内分泌科门诊

Endocrinology Referral Guidelines for MAP Handbook

范围:

• To provide consultations at a subspecialty level in endocrinology.

Appropriate patients for referral include:

• Lipid Abnormalities in a patient with family or personal history of early CVD, inability to achieve fasting TG 500 or non-fasting >800
• 甲状腺结节
• 甲状腺癌
• 甲状腺机能亢进
• 甲状腺功能减退难以控制
• 骨质疏松和骨质减少
• 钙和甲状旁腺疾病
• 垂体肿瘤与疾病
• 肾上腺肿块与疾病
• 闭经 & 乳溢
• 性腺机能减退
• 1型糖尿病患者
• Type 2 Diabetics requiring ≥ 300 units of insulin daily or U-500 insulin
• 糖尿病 being managed with an insulin pump

Please do NOT refer the following patients:

• Pediatric patients < 18 years old
• Patients with Type 2 糖尿病 unless already using an Insulin Pump or requiring ≥ 300 units of insulin daily or U-500 insulin – this is a strict requirement
• Obesity in absence of overt Endocrinopathy?
• Gynecomastia in absence of hypogonadism

Documentation required for scheduling an appointment:

• 既往病史(PMH)
• 当前用药清单
• Most recent progress note describing condition for which patient is being referred
• Recent pertinent labs (appropriate labs per worksheet, 在过去一个月内绘制的, 证实障碍. Please send lab flow sheets if they exist.)
• Recent pertinent scans or imaging reports

Brief summary of appropriate URGENT referrals:

Patients with symptoms that are both acute and severe should be referred to the Emergency Department. 这份名单是给所有其他病人的.

• Pregnant patients with Endocrine conditions addressed in Endocrine Specialty Clinic
• 不受控制的甲状腺机能亢进
• Pituitary Macroadenoma (Pituitary adenoma 1cm or greater in size)
• Biopsy-proven/newly diagnosed thyroid cancer or other endocrine cancers
• Documented recent Adrenal Crisis/Addison’s Disease diagnosis

Brief summary of appropriate ROUTINE referrals:

糖尿病

• 血红蛋白A1C
• CMP
• 空腹脂质小组
• Urine spot microalbumin and creatinine
• 2周血糖记录
• See clinical pharmacist prior to referral when possible

Difficult to Control Lipid Abnormalities

• 空腹脂质小组
• 空腹血糖
• 糖化血红蛋白
• CMP
• TSH
• 游离T4

肾上腺肿块与疾病

• 骨形态发生蛋白
• 24-hour urine for Free Cortisol, Creatinine, Metanephrines and Catecholamines
• For Adrenal Insufficiency: Check 8am cortisol –

If <11, check ACTH (Cosyntropin) Stimulation test*
– Do not perform ACTH (Cosyntropin) Stimulation test if patient on glucocorticoids – refer to 内分泌科门诊
– ACTH (Cosyntropin) Stimulation test: If neither 30 minute nor 60 minute cortisol measurement stimulates to 18, start Hydrocortisone 20mg QAM/10mg Q3pm and refer to 内分泌科门诊

 甲状腺结节

• Thyroid Ultrasound within past 12 months for nodules ≥ 1cm
• TSH
• 游离T4

甲状腺癌(新诊断)

• 病理报告
• Imaging studies (Ultrasound, CT, MRI, etc.)
• 手术报告(如相关)

甲状腺癌(病史)

• Original pathology report with staging (if available)
• Records of previous treatment (radioactive iodine, etc.)
• 免费的TSH
• 游离T4
• 甲状腺球蛋白水平
• Thyroid ultrasound within past 12 months

甲状腺机能亢进

• TSH
• 游离T4
• 免费的T3

甲状腺功能减退难以控制

• TSH
• 游离T4
• Ensure patient is medication-compliant with pharmacy refill check
• Ensure patient is taking medication correctly: in morning, 服用其他药物前30分钟, 食物, 或者是水以外的液体

钙和甲状旁腺疾病

• 完整的甲状旁腺素
• 血清钙
• 血清白蛋白
• 24-hour urine for calcium and creatinine, including collection volume
• 维生素D 25-OH

闭经 & 乳溢

• 泌乳素水平
• TSH
• FSH
• LH

多囊卵巢综合征和多毛症

• TSH
• FSH
• LH
• 泌乳素水平
• 总睾酮
• 硫酸脱氢表雄酮(dhea - s
• 17-hydroxyprogesterone
• 糖化血红蛋白
• 脂质板

骨质疏松症

• DXA扫描结果
• CMP
• TSH
• 完整的甲状旁腺素
• 25 (OH)维生素D
• SPEP
• UPEP
• 24-hour urine for calcium and creatinine

Pituitary Masses and Disorders including SIADH and 糖尿病 Insipidus

• MRI of the pituitary/Sella Turcica with and without contrast
  • 如果有MRI禁忌, 接触内分泌学家, 通过转介协调员, 如需额外指引
• 血清催乳素水平
• TSH
• 免费t4
• LH
• FSH
• igf - 1
• 8:00血清皮质醇水平

性腺机能减退/Premature Ovarian Failure and Gynecomastia secondary to hypogonadism

Do all labs at 8:00am, no later than 9:00am:

• 总睾酮-两次测试, 在不同的日子, demonstrating low total testosterone are needed for referral; one to include free testosterone and sex hormone binding globulin
• 泌乳素水平
• TSH
• FSH
• LH
• For patients age < 40: Ferritin, Serum Iron, TIBC, CBC

Have questions or comments about the specialty referral guidelines? 提交到这里.