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
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| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days): |
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To contact the relevant service, see HealthPathways: Acute Paediatric Assessment (external site)
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| Presenting issues |
| 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
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| 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 due to financial reasons or geographical location).
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.
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| 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
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| Examination |
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| Investigations |
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| Highly desirable |
| History |
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| Examination |
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| Investigations |
- BP
- U&Es
- BGL
- Morning (08:00-09:00) cortisol
- 17-OH progesterone
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| Indicative triage category |
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Category 1
Appointment within 30 days
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- Follow up clinic from emergency presentation
- Suspected or confirmed Cushing's syndrome
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Category 2
Appointment within 90 days
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- Any form of suspected adrenal disorder
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Category 3
Appointment within 365 days
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- No defined category 3 criteria
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| Useful information |
- See Australia and New Zealand Society for Endocrinology and Diabetes for clinical resources (external site)
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Last reviewed: 18-03-2024