Hypertension (endocrine)

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.

    • 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
    • Refer to local HealthPathways or local guidelines
    • 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) CPC
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Confirmed or suspected phaeochromocytoma
  • Patients with severe persistent hypertension (SBP >180mmHg but below 220 mmHg) without concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
    • signs of heart failure
    • chest pain
  • 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 calendar days)
  • 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 calendar days)

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

  • 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

3. Additional referral information Useful for processing the referral

  • 24 hour ambulatory Blood Pressure monitoring

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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