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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.