Pituitary disorders

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Note: for any pituitary mass, endocrinologist advice is required prior to any neurosurgical assessment.

​​​​​​Emergency

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

  • New onset adrenal insufficiency or hypopituitarism
  • Suspected or confirmed arginine vasopressin deficiency (AVP-D; previously known as cranial diabetes insipidus) with hypernatraemia > 150 mmol/L or hyponatraemia < 125 mmol/L with AVP-D already on treatment
  • Suspected pituitary tumour with any of the following features:
    • Acute new visual field defect (often initially unilateral temporal field loss progressing to classic bitemporal superior quadrantanopia or hemianopia)
    • Hyponatraemia < 125 mmol/L
    • Neurological signs or symptoms
    • Ophthalmoplegia (pituitary apoplexy)
    • Symptomatic cortisol insufficiency
    • Thunderclap headache

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.

  • ​H​yperprolactinaemia > 50,000 mIU/L
  • Hypopituitarism (excluding adrenal insufficiency)
  • Suspected acromegaly
  • Suspected arginine vasopressin deficiency (AVP-D; previously known as cranial diabetes insipidus)
  • Suspected Cushing's syndrome
  • Suspected metastasis to the pituitary (e.g. history of breast cancer, lung cancer and/or renal cancer)​​
​Category 2
Recommended to be within 90 calendar days.
  • ​Concern for pituitary hyperfunction or hypofunction
  • Known pituitary tumour or disorder on therapy
  • Hyperprolactinaemia < 50,000 mIU/L
  • Pituitary or sellar mass > 10 mm​

Category 3
Recommended to be seen within 365 calendar days.

  • Empty sellar mass on imaging
  • Pituitary or sellar mass < 10 mm
  • Primary amenorrhoea
  • Secondary amenorrhoea or hypogonadism​

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 any pituitary disorder
    • History of treatment with immunotherapy or drugs known to cause hypophysitis or hyperprolactinaemia
    • History of anorexia nervosa or other eating disorder
    • History of obesity, diabetes mellitus, osteoporosis, hypertension, obstructive sleep apnoea
    • Last menstrual period
    • Headaches
    • Physical examination findings (including presence of any visual or cranial nerve deficits)
    • Full blood count (FBC)
    • Electrolytes, urea and creatinine (EUC)
    • Liver function tests (LFTs)
    • Fasting lipids and blood glucose level (BGL)
    • HbA1c
    • Prolactin
    • Luteinising hormone (LH)
    • Follicle‑stimulating hormone (FSH)
    • Oestradiol (female) or testosterone (male)
    • Thyroid stimulating hormone (TSH)
    • Free thyroxine (fT4)
    • Cortisol (early morning 0800-1000)
    • Adrenocorticotropic hormone (ACTH) (early morning 0800-1000)
    • Growth hormone
    • Insulin-like growth factor (IGF-1)
    • Visual field assessment (for pituitary or sellar mass > 10 mm or those complaining of visual symptoms)
    • Computed tomography (CT) or magnetic resonance imaging (MRI) brain scan report (including pituitary if performed previously)
      Note: Medicare rebate is not available for general practitioners ordering a pituitary MRI
    • Human chorionic gonadotropin test (ßhcg), androgen profile, pelvic ultrasound (if secondary amenorrhoea)

If available

  • ​​1 mg dexamethasone suppression test, late night salivary cortisol, 24-hour urinary free cortisol measurement (if suspected 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