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Hypertension (endocrine)

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.

  • Hypertensive emergency (BP>220/120)
  • Severe hypertension (systolic BP >180) with any of the following concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilledema
    • signs of heart failure
    • chest pain
    • acute kidney injury
  • If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department or maternity assessment unit of a facility that offers obstetric services where possible.
  • Phaeochromocytoma in crisis with uncontrolled hypertension

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

  • Confirmed or suspected phaeochromocytoma
  • Patientswith severe persistent hypertension (SBP>180mmHG but below 220mmHG) without concerning features
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
    • signs of heart failure
    • chest pain
    • acute kidney injury
  • Hypertension that persists after trial of oral medication as described by the Heart Foundation Hypertension Guideline
  • Confirmed or suspected Cushing’s Syndrome
  • Confirmed or suspected Primary Hyperaldosteronism with potassium <3mmol/L

Category 2

Appointment within 90 days is desirable

  • Primary hyperaldosteronism (Conn’s syndrome) with potassium ≥3 mmol/L
  • Patients suspected of having any other secondary endocrine cause for hypertension
  • Patients with hypertension (but ≤180/100) in whom renal artery stenosis is suspected (consider referral to vascular if available)
  • Patients with resistant hypertension (but ≤180/100) despite receiving 3 or more antihypertensive agents in optimal dose and no underlying ischaemic heart disease, cardiomyopathy, or chronic kidney disease
  • Patients with hypertension (but ≤180/100) who have intolerances to multiple antihypertensive agents

Category 3

Appointment within 365 days is desirable

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 HealthPathways for assessment and management information if available.
  • Many drugs affect renin and aldosterone secretion and may affect interpretation of aldosterone: renin ratio – it is best to check the aldosterone: renin ratio prior to commencing anti-hypertensive treatment if possible in people with young onset of hypertension
  • Hypertension (General Medicine)

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

  • Renin, aldosterone
  • Plasma free metadrenaline and normetadrenaline
  • 1mg dexamethasone suppression test and/ or 24hr urinary free cortisol
  • Renal duplex report (only if renal artery stenosis suspected)
  • Details of all treatments offered and efficacy
  • BP (BP measurements on both arms preferable)
  • Relevant previous medical history and co-morbidities
  • FBC, ELFTs, eGFR, fasting lipids
  • Urinalysis
  • Urinary protein estimation or albumin creatinine ratio
  • CXR report
  • ECG

Additional Referral Information (Useful for processing the referral)

  • 24 hour ambulatory Blood Pressure monitoring

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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