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Glucocorticoid excess (Cushing’s syndrome)

Emergency department referrals

Phone on call Diabetic and Endocrinology Registrar via:

  • Royal Brisbane & Women’s Hospital switch - (07) 3646 8111
  • The Prince Charles Hospital switch - (07) 3139 4000
  • Redcliffe Hospital switch – (07) 3883 7777
  • Caboolture Hospital switch – (07) 5433 8888

and send patient to the Department of Emergency Medicine (DEM) at their nearest hospital.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance of necessary) or seek emergent medical advice if in a remote region.

  • Hypokalaemia with potassium <3mmol/L

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Suspected or confirmed Cushing’s syndrome

Category 2

Appointment within 90 days is desirable

  • Low risk of Cushing’s syndrome

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to local Healthpathways or local guidelines
  • 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 (in these women please check 24-hour urinary free cortisol and midnight salivary cortisol, rather than 1mg DST)

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

  • Detailed history including: central obesity, hypertension, osteoporosis, muscle weakness, diabetes mellitus, emotional liability
  • Please include a full list of medications (especially COCP and anti-epileptic drugs, and any steroid containing inhaled or topical treatment)
  • ELFTs
  • Glucose
  • ACTH and cortisol
  • 24-hour urine free cortisol and/or, 1mg overnight dexamethasone suppression test

Additional Referral Information (Useful for processing the referral)

  • If confirmed, hypercortisolism and ACTH is suppressed then request DHEAS and triple-phase CT adrenal
  • If ACTH is not suppressed, please include the remainder of the pituitary panel (fT4/ fT3/ TSH, prolactin, IGF-1, LH, FSH and estradiol for females or testosterone for males)
  • Mid-night salivary cortisol

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • 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

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • 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.)
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