Endocrinology — New Patient Consultation Template

Consultation Information

Referring physician: [Name, specialty]
Reason for referral: [Chief complaint]
Date of consultation: [Date]
Urgency: Routine / Urgent

Chief Complaint

[Primary endocrine concern]
Duration: [X] days/weeks/months/years
Current status: Stable / Worsening / Newly diagnosed

History of Present Illness

For Diabetes Mellitus

Diabetes History:

Type: Type 1 / Type 2 / LADA / MODY / Secondary / Gestational / Prediabetes
Date of diagnosis: [X]
Age at diagnosis: [X] years
Initial presentation: [Asymptomatic screening / Symptoms / DKA / HHS]
C-peptide: [If available]
Antibodies (GAD, IA-2, ZnT8): [If tested]

Current Glycemic Control:

Recent A1c: [X]% — Date: [X]
A1c trend: [Prior values]
Fasting glucose range: [X] - [X] mg/dL
Pre-meal glucose range: [X] - [X] mg/dL
Post-meal glucose range: [X] - [X] mg/dL
Time in range (if CGM): [X]%

Self-Monitoring:

SMBG frequency: [X] times/day
CGM: No / Yes — Device: [X]
Glucose patterns: [AM highs, post-prandial spikes, nocturnal lows]

Hypoglycemia:

Frequency: None / [X] per week/month
Severity: Mild (self-treated) / Moderate / Severe (assistance required)
Awareness: Intact / Impaired
Timing: [Fasting, post-meal, nocturnal, exercise-related]
Triggers: [Missed meals, insulin dosing, exercise]

Hyperglycemia Episodes:

DKA history: None / [Number of episodes, last date, triggers]
HHS history: None / [Episodes]

Diabetes Complications:

Microvascular:

• Retinopathy: None / NPDR / PDR — Last eye exam: [Date]
• Nephropathy: None / Microalbuminuria / Macroalbuminuria / CKD Stage [X]
• Neuropathy: None / Peripheral / Autonomic — [Symptoms]

Macrovascular:

• CAD: No / Yes — [History]
• CVA/TIA: No / Yes — [History]
• PAD: No / Yes — [Claudication, ABI]

Foot:

• Last foot exam: [Date]
• Ulcers: No / Yes — [History]
• Amputations: No / Yes — [Level]
• Charcot: No / Yes

For Thyroid Disorders

Hypothyroidism:

Duration: [X] years
Etiology: Hashimoto's / Post-RAI / Post-surgical / Central / Unknown
Current dose: [Levothyroxine, dose]
Symptoms: [Fatigue, weight gain, constipation, cold intolerance, etc.]

Hyperthyroidism:

Duration: [X]
Etiology: Graves' / Toxic nodule / Toxic MNG / Thyroiditis / Exogenous
Symptoms: [Weight loss, tremor, palpitations, heat intolerance, etc.]
Prior treatment: [Medications, RAI, surgery]
Graves' ophthalmopathy: None / [Active, inactive, severity]

Thyroid Nodule:

Discovery: Palpation / Imaging / [Incidental on CT/PET]
Size: [X] cm
TI-RADS/Bethesda: [Category]
FNA: Not done / [Date, result]
Symptoms: None / [Dysphagia, dysphonia, pain]

Thyroid Cancer:

Type: Papillary / Follicular / Medullary / Anaplastic
Stage: [TNM]
Treatment: [Surgery, RAI, external beam, TKI]
Surveillance: [Thyroglobulin, imaging schedule]

For Adrenal Disorders

Cushing's Syndrome:

Features: [Central obesity, striae, moon facies, buffalo hump, HTN, DM, osteoporosis]
Etiology suspected: Pituitary / Adrenal / Ectopic / Exogenous
Testing: [24-hr UFC, LDST, midnight cortisol — results]

Adrenal Insufficiency:

Type: Primary (Addison's) / Secondary / Tertiary
Etiology: [Autoimmune, post-surgical, medications, etc.]
Diagnosis: [ACTH stim test results]
Symptoms: [Fatigue, weight loss, hyperpigmentation, hypotension]
Current replacement: [Hydrocortisone/prednisone dose]
Stress dosing knowledge: Yes / No

Pheochromocytoma/Paraganglioma:

Symptoms: [Episodic HTN, headache, sweating, palpitations]
Testing: [Plasma/urine metanephrines]
Imaging: [CT, MRI, MIBG]
Genetic testing: [If applicable]

Adrenal Incidentaloma:

Size: [X] cm
Imaging characteristics: [Density, washout]
Functional workup: [1mg DST, metanephrines, aldosterone/renin]

For Pituitary Disorders

Pituitary Adenoma:

Type: Non-functioning / Prolactinoma / GH-secreting / ACTH-secreting / TSH-secreting
Size: Microadenoma (<10mm) / Macroadenoma (≥10mm)
Visual symptoms: None / [Field defects]
Headaches: None / Present
Hormone excess:

• Prolactin: [Level]
• IGF-1/GH: [Levels]
• ACTH/cortisol: [Levels]

Hypopituitarism:

• Growth hormone: Intact / Deficient
• ACTH/cortisol: Intact / Deficient
• TSH/thyroid: Intact / Deficient
• LH/FSH/gonadal: Intact / Deficient
• ADH: Intact / DI

For Metabolic Bone Disease

Osteoporosis:

DXA: T-score [Spine], [Hip] — Date: [X]
FRAX score: [10-year major %, hip %]
Fracture history: None / [Vertebral, hip, wrist — dates]
Secondary causes evaluated: [Vitamin D, calcium, PTH, celiac, etc.]
Current treatment: [Bisphosphonate, denosumab, teriparatide, romosozumab]

Hyperparathyroidism:

Calcium: [X] mg/dL (elevated)
PTH: [X] pg/mL (elevated/inappropriately normal)
Symptoms: [Stones, bones, groans, moans, psychiatric overtones]
Localization: [Sestamibi, US — findings]
Indication for surgery: [Symptomatic, elevated calcium, end-organ effects]

Vitamin D Deficiency:

25-OH Vitamin D: [X] ng/mL
Symptoms: [Fatigue, bone pain, muscle weakness]
Risk factors: [Malabsorption, medications, limited sun]

For Other Endocrine Concerns

Hypogonadism (Male):

Symptoms: [Low libido, ED, fatigue, decreased muscle mass]
Testosterone: [Total, free — AM levels]
LH/FSH: [Levels — primary vs secondary]
Etiology: [Primary, secondary, functional]

PCOS:

Oligo/amenorrhea: Yes / No
Hyperandrogenism: Clinical / Biochemical
Polycystic ovaries: Yes / No
Rotterdam criteria: [X of 3]
Associated: Insulin resistance / Obesity / Hirsutism / Acne / Infertility

Endocrine Review of Systems

[ ] Weight change [ ] Fatigue [ ] Heat/cold intolerance [ ] Skin changes
[ ] Hair loss [ ] Palpitations [ ] Tremor [ ] Sweating
[ ] Polyuria/polydipsia [ ] Hypoglycemia symptoms [ ] Bone pain
[ ] Fractures [ ] Muscle weakness [ ] Mood changes [ ] Menstrual changes
[ ] Decreased libido [ ] Erectile dysfunction

Past Medical History

[Relevant conditions]
Cardiovascular: [CAD, CHF, HTN]
Kidney disease: [CKD stage, proteinuria]
Liver disease: [Type]
Malabsorption: [Celiac, bariatric surgery, IBD]
Prior malignancy: [Type — relevant for bone disease, thyroid]
Autoimmune diseases: [Type — associated endocrinopathies]

Surgical History

[Relevant surgeries]
Thyroidectomy: No / Yes — [Extent, date]
Parathyroidectomy: No / Yes — [Date]
Adrenalectomy: No / Yes — [Side, date]
Pituitary surgery: No / Yes — [Date, approach]
Bariatric surgery: No / Yes — [Type, date]

Medications

Current endocrine medications:

• Diabetes: [Insulin regimen, oral agents, GLP-1, SGLT2]
• Thyroid: [Levothyroxine, methimazole, PTU]
• Adrenal: [Hydrocortisone, fludrocortisone, prednisone]
• Bone: [Bisphosphonate, denosumab, teriparatide, calcium, vitamin D]
• Gonadal: [Testosterone, estrogen, progesterone]

Other medications: [List — note those affecting endocrine function]
Steroids: [Any form — dose, duration]

Allergies

[Drug allergies with reactions]
Contrast allergy: No / Yes

Family History

Diabetes: No / Yes — [Relationship, type]
Thyroid disease: No / Yes — [Type, relationship]
MEN syndromes: No / Yes — [Type]
Pheochromocytoma: No / Yes
Osteoporosis/fractures: No / Yes — [Relationship]
Early cardiovascular disease: No / Yes

Social History

Tobacco: Current / Former / Never — Pack-years: [X]
Alcohol: [Quantity, frequency]
Exercise: [Type, frequency]
Diet: [Relevant patterns]
Occupation: [Relevant exposures]

Physical Examination

Vital Signs

BP: [X/X]
HR: [X]
Temp: [X]°F
Weight: [X] — BMI: [X]
Height: [X]

General

Appearance: [Body habitus — central obesity, muscle wasting]
Cushingoid features: None / Present — [Moon facies, buffalo hump, striae]

HEENT

Eyes: [Proptosis, lid lag, lid retraction, periorbital edema]
Thyroid:

• Size: Normal / Enlarged — [Estimated grams]
• Consistency: Soft / Firm / Hard
• Nodules: None / [Location, size]
• Tenderness: None / Present
• Bruit: Absent / Present

Cardiovascular

Rhythm: Regular / [AFib, other]
Murmurs: None / [Description]
Edema: None / [Grade, location]

Skin

Hyperpigmentation: Absent / Present — [Creases, mucosa]
Striae: None / [Color, location]
Acanthosis nigricans: Absent / Present — [Location]
Hirsutism: Absent / Present — Ferriman-Gallwey score: [X]
Acne: None / [Severity]
Pretibial myxedema: Absent / Present
Vitiligo: Absent / Present

Musculoskeletal

Proximal muscle weakness: Absent / Present
Kyphosis: Absent / Present
Height loss: [If known]

Neurologic

DTRs: Normal / [Delayed relaxation, hyperactive]
Tremor: Absent / Present — [Fine, coarse]
Peripheral neuropathy: Absent / Present — [Distribution]

Diabetic Foot Exam (if applicable)

Finding	Right	Left
Skin	Intact / [Callus, ulcer]	[Findings]
Pulses	Present / Diminished / Absent	[Findings]
Monofilament	Protective / Diminished / Absent	[Findings]
Vibration	Intact / Diminished	[Findings]
Deformity	None / [Charcot, hammertoe, etc.]	[Findings]

Laboratory Review

Diabetes

A1c: [X]% — Date: [X]
Fasting glucose: [X] mg/dL
Lipid panel: TC [X], LDL [X], HDL [X], TG [X]
Creatinine/eGFR: [X] / [X]
UACR: [X] mg/g

Thyroid

TSH: [X] mIU/L
Free T4: [X] ng/dL
Free T3: [X] pg/mL (if checked)
Thyroid antibodies: TPO [X], TRAb [X]
Thyroglobulin: [X] (if cancer)

Adrenal

AM cortisol: [X] mcg/dL
ACTH: [X] pg/mL
24-hr UFC: [X] mcg/24hr

• mg DST cortisol: [X] mcg/dL

DHEA-S: [X]
Aldosterone/renin: [X] / [X]
Metanephrines: [Plasma or 24-hr urine]

Pituitary

Prolactin: [X] ng/mL
IGF-1: [X] ng/mL
LH/FSH: [X] / [X]
Testosterone (male): [X] ng/dL
Estradiol (female): [X] pg/mL

Bone/Calcium

Calcium: [X] mg/dL
Phosphorus: [X] mg/dL
PTH: [X] pg/mL
25-OH Vitamin D: [X] ng/mL
Alkaline phosphatase: [X]
24-hr urine calcium: [X] mg/24hr

Imaging

Thyroid ultrasound: [Date, findings]
DXA: [Date, T-scores]
Pituitary MRI: [Date, findings]
Adrenal CT/MRI: [Date, findings]

Assessment

1) [Primary endocrine diagnosis]
Severity/control: [X]
Complications: [List]
2) [Secondary diagnoses]
3) [Risk factors and comorbidities]

Plan

Diagnostic Workup

• [ ] Labs: [Specific tests]
• [ ] Thyroid ultrasound
• [ ] Fine needle aspiration
• [ ] DXA scan
• [ ] Pituitary MRI
• [ ] Adrenal imaging
• [ ] Dynamic testing: [Specific test]
• [ ] Other: [Specify]

Medical Treatment

[Diabetes management]

• [ ] Continue current regimen
• [ ] Intensify: [Add agent, adjust doses]
• [ ] Start insulin: [Regimen]
• [ ] CGM initiation
• [ ] Target A1c: [X]%

[Thyroid management]

• [ ] Start/adjust levothyroxine: [Dose]
• [ ] Start antithyroid medication: [Drug, dose]
• [ ] Thyroid hormone withdrawal
• [ ] RAI therapy referral

[Other endocrine]

• [ ] [Specific medications and doses]

Surgical Referral (if indicated)

• [ ] Thyroidectomy
• [ ] Parathyroidectomy
• [ ] Adrenalectomy
• [ ] Pituitary surgery

Referrals

• [ ] Ophthalmology (diabetic eye exam)
• [ ] Podiatry
• [ ] Diabetes education/DSMES
• [ ] Dietitian/nutrition
• [ ] Endocrine surgery
• [ ] Nuclear medicine
• [ ] Other: [Specify]

Patient Education

• Disease process and treatment goals
• Medication instructions
• Sick day rules (if on steroids/insulin)
• Hypoglycemia management
• Signs requiring urgent evaluation

Follow-up

Return: [X] weeks/months

• Labs prior to visit: [Specific tests]

Sooner if: [Specific concerns]

Communication

Discussed with patient: [Topics covered]
Report sent to: [Referring physician, PCP]