Adrenal mass

ADULT

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

    • Severe hypertension (see above)
    • Phaeochromocytoma crisis
    • Potassium <3mmol/L
    • Suspected adrenal haemorrhage
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Adrenal tumour with suspicious features for malignancy and / or > 4 cm
  • Adrenal tumour with evidence that it is functional
    • excess cortisol (Cushing's syndrome)
    • excess aldosterone
    • excess catecholamines (phaeochromocytoma)
    • excess androgens - hirsutism, virilisation
Category 2
(appointment within 90 calendar days)
  • Adrenal incidentaloma with no suspicious features for malignancy or production of excess cortisol, aldosterone, catecholamines or androgens and ≥2cm
  • Surveillance of known adrenal adenoma
Category 3
(appointment within 365 calendar days)
  • Adrenal incidentaloma with no suspicious features for malignancy or production of excess cortisol, aldosterone, catecholamines or androgens and <2cm

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Advise presence of hypertension or hypokalaemia
  • For incidental adrenal lesion: ELFT, plasma metanephrines, morning (08:00-09:00) ACTH and cortisol1mg dexamethasone suppression test, aldosterone and renin with aldosterone:renin ratio
  • Current and previous CT or other imaging preferred with dedicated adrenal protocol

3. Additional referral information Useful for processing the referral

  • Relevant investigations - any relevant imaging studies
  • If abnormal 1mg dexamethasone suppression test (post-dex cortisol >50 nmol/L), ACTH and DHEAS

4. Request

  • Patient's Demographic Details

    • 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

    Referring Practitioner Details

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

    Relevant clinical information about the condition

    • 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

    Reason for request

    • 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

    Clinical modifiers

    • 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

    Other relevant information

    • 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.)

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

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 2 December 2024

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