Endocrinology referrals

Directly Bookable Service for Endocrinology

The GP surgery will generate an appointment referral request with appropriate priority (urgent or routine) for the service on e-Referral and UBRN in the usual way.

An electronic proforma or appropriate letter needs to be attached to the e-Referral Service by the surgery within 48 hours for a routine or urgent appointment.

In the case that the Trust cannot provide an immediate appointment, 'Defer to Provider' can be selected and Trust processes will be in place to contact the patient within 48 hours for an urgent or routine appointment.

18WW clock will start on the date the GP or patient makes the appointment booking.

GPs should check their patients have appointments on their e-Referral worklist. This applies to all appointment requests made through e-Referral.

Conditions treated

1. Thyroid disorders

• Hyperthyroidism
• Hypothyroidism
• Goitre
• Thyroid nodule(s)
• Thyroiditis
  
• Thyroid cancer
• Abnormal thyroid function tests

2. Gonadal disorders

• Polycystic ovary syndrome
  
• HRT
  
• Menopause (early or natural)
  
• Delayed puberty
• Precocious puberty
• Primary amenorrhoea
• Turner's syndrome
• Klinefelter's syndrome
• Gonadal dysgenesis
• Testicular feminisation
• Hermaphroditism
• Transsexualism
• Masculinising tumours
• Testicular tumours
• Impotence

3. Pituitary disorders

• Pituitary tumour
• Prolactinoma
• Acromegaly
• Cushing's syndrome
• Non functioning tumour
• Normoprolactinaemic galactorrhoea
• Pituitary apoplexy
• Craniopharyngioma
• Hypophysitis
• Hypopituitarism
• Diabetes insipidus
• Hypothalamic syndromes

4. Adrenal disorders

• Phaeochromocytoma
• Addison's disease
• Adrenal carcinoma
• Congenital adrenal hyperplasia
• Bartter's syndrome
• Gitelmann's syndrome

5. Calcium (parathyroid) disorders

• Hyperparathyroidism
• Malignant hypercalcaemia
• Hypercalciuria
• Hypoparathyroidism
• Osteomalacia

6. Pancreatic disorders

• Hypoglycaemia
• Insulinoma
• Zollinger-Ellison syndrome

7. Miscellaneous

• Anorexia nervosa
• Gynaecomastia
  
• Carcinoid syndrome
• Pancreatic endocrine tumour
• Multiple Endocrine Neoplasia Types I/II

8. Growth disorders

9. Neuroendocrine tumours

• Pancreatic islet cell tumours
• Carcinoid tumours
• Bronchial carcinoids
• Paragangliomas

Suggested investigations

No.	Category	Disease	Investigations
1.	Thyroid disorder	Thyrotoxicosis	Gastric parietal cell AB, thyroid AB, TSH, free T4, free T3
		Hypothyroidism/Goitre	Thyroid AB, gastric parietal cell AB, free T4, TSH, 9am cortisol
2.	Gonadal disorders	Hirsutism/PCOS (off pill 6/52)	testosterone, DHEAS, androstenedione, SHBG, prolactin, LH, FSH, oestradiol, 17-OH progesterone
		Female hypogonadism	prolactin, LH, FSH, oestradiol
		Impotence	FSH, LH, testosterone, oestradiol, prolactin
		Male hypogonadism	PSA, LFTs, ferritin, gamma GT
3.	Pituitary disorders	Raised prolactin	TSH, free T4, FSH, LH, oestradiol, prolactin, testosterone
		Pituitary/?Hypopituitarism	9am cortisol, TSH, free T4, FSH, LH, oestradiol, testosterone, prolactin, HGH, IGF1
		Acromegaly	GH, IGF1, 9am cortisol, prolactin, FSH, LH, oestradiol, testosterone, FSH, free T4
4.	Adrenal disorders	Conn's	U&Es, spot urine for sodium and potassium
		Addison's	TSH, free T4, 9am cortisol, 9am ACTH
5.	Calcium (parathyroid) disorders	Hypercalcaemia	PTH, calcium, phosphate, alk phos, U&Es, albumin, immunoglobulins, electrophoresis, CRP, sACE, 2 x 24 hour urinary calcium

Service notes

Subfertility or hirsutism plus menstrual disorders are often best seen initially in the endocrine clinic. Some patients may need to be referred directly to the gynaecologist depending on the nature of their presentation.

Please always supply information on any medications given in the last three months that may elevate prolactin (consulting BNF if necessary).

• A 9.00am cortisol < 100 nmol/L consider urgent.
• Prolactin > 3000 mU/L consider urgent.

Email advice

We run an email consultation service for GPs, staffed by our SPRs and consultants, which aims to give a 24 to 48 hour email enquiry return time.

Email: oxon.endocrinologyadvice@nhs.net

This service is staffed Monday to Friday 9.00am - 5.00pm.

There is a separate email advice line for paediatric endocrinology and a separate email advice line for diabetes and lipid queries:

Email advice lines

Telephone advice

Please call via switchboard Monday to Friday 9.00am - 5.00pm.

For urgent advice out of hours please contact the on-call Endocrinology team via switchboard.

Tel: 0300 304 7777

Alternative services

• Osteoporosis and metabolic bone disease - seen at the Nuffield Orthopaedic Centre, Professor John Wass.
• Paediatric endocrinology - seen by Dr Fiona Ryan, John Radcliffe Hospital.
• Euthyroid nodules - consider referral to Mr Greg Sadler, Endocrine Surgeon at the John Radcliffe Hospital under specialty surgery not otherwise specified. Clinic type Endocrine Surgery.