Adrenal disorders

​​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • Hypopituitarism with haemodynamic compromise or systemic symptoms
  • Symptomatic severe hypertension > 180/110 mmHg due to suspected hormonal excess
    (e.g. phaeochromocytoma, primary aldosteronism)
  • Suspected or confirmed acute adrenal insufficiency (as indicated by hypotension, vomiting, hyponatraemia, hyperkalaemia, anorexia and/or nausea)

When public outpatient services are not routinely provided

  • ​​​Unexplained fatigue without an endocrine disorder

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.

  • Adrenal tumour with any of the following features:
    • Suspicious features for malignancy
    • Rapidly growing
    • > 4 cm
    • Heterogeneous
    • Attenuation = 20 HU
  • Clinical and/or biochemical evidence of Cushing's syndrome or phaeochromocytoma
  • Hypopituitarism (excluding adrenal insufficiency)
  • Newly suspected or confirmed primary or secondary adrenal insufficiency without haemodynamic compromise or systemic symptoms
  • Primary aldosteronism with uncontrolled hypertension and/or refractory hypokalaemia​
​Category 2
Recommended to be seen within 90 calendar days.
  • Adrenal tumour with biochemical evidence of excess aldosterone or androgen secretion, or hypertension suspicious for adrenal cause
  • Recently treated hypoadrenal or Addisonian crisis Stable, medically treated Cushing's syndrome
  • Treated adrenal insufficiency with persistent symptoms​

Category 3
Recommended to be seen within 365 calendar days.

  • Adrenal incidentaloma with no suspicious features
    for malignancy or production of excess cortisol, aldosterone, catecholamines or androgens
  • Congenital adrenal hyperplasia for review
  • Hirsutism for investigation
  • Stable, treated glucocorticoid insufficiency
  • Suspected primary aldosteronism with controlled blood pressure who may require evaluation for surgical or medical management​

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • History of medical, surgical and cancer, diabetes, hypertension, obesity and/or osteoporosis
    • Anti-hypertensive medications
    • Potassium supplements
    • Physical examination findings
      • Height, weight and body mass index
      • Blood pressure trends (with postural measurement)
    • Serum cortisol (early morning – 0800 to 1000) (unless acutely unwell then random)
    • Adrenocorticotropic hormone (ACTH) (unless acutely unwell then random)
    • Electrolytes, urea and creatinine (EUC)
    • Liver function test (LFT)
    • Calcium, magnesium, phosphate (CMP)
    • Blood glucose level (BGL) (random or fasting)
    • Plasma metanephrines and normetanephrines
    • Aldosterone:renin ratio (if hypertension is present to screen for primary aldosteronism) with documented anti-hypertensive medications
    • Testosterone
    • Dehydroepiandrosterone sulphate (DHEAS) (if hirsutism also with 17-OHP level, or adrenal mass)
    • Any prior adrenal imaging​

If available

  • Androgen profile
    • Follicle-stimulating hormone (FSH)
    • Luteinising hormone (LH)
    • Sex hormone-binding globulin (SHBG)
    • Androstenedione
  • 1 mg overnight dexamethasone suppression test (1DST) (to screen for Cushing's syndrome)
  • 24-hour urinary free cortisol (to screen for Cushing's syndrome)​

​Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team. 

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing