Adrenal

Patients with suspected adrenal disease can be referred to the general endocrine clinics at BGH

Who to refer, who not to refer, how to refer

Who to refer:

Patients with an incidental finding of an adrenal nodule/mass (incidentaloma) on routine imaging
Endocrine evaluation is required for all patients, within the principals of realistic medicine, and especially prior to possible surgical referral or biopsy

Tests of function will be arranged by the endocrine team either prior to or at clinic
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 (+/- hypoglycaemia) who are acutely unwell and require admission should be discussed with the medical registrar on call (bleep 6006).
Patients who do not require admission but where there is a high index of suspicion of adrenal insufficiency can be discussed with the endocrine consultant on call via Diabetes and Endocrine email inbox (endocrinology@borders.scot.nhs.uk) or bleep 6698 in hours if urgent discussion required

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 patient presents with acute/severe symptoms such that clinical suspicion of phaeochromocytoma is particularly high please refer urgently to the endocrine clinic, or if necessary email Diabetes and Endocrine email inbox (endocrinology@borders.scot.nhs.uk) or bleep 6698 for phone advice in hours.
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

Patients suspected of having primary aldosteronism
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.

Patients with young onset (< 40 years) or resistant hypertension

Patients suspected of having Cushings Syndrome

Patients on long term steroids

Endocrinology can organise a short synacthen test if required for people on longterm weaning steroids who – having trialled slow wean as per NICE Guidelines 2024 - have a suboptimal 9 am cortisol level on 4 mg or less prednisolone or equivalent, and assist with interpretation of that test. Most patients will initially remain under the care of the referring team, with advice from endocrine, but in the event of long term teriary adrenal insufficiency may be seen by endocrinology.

Please see separate document on this link to steroid therapy page

How to refer

Please send referrals to Endocrinology through SciGateway:

Borders General Hospital -> Endocrinology & Diabetes -> Borders General Referral

If any queries please contact the endocrinology email advice on: diabetes.endocrinology@borders.scot.nhs.uk

Primary care management

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 by email with any queries.