Endocrine referral guidelines

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    Endocrine referral guidelines
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    Department of Defense organization in the United States. Share sensitive information only on official, secure websites. Browser has allowed it to be opened win. PCM should refer the patient for obesity if there is evidence supportive of an underlying endocrine disorder. PCO, growth hormone deficiency and very rarely hypothalamic dysfunction. PCM should treat hypothyroidism and reassess weight after thyroid function has normalized for at least 6 months. Active Duty prediabetics should be referred to prevent progression to diabetes. Consider medications as a factor in weight gain. Cr and TSH prior to routine endocrine referral. Hypothyroidism is defined as an elevated TSH with a low FT4. Subclinical hypothyroidism is an elevated TSH and normal FT4. Check TSH, FT4 and TPO Antibodies. In elderly patients or those with underlying cardiac disease levothyroxine replacement should be started LOW and increased SLOWLY to avoid adverse cardiac effects. The PCM should then presume that the symptoms are unrelated to thyroid function and referral is not required. Patients should take thyroid hormone on an empty stomach, and not with calcium containing products, iron, or antacids. Pregnant women on levothyroxine should have thyroid function checked after pregnancy is confirmed and again 4 to 6 weeks afterwards, with goal TSH lower limit of normal to 2. Hypothyroidism in pregnant patients is to be avoided. For any concerns in this patient group early referral to OBgyn or endocrine is appropriate. Hyperthyroidism is defined as suppressed TSH with elevated FT4 or T3. If the patient is on thyroid hormone, reduce the dose and titrate until TSH is in the normal range. Endocrinology evaluation if no contraindications to beta blockers for overt thyrotoxic patients. They are more likely to be concerning if found in children, the elderly and in men. Check TSH and thyroglobulin, thyroglobulin antibodies. Assure patient has original pathology results and all notes pertaining to their prior therapy with them at their appointments. The PCM is asked to manage all diabetics during their routine visits. Please use the appropriate Family Practice physicians and Internists to assist in managing the urgent and routine needs of Diabetics in your population. Referral to Podiatry and Nephrology as required should be initiated after examination by the PCM. All new Diabetics should be referred to Diabetes Education and Diabetes Nutrition classes. All diabetic should be using a glucometer to check, at a minimum, fasting blood sugars. Type 1 Diabetics can be referred to Endocrinology if Internal Medicine clinicians are unavailable. Endocrinology or Diabetic Clinic. Refer to Internal Medicine with admission if there are any concerns for neuroglycopenia that require supervised fasting. Metformin use may restore ovulation, decrease weight, and improve insulin resistance in some individuals. Once placed on medications for management, the patient may return to the PCM for continued care as these medications are meant to be chronic. Please contact the consulting provider if further questions remain about ongoing care. Evaluation should rule out underlying causes of hormonal disequilibrium, with the most common reasons being idiopathic, familial and PCOS. Calcium above the upper limit of normal or elevated ionized calcium. All Calcium labs should be performed with a concomitant albumin. The correction for Calcium is to add 0. If the patient has symptomatic hypercalcemia, the patient should be managed as an inpatient. If the patient is asymptomatic, an outpatient evaluation should ensue. Ca, phosphate, creatinine, alkaline phos. DXA should be ordered in any postmenopausal woman and in anyone with risk factors that would increase possibility of fracture. Calcium daily and 1000 IU vitamin D. Primary Hyperaldosteronism or Pheochromocytoma. Many common medications and as well as withdrawal from certain drugs can adversely affect screening tests. It is beyond the scope of these guidelines to list all contributors and the reader is directed to any reputable internal medicine reference or website for complete screening instructions or they may contact the endocrine clinic for questions. Check plasma free metanephrines. Adrenal Insufficiency can present in an otherwise asymptomatic patient when they encounter physical stressors. An appropriate evaluation includes an AM random cortisol and renal panel. Coexisting autoimmune disease make this more likely. Check AM unstressed fasting cortisol. CBC, and fasting BG, treat volume depletion. Gastric bypass require ongoing evaluation for malabsorption and vitamin deficiency. If they are not receiving this care from their bariatric surgery center, please evaluate the following and refer if they have issues. All Gastric bypass patients should be referred to the TAMC bariatric surgery center for ongoing care. Iron panel, vitamin B12, folate, vitamin D, vitamin A, carotene, renal panel and PTH. Endocrine for more urgent refe filexlib.
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