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Adrenal Disorders Referral Access Criteria

Adrenal Disorders Referral Access Criteria

Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for adrenal disorders. This RAC is applicable to referrals for patients aged <16 years only.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Adrenal crisis – haemodynamic compromise (hypotension, tachycardia) associated with vomiting, and/or hyponatraemia, and/or hypoglycaemia resulting in unconsciousness or seizure
  • New case of congenital adrenal hyperplasia
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
  • Nil
To contact the relevant service, see Clinician Assist WA: Acute Paediatric Assessment (external site)
Clinical indications for outpatient referral
 If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Hyponatraemia
  • Hypoglycaemia
  • Hypotension
  • Tachycardia
  • Vomiting illness 
  • Abdominal pain
  • Changes in skin pigmentation
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Relevant history, onset, duration and severity of symptoms
  • Current medication list
  • Any known allergies
  • State presence or absence of symptoms suggestive of adrenal disorder:
    • Low energy levels
    • Increasing pigmentation of skin
    • Salt craving
  • State if follow up care following presentation to ED for congenital adrenal hyperplasia
    • Females: virilisation may be present
    • Males: increased scrotal pigmentation may be present
Examination
  • Nil
Investigations
  • Nil
Highly desirable
History
  • Nil
Examination
  • Nil
Investigations
  • BP
  • U&E
  • BSL
  • Morning (08:00-09:00) cortisol
  • 17-OH progesterone
Indicative clinical urgency category

Category 1

Appointment within 30 days           
  • Follow up clinic from emergency presentation
  • Suspected or confirmed Cushing's syndrome

Category 2

Appointment within 90 days

  • Any form of suspected adrenal disorder

Category 3

Appointment within 365 days

  • No defined category 3 criteria
Exclusions
  • Nil
Useful information
  • See Australia and New Zealand Society for Endocrinology and Diabetes for clinical resources (external site)

Feedback

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Last reviewed: 18-03-2024
wa.gov.au