Referral to emergency

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

  • suspected Addisonian crisis symptoms may include:
    • nausea
    • vomiting
    • hypotension
  • suspected or confirmed acute adrenal insufficiency
  • phaeochromocytoma in crisis with uncontrolled hypertension

Please contact endocrinology on-call in your local major hospital for advice or to escalate and discuss any clinical concerns prior to referring

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 - appointment clinically indicated within 30 days

  • adrenal tumour with concerning features for malignancy and/or greater than 4cm
  • adrenal tumour with evidence that it is functional:
    • excess cortisol (Cushing’s syndrome)
    • excess aldosterone (primary hyperaldosteronism)
    • excess catecholamines (phaeochromocytoma)
    • excess androgens

Category 2 — appointment clinically indicated within 90 days

  • adrenal incidentaloma without concerning features/excess production of:
    • cortisol
    • aldosterone
    • catecholamines
    • androgens

Category 3 — appointment clinically indicated within 365 days

  • nil

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • past medical/surgical/cancer history, including osteoporosis
  • current medications and dosages
  • use/frequency of alcohol, tobacco, and other drugs
  • allergies and sensitivities
  • onset, duration, and progression of symptoms
  • management history including treatments trialled/implemented prior to referral
  • physical examination results
  • blood pressure
  • adrenal computerised tomography (CT)


  • electrolytes (presence of hypokalaemia) and aldosterone/renin ratio if hypertension is present to screen for primary hyperaldosteronism
  • 1mg overnight dexamethasone suppression test (1DST) to screen for Cushing’s syndrome
  • on a separate day to 1DST:
    • adrenocorticotropic hormone (ACTH), this needs to be done at a major laboratory as ACTH must be put on ice and processed immediately
    • dehydroepiandrosterone sulphate (DHEAS)
  • plasma free metanephrines to screen for pheochromocytoma
  • serum testosterone if there is evidence of virilisation

Additional information to assist triage categorisation

Relevant diagnostic/imaging reports, including location of company and accession number

Clinical management advice

Adrenal growths are frequently discovered unexpectedly during imaging, especially among older individuals, with the majority being non-cancerous:

  • while many are non-active (incidentalomas), it's crucial to conduct tests to rule out excessive hormone production as part of the management process.
  • instances of primary adrenal carcinoma or secondary malignancies are rare origin.

Refer urgently to endocrine clinic if:

  • concerning features on imaging computerised tomography (CT) suggestive of adrenocortical carcinoma
  • indications (clinical or biochemical) reveal that the mass is actively functioning:
    • excess cortisol (Cushing’s syndrome)
    • excess aldosterone (primary hyperaldosteronism)
    • excess catecholamines (phaeochromocytoma)
    • excess androgens.

Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.

Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.

Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.

Clinical resources

Consumer resources