Diabetes and Endocrinology

Conditions

Please note this is not an exhaustive list of all conditions for Endocrinology and Diabetes outpatient services and does not exclude consideration for referral unless specifically stipulated in the out-of-scope section.

Paediatric services

Referrals for children and young people should follow the Children’s Health Queensland referral guidelines.

Adult conditions – Emergency Referrals

Pancreatic disease

• Diabetic ketoacidosis  – A
• Acute severe hyperglycaemia
• Acute severe hypoglycaemia – A
• Hyperosmolar hyperglycaemic state (HHS) – A
• Newly diagnosed type 1 diabetes – B (call registrar or consultant on call)
• Foot ulcer with infection and systemically unwell or febrile – A
• Invasive infection or rapidly spreading cellulitis of the foot (defined by peripheral redness around the wound >2cm) – A
• Acute foot ischaemia – A
• Wet gangrene foot – A
• Diabetes and severe vomiting – A

Urgent cases – (refer to key below)
A – client to present to emergency department immediately
B – client to present to diabetes specialist service within 24 hours.  If no specialist service is available, present to an emergency department.

High Risk Foot

• Foot ulcer with infection and systemically unwell or febrile – A
• Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm) – A
• Acute ischaemia
• Wet gangrene
• Acute or suspected Charcot

Thyroid disorders

• Hyperthyroidism complicated by cardiac, respiratory compromise or other indications of severe illness (fever, vomiting, labile blood pressure, altered mental state)
• Neutropenic sepsis in patient taking carbimazole or propylthiouracil
• Hyperthyroidism with hypokalaemia or paralysis
• Suspected myxoedema coma (altered consciousness, hypothermia, fluid overload, bradycardia, hyponatraemia)
• Stridor associated with a thyroid mass
• Possible tracheal or superior vena cava obstruction from retrosternal thyroid enlargement

Adrenal disease

• Addisonian crisis
• Suspected or confirmed acute adrenal insufficiency
• Phaeochromocytoma in crisis with uncontrolled hypertension
• Malignant hypertension

Pituitary disorders

• All patients with visual field loss (usually temporal and classically bitemporal superior quadrantopia / hemianopia)
• Pituitary tumour with severe headache
• Pituitary tumour with evidence of symptomatic cortisol insufficiency
• Hyperprolactinaemia with visual impairment or other neurological signs

Calcium, electrolyte and metabolic bone disorders

• Acutely symptomatic hypocalcaemia (e.g. tetany) with serum calcium <2.0mmol/L
• Severe symptomatic hypercalcaemia (usually serum calcium > 3.0 mmol/l)
• Hypernatraemia or hyponatraemia with acute confusion/delirium
• Suspected or confirmed diabetes insipidus with hypernatraemia

Out of scope services

Not all services are funded in the Queensland public health system. The following are not routinely provided in a public Endocrinology and Diabetes service.

• Pre-diabetes
• Stable, well-controlled type 2 diabetes
• Newly diagnosed type 2 diabetes and not acutely unwell
• Referrals where the primary problem requiring attention is not directly related to the diabetes and should be directed to another specialty service e.g. chest pain for investigation should go to cardiology
• Dietary advice for weight reduction, high cholesterol, hypertension or CVD in patients with diabetes
• Newly diagnosed primary hypothyroidism, including subclinical hypothyroidism – Note: In women of child bearing age who are pregnant or wishing to become pregnant or not using contraception, thyroxine should be commenced and titrated, aiming for a TSH less than 2.5
• Positive thyroid antibodies with normal thyroid function
• Osteopenia
• Routine uncomplicated osteoporosis

Specialists list

Clinic details

Royal Brisbane and Women’s Hospital (RBWH)

Monday – Friday: 7am – 5pm
Level 1 Specialist Outpatient Department, James Mayne Building, RBWH

The Prince Charles Hospital (TPCH)

Monday – Friday: 8am – 4.30pm
Specialist Clinics, Ground Floor, TPCH

Redcliffe Hospital

Monday: 8am – 4.30pm / Wednesday: 1pm – 4.30pm
Level 1, Specialist Outpatient Department, Main Building, Redcliffe