Referrals:  When should you refer and to whom

Diagnosis of pituitary disease is not straightforward.

There are a wide range of symptoms, reflecting the various conditions caused by a Pituitary tumour.  Some are specific and obvious but many are vague and may not point to the pituitary.

Most GPs see only one or two cases in their whole careers which compounds the problem.

The tables following list symptoms associated with various tumour types: more details are included in the specific sheets.

Whilst you would not want to send every patient with a headache to an Endocrinologist, those with high circulating Thyroxine and high TSH should be referred. To this end a list of basic tests is also included.

For Acromegaly & Prolactinoma especially, there should be a low threshold for referral for any patient with any suspicion of these conditions as the greatest challenge in their diagnosis is thinking of the disease. Once suspected biochemical confirmation or exclusion of the disease is usually straightforward.

Who should you refer to?

Ideally to a specialist endocrinologist or a local physician with a special interest in endocrinology.

It is better to see an endocrinologist first rather than a surgeon as the surgeon will need to refer the patient to an endocrinologist in any case. In some cases surgery is not recommended.

The endocrinologist can arrange all the specialist diagnostic tests to be completed prior to surgery enabling accurate monitoring of treatment to take place.

Life-long relationship

Life-long specialist monitoring will be required after initial treatment to ensure the appropriate and optimum balance of hormones is achieved. Many patients will be on life-long hormone replacement. In most cases a shared care protocol is established between the specialist and the patient’s GP.

Presenting Symptoms

These are the main symptoms; see individual sheets for additional information.