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Hyperprolactinaemia

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 if necessary) or seek emergent medical advice if in a remote region.

  • Pituitary tumour with sudden severe headache
  • Acute onset visual loss or diplopia
  • Pituitary tumour with likely adrenal crisis (hypotension, tachycardia, vomiting, altered level of consciousness)

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

  • Pathological headaches with large (>10mm) pituitary mass
  • Serum prolactin >10x upper limit of normal range

Category 2

Appointment within 90 days is desirable

  • Serum prolactin 2-10x upper limit of normal range with galactorrhoea or oligo-amenorrhoea in women, hypogonadism in men

Category 3

Appointment within 365 days is desirable

  • Serum prolactin up to 2x upper limit of normal range without galactorrhoea or oligo-amenorrhoea in women, hypogonadism in men

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
  • Withdraw any drugs likely to elevate serum prolactin if possible. Drug induced hyperprolactinaemia normalises within 4 days of cessation.
  • If patient is not clearly symptomatic, repeat serum prolactin and ask for macroprolactin (a variant of prolactin which is inactive) level
  • Pituitary MRI scan if serum prolactin after macroprolactin adjustment is x 4 upper limit normal off relevant drugs in asymptomatic patients,  or above upper limit normal in the presence of headache, neurological signs, pathological menstrual disturbance, galactorrhea or male androgen deficiency. 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 (08:00-09:00) cortisol, ACTH, TSH, T4, IGF1

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

  • Details of all treatments offered and efficacy
  • Symptoms and duration
  • Plans re pregnancy if relevant
  • Serum prolactin with repeat level and macroprolactin if no symptoms
  • TFT (TSH, free T4) creatinine and eGFR
  • 0800-0900 serum testosterone LH, FSH, SHBG in men
  • E2, LH and FSH in women
  • ßHCG in premenopausal women

Additional Referral Information (Useful for processing the referral)

  • Use of medications known to increase prolactin particularly:
    • Antipsychotics
    • Antiemetics
    • Opioids

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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