Question ENDOCRINE VS GYN

Specialties NP

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Question to my Nurse Practitioners in family medicine: 

I often have this question. How do I know when to send patient to endocrinologist vs gynecologist? I am always confused. 
 

I check thing such as: 

LH and FSH

PROLACTIN

DHEA 

TESTOSTERONE LEVELS 

when checking these ; and they are elevated; where do I send the patient. Simple terms please.

example: elevated DHEA AND IRREGULAR MENSES 

 

 

thank you 

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Specializes in Psychiatric and Mental Health NP (PMHNP).

As a provider, it is important to formulate a list of Differential Diagnoses.  Based on that, send the patient to the best specialist.  Worst case, the specialist will refuse the referral and state why.  In the example provided, the possible dx that comes to mind is PCOS.  This would be referred to Ob/Gyn

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14 hours ago, FullGlass said:

As a provider, it is important to formulate a list of Differential Diagnoses.  Based on that, send the patient to the best specialist.  Worst case, the specialist will refuse the referral and state why.  In the example provided, the possible dx that comes to mind is PCOS.  This would be referred to Ob/Gyn

Yes! Always! Just want to see if someone can help me differentiate a little better. I know they can refuse; but for my own knowing of direction to take it helps to have a little mental picture of which direction for those particular labs. Sometimes the labs are kinda mixed a little elevation of each. 

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Specializes in Psychiatric and Mental Health NP (PMHNP).
On 12/18/2020 at 6:48 AM, TheFuture09 said:

Yes! Always! Just want to see if someone can help me differentiate a little better. I know they can refuse; but for my own knowing of direction to take it helps to have a little mental picture of which direction for those particular labs. Sometimes the labs are kinda mixed a little elevation of each. 

Without full information, which I don't have, it is impossible to formulate list of Diff Dx.  The diagnoses are based on a combination of patient complaint, history, exam, and labs.  You can also ask another clinician where you work.  You can't always figure things out based on one appointment and labs.  You could send the patient to Ob/Gyn and if that specialist can't help, they will let you know.  Then you could consider Endocrinology.  (This is an example, again, I don't have the entire chart).

Good luck.

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Specializes in Former NP now Internal medicine PGY-3.

do you even know why you ordered those tests?

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On 12/22/2020 at 11:21 AM, FullGlass said:

Without full information, which I don't have, it is impossible to formulate list of Diff Dx.  The diagnoses are based on a combination of patient complaint, history, exam, and labs.  You can also ask another clinician where you work.  You can't always figure things out based on one appointment and labs.  You could send the patient to Ob/Gyn and if that specialist can't help, they will let you know.  Then you could consider Endocrinology.  (This is an example, again, I don't have the entire chart).

Good luck.

 

1 hour ago, Tegridy said:

do you even know why you ordered those tests?

Yes I do know why I did. Is there a problem with just wanting more clarity? I am asking a question for people who want to help.

thank you  

On 12/22/2020 at 11:21 AM, FullGlass said:

Without full information, which I don't have, it is impossible to formulate list of Diff Dx.  The diagnoses are based on a combination of patient complaint, history, exam, and labs.  You can also ask another clinician where you work.  You can't always figure things out based on one appointment and labs.  You could send the patient to Ob/Gyn and if that specialist can't help, they will let you know.  Then you could consider Endocrinology.  (This is an example, again, I don't have the entire chart).

Good luck.

Thanks for the information. Truly appreciated. 
Just wanted some clarity for direction when it comes to this kind of patient. 

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What’s were the patient complaints? What were the physical exam findings? Why specifically the need to refer?  Curious what those specialties could do that you can’t do yourself?

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4 hours ago, djmatte said:

What’s were the patient complaints? What were the physical exam findings? Why specifically the need to refer?  Curious what those specialties could do that you can’t do yourself?

There are different reasons why we can and should send to specialist after we have done what we are comfortable doing. It is at our own digression depending “on the scenario”. 
 

the scenario was stated above.  
Thing such as Irregular menses, heavy menses,  amenorrhea, etc 

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2 hours ago, TheFuture09 said:

There are different reasons why we can and should send to specialist after we have done what we are comfortable doing. It is at our own digression depending “on the scenario”. 
 

the scenario was stated above.  
Thing such as Irregular menses, heavy menses,  amenorrhea, etc 

Everyone is welcome to punt given their comfort level and expertise, but much of this I can see handling at the primary care level until your own interventions don’t resolve the problem. If pediatric, I might be inclined to punt depending on initial labs.
 

 I still would like to see a transvag us, TSH, prolactin, total insulin, and probably a pap before I make that call. If PCO is the suspect (Rotterdam criteria met and other eteologies ruled out) then it’s absolutely diagnosed and treatable by a pcp. 
 

 

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8 hours ago, djmatte said:

Everyone is welcome to punt given their comfort level and expertise, but much of this I can see handling at the primary care level until your own interventions don’t resolve the problem. If pediatric, I might be inclined to punt depending on initial labs.
 

 I still would like to see a transvag us, TSH, prolactin, total insulin, and probably a pap before I make that call. If PCO is the suspect (Rotterdam criteria met and other eteologies ruled out) then it’s absolutely diagnosed and treatable by a pcp. 
 

 

Sooo question,

Your actively treating PCOS patients in your family medicine clinic and endocrine disorders? I don’t know, I think your being somewhat unrealistic in your comments. I am only asking for guidance and direction when it does come to referring-not everyone practice the same. Yes I would check all those other items; but I will also let them check in with a GYN/Endocrine according to abnormalities in labs/imaging/test  to explore all options best for them. There is a reason they are specialist as well.

 

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I actively treat PCOS, hypo/hyper thyroid, Type 1 and 2 diabetes, and a range of other chronic illnesses that could easily be relegated to a specialty.  It's been my experience some specialties are particularly interested in complex patients who don't react to more basic therapies or doing more lucrative procedures.  

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At the end of the day, it comes to your comfort level.  I have the luxury of supervising docs for many of these problems and had good education and insight by them to work them up and manage these patients from our clinics.  If some of them turned out to be pituitary problems, hysteroscopies, or other more problematic care, I would defer in a heart beat.  Anything that requires more invasive situations I just let the specialist handle.

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