Endocrine Evaluation in Obesity: Clinical Practice Guidelines (2020)

European Society of Endocrinology

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

January 28, 2020

In January 2020, the European Society of Endocrinology published clinical practice guidelines on endocrine workup in patients with obesity.[1]

It is recommended that patients with obesity not routinely be referred to an endocrinologist. Referral should be considered in such instances as a strong suspicion of endocrine disease such as endogenous hypercortisolism, hypogonadism (in males), or androgen excess (in women). Patients with morbid or therapy-resistant obesity, those who undergo rapid weight gain, and patients who are bariatric surgery candidates may also be considered for referral to an endocrinologist.

It is recommended that in patients with obesity, weight loss be emphasized as essential to restoring hormone balances.

It is recommended that in patients with obesity, hormonal evaluation include an assessment of drugs and dietary supplements that can affect hormone measurements.

It is recommended that thyroid function evaluation be performed in all patients with obesity.

Routine measurement of free triiodothyronine (FT3) is not recommended in patients with an elevated thyroid-stimulating hormone level.

It is recommended that consideration be given to hypercortisolism testing in bariatric surgery candidates.

It is recommended that patients using corticosteroids not be tested for hypercortisolism.

It is recommended that a 1 mg overnight dexamethasone suppression test be employed as the first screening tool when hypercortisolism testing is considered.

In the case of a positive 1 mg overnight dexamethasone suppression test, employment of a second biochemical exam—either a 24-hour urine cortisol or late-night salivary cortisol test—is recommended.

Once the presence of hypercortisolism has been confirmed, the cause/source of the condition should be determined through adrenocorticotropic hormone (ACTH) measurement and imaging.

In most cases, treatment of proven endogenous hypercortisolism does not normalize the body mass index (BMI).

In patients with obesity who have biochemical and clinical hypogonadism, it is recommended that the importance of weight loss to the restoration of eugonadism be emphasized.

It is recommended that assessment of androgen excess be performed when clinical features raise suspicion for the presence of polycystic ovarian syndrome. It is suggested that total and free testosterone be measured, along with delta 4-androstenedione and sex hormone–binding globulin. The guidelines also recommend evaluation of ovarian morphology and blood glucose.

Unless syndromic obesity is suspected, it is not recommended that patients be routinely tested for levels of the hormones leptin and ghrelin.

For more information, please go to Obesity.

For more Clinical Practice Guidelines, please go to Guidelines.

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