  • Refer to Statewide Paediatric and Adolescent Gynaecology Service (SPAG) at LCCH/RBWH http://www.childrens.health.qld.gov.au/home/lcch/departments-services/gynaecology-service/

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

Delayed puberty (16 years and over)

Suspected hypopituitarism

New onset virilisation in a female (hirsutism, acne, balding)

Serum testosterone >5nmol/l in a female

No category 2 criteria

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)

 

Osteoporosis and Metabolic Bone Disease

Essential information (Referral will be declined without this)

  • General referral information
  • History including
  • menopausal status
  • alcohol history
  • fractures & medications
  • glucocorticoid therapy
  • early menopause
  • hypogonadism
  • weight loss
  • diarrhoea and iron deficiency
  • Details of all treatments offered and efficacy
  • FBC ELFT ESR vitamin D PTH ionised calcium TSH serum EPP anti-tissue transglutaminase antibodies results
  • Lateral XR thoracic and lumbar spine reports
  • Bone mineral density and XR reports of fracture if relevant
  • For men please include tests for hypogonadism (morning testosterone, LH, FSH and SHBG) results

Additional referral information (useful for processing the referral)

  • No additonal information

Other useful information for management (not an exhaustive list)

  • Optimize calcium and vitamin D3 status (if vitamin d deficient)
  • Weight-bearing exercise
  • Oestrogen or testosterone if hypogonadal
  • Bisphosphonates or Denosumab
  • Use a fracture risk calculator (FRAX or Garvan) to help guide the need for specific drug therapy
  • Uncomplicated postmenopausal osteoporosis with fracture should be able to be managed in primary care
  • Clinical Resources
  • Fracture risk assessment tool (FRAX) http://www.shef.ac.uk/FRAX/tool.jsp?locationValue=9
  • Garvan fracture risk calculator http://www.garvan.org.au/bone-fracture-risk
  • Calcium and bone health-position statement for ANZBMS, osteoporosis Australia and ESA

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

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  at the PBS threshold

Osteoporosis on BMD without fracture

Other (suspected) metabolic bone disease  eg. Osteogenesis imperfecta

 

Pituitary Mass

Essential information (Referral will be declined without this)

  • General referral information
  • History of illness: (include details of symptoms of raised ICP, specific neurological deficits, seizures or visual disturbances)
  • History should include questions to assess for functionality, hypopituitarism and compressive symptoms. If the history is suggestive of a pituitary adenoma (PA) then questioning should include reference to potential familial pituitary disorders
  • Clinical examination results – which is predominantly focussed on looking for evidence of hormone hypersecretion, hormone hyposecretion, and compressive signs (visual deficits, cranial nerve deficits)
  • Details of all treatments offered and efficacy
  • Prolactin results
  • 09:00 Cortisol, ACTH results
  • TSH T4 results
  • LH and FSH and if male, morning testosterone and SHBG, if female, oestradiol
  • IGF1 and growth hormone results
  • Visual field assessment (for macroadenomas or those complaining of visual symptoms)
  • MRI scan reports of pituitary (if performed previously)

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • No other information

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

Newly diagnosed pituitary tumour

Suspected pituitary failure

If any obvious hormonal excess or deficiency

Known pituitary dysfunction or hyperfunction, or pituitary tumours on therapy

 

No category 3 criteria

 

Prolactinaemia

Essential information (Referral will be declined without this)

  • General referral information
  • Details of all treatments offered and efficacy
  • Duration of symptoms & associated symptoms
  • Plans re pregnancy if relevant
  • Serum prolactin with repeat level and measure macroprolactin if no symptoms
  • TFT (TSH, T4) creatinine and eGFR results
  • 0800-0900 serum testosterone in men along with LH and FSH, SHBG results
  • E2, LH and FSH results in women
  • ßHCG results in premenopausal women

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • Withdraw any drugs likely to elevate serum prolactin if possible
  • If patient is not clearly symptomatic, repeat serum prolactin and ask for macroprolactin (a variant of prolactin which is inactive) level
  • Pituitary MRI scan only if serum prolactin after macroprolactin adjustment is at least x 4 upper limit normal off relevant drugs or above upper limit normal and headache or neurological signs, pathological menstrual disturbance, galactorrhea or male androgen deficiency is present. In other cases, MRI may be performed if needed by the endocrine unit.
  • If pituitary mass detected then assess the rest of the anterior pituitary function with morning cortisol, ACTH, TSH, T4, IGF1

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

Pathological headaches with pituitary mass

Serum prolactin >x10 upper limit of normal range

All other cases of hyperprolactinaemia

 

No Category 3 criteria

 

Thyroid Enlargement / Thyroid Nodules

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Thyroid nuclear medicine scan if thyrotoxic with thyroid nodule
  • CT neck without contrast if compressive symptoms
  • FNAC if euthyroid and thyroid nodule >10mm

Other useful information for management (not an exhaustive list)

 

  • Thyroid nodules may not require further investigation if:
  • thyroid function is normal and no local symptoms and likelihood of thyroid cancer is low (nodule <10mm)
  • age, comorbidities or other patient characteristics make diagnosis of thyroid cancer irrelevant
  • If a nodule is detected on USS, the report should classify whether the nodule/s is/are benign, equivocal, indeterminate or suspicious for malignancy. If this is not stated in the report, then it is recommended to discuss with reporting radiologist.

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

Abormal thyroid function

The following conditions are to be referred if accompanied with normal thyroid function to Mater General Surgery Service

  • unexplained hoarseness or voice changes associated with a goitre
  • goitre associated with symptomatic airway narrowing
  • cervical lymphadenopathy associated with a thyroid mass (usually deep cervical or supraclavicular region)
  • a rapidly enlarging thyroid mass over a period of weeks (a rare presentation of thyroid cancer and usually associated with anaplastic thyroid cancer or thyroid lymphoma)
  • lymphadenopathy
  • stridor, venous congestion on elevation of upper limbs
  • dominant nodule >4cm in size
  • abnormal cytology

 

 

 

Diffuse goitre, multi-nodular goitre or solitary nodule (<4cm in size)

 

No category 3 criteria

 

Turner Syndrome

Essential information

  • FBC, ELFT, Fasting lipids and glucose, TFTs
  • Most recent echocardiogram
  • Bone densitometry
  • Renal Tract Ultrasound
  • Current medication regime
  • Correspondence and documents from other facilities or specialists

Additional information

  • No additional information

Other useful information for management

  • The Mater offers a comprehensive service for Turner Syndrome, with an endocrinologist with expertise in women’s health and a cardiologist in attendance
  • The Turner Association of Australia offers local support groups and resources

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

Turner Syndrome with complex and urgent needs

 

Turner Syndr

No Category 3 criteria

 

Other Diabetes and Endocrine Condition

Essential information (Referral will be declined without this)

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

 

 

Our Specialists

 

Dr Helen Barrett

Director of Endocrinology, Endocrinologist

Dr Tom Dover

Endocrinologist

Dr Christine Jang

Endocrinologist

Prof. David McIntyre

Endocrinologist

Dr Adam Morton

Endocrinologist

Dr Janelle Nisbett

Endocrinologist

Dr Trisha O'Moore-Sullivan

Endocrinologist

Dr Stephanie Teasdale

Endocrinologist

Margie Vitanza

Clinical Nurse Consultant - Diabetes Educator

Trish Bowden, Bronwyn Buckley, Sarah Clucas, Karen Haworth Michelle Jiang, Marina Noud,

Clinic Nurse - Diabetes Educators

Helen d'Emden, Claire Waugh

Dietician Diabetes Educator

Carolyn Uhlmann

Psychologist

Amy Jones

Podiatrist


Bulk Billed Clinics

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.

Contact Us 

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 

Current Waiting Time for Appointments

We provide up to date data on how long patients are waiting for their first appointment by specialty here

Referral Guideline Development

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: 18 June 2018

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