Information
Patients with suspected adrenal disease can be referred to the general endocrine clinics at RIE, WGH or SJH.
Who to refer:
Patients with an incidental finding of an adrenal mass on routine imaging
· Endocrine evaluation is required prior to possible surgical referral
· This is particularly important if the patient has hypertension, signs of hyperandrogenism, or signs of Cushing’s syndrome.
Patients with suspicion of adrenal insufficiency
· Patients with hypotension, hyponatraemia or hypoglycaemia should be discussed with the endocrine registrar on call to arrange an early short synacthen test or admission.
· For patients in West Lothian, discussion should take place by phone or Email with Dr Karen Adamson, Dr Rohana Wright, Dr Liesbeth Van Look or Dr Radzi Noh.
Patients suspected of having a phaeochromocytoma
· Suggestive features include hypertension (which may be paroxysmal rather than sustained), paroxysmal pallor or sweating, paroxysmal tachycardia or feeling of impending doom. Please note that phaeochromocytomas do not cause facial flushing
· If a 24h urine is being checked as a screening test (urine metanephrines), please ensure that the collection goes in a container with acid preservative
Who not to refer:
Patients suspected of having primary hyperaldosteronism
These patients should be referred to Dr Roger Brown in the Hypertension and Lipid Clinic at the Metabolic Unit in the Western General Hospital.
Patients who may have primary hyperaldosteronism include:
· Patients with hypertension and unprovoked hypokalaemia in the absence of a medication that might lower potassium.
· Patients with hypertension and a family history of hyperaldosteronism.
· Patients with hypertension and stroke under the age of 40.
Adrenal disease is a broad and potentially complex area which should be investigated and managed in secondary care. If steps should be taken in primary care prior to the patient’s attendance at clinic, consultants will be able to advise when triaging the referral. Do not hesitate to contact us using the ‘advice only’ option with any queries
