Endocrine Work-up in Obesity: Key Recommendations from the European Society of Endocrinology Guideline

Dr. Sanjay Kalra, Treasurer, International Society of Endocrinology (ISE), Vice President, South Asian Obesity Forum (SOF), Bharti Hospital, Karnal, INDIA

According to the European Society of Endocrinology (ESE) Clinical Guideline on the Endocrine Work-up in Obesity, routine endocrine testing in obesity should be focused and selective. Thyroid function should be assessed in all patients, while other hormonal tests are recommended only when clinically indicated.

Obesity can affect several hormonal pathways and may coexist with endocrine disorders. The ESE Clinical Guideline on the Endocrine Work-up in Obesity advises a focused laboratory approach, where only clinically relevant hormonal tests are ordered rather than extensive routine screening.

Key recommendations from the guideline:

●       Screen all patients for thyroid dysfunction:
Thyroid function testing using thyroid-stimulating hormone (TSH) is recommended for all patients with obesity because hypothyroidism is relatively common.

●        If TSH is high, measure free thyroxine (Free T4) and anti–thyroid peroxidase antibodies (anti-TPO).

●       Avoid routine testing of other hormones:
Routine screening for hormones such as growth hormone, leptin, or ghrelin is generally not recommended unless there is suspicion of a specific endocrine disorder.

Tests only when clinically indicated

If hypercortisolism (Cushing syndrome) is suspected

●       1 mg overnight dexamethasone suppression test – recommended first screening test.

●       24-hour urinary cortisol – confirmatory test if screening is abnormal.

●       Late-night salivary cortisol – alternative confirmatory test.

●       Adrenocorticotropic hormone (ACTH) – used after confirming hypercortisolism to identify the source.

If male hypogonadism is suspected

●       Total testosterone

●       Free testosterone

●       Sex hormone-binding globulin (SHBG)

●       Luteinizing hormone (LH)

●       Follicle-stimulating hormone (FSH)

These tests help confirm hypogonadism and determine whether it is primary or secondary.

If female gonadal dysfunction or PCOS is suspected

●       LH

●       FSH

●       Total testosterone

●       SHBG

●       Estradiol

●       Prolactin

●       17-hydroxyprogesterone

●       Δ4-androstenedione

These tests help evaluate menstrual irregularities, infertility, or androgen excess. The ESE Clinical Guideline on the Endocrine Work-up in Obesity recommends a targeted endocrine evaluation. The guideline also emphasizes that weight loss remains the most effective strategy for improving obesity-related hormonal abnormalities, and that treatment of endocrine disorders alone usually results in only modest weight reduction.

(Source: Pasquali R, Casanueva F, Haluzik M, Van Hulsteijn L, Ledoux S, Monteiro MP, Salvador J, Santini F, Toplak H, Dekkers OM. European Society of Endocrinology Clinical Practice Guideline: endocrine work-up in obesity. European journal of endocrinology. 2020 Jan;182(1):G1-32.)