Differences in Sexual Development Referral Access Criteria
Differences in Sexual Development Referral Access Criteria
| Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for differences in sexual development. This RAC is applicable to referrals for patients aged <16 years only. |
| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
- New case of congenital adrenal hyperplasia
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| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
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- Ambiguous genitalia with concerns about genital development
To contact the relevant service, see Clinician Assist WA: Acute Paediatric Assessment (external site)
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| Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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- Signs of genital ambiguity
- Adrenal crisis
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| Mandatory information |
| Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
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| History |
- History of suspected genital ambiguity
- Family history of ambiguous genitalia
- Current medication list
- Any known allergies
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| Examination |
- Staging of puberty (delayed/arrested/pre-pubertal)
- Genital examination
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| Investigations |
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| Highly desirable |
| History |
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| Examination |
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| Investigations |
- Any genetic tests
- Ultrasound (US) pelvic and/or scrotum (for gonads and internal reproductive organs)
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| Indicative clinical urgency category |
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Category 1
Appointment within 30 days
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- Follow up clinic from emergency presentation
- Suspected new congenital adrenal hyperplasia
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Category 2
Appointment within 90 days
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- Any form of suspected genital ambiguity
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Category 3
Appointment within 365 days
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- No defined category 3 criteria
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| Exclusions |
- Gender dysphoria or gender incongruence
- Gender reassignment procedures unless there are congenital abnormalities
- Penile procedures for sex transformation unless there are congenital abnormalities
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| Useful information |
- See Australia and New Zealand Society for Endocrinology and Diabetes for clinical resources (external site)
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Last reviewed: 18-03-2024