What lab tests are indicated for a female patient with dizziness, hair loss, body odor, menstrual irregularities, abdominal bloating, and pain?

Laboratory Tests for Patient with Multiple Symptoms Including Dizziness, Hair Loss, and Menstrual Irregularities

Based on the patient's complex presentation with multiple symptoms including dizziness, hair loss, menstrual irregularities, and gastrointestinal symptoms, a comprehensive laboratory workup is necessary to evaluate potential endocrine, nutritional, and vestibular causes.

Initial Laboratory Evaluation

• Complete Blood Count (CBC) to assess for anemia, infection, or other hematologic abnormalities that could contribute to dizziness 1
• Comprehensive Metabolic Panel including electrolytes, renal function, and liver function tests to evaluate for metabolic disturbances 1
• Thyroid Function Tests (TSH, Free T4) to rule out hypothyroidism, which can cause hair loss, menstrual irregularities, and gastrointestinal symptoms 1
• Fasting Glucose/Insulin to assess for insulin resistance, particularly given the history of semaglutide use 1
• Iron Studies (serum iron, ferritin, total iron binding capacity) to evaluate for iron deficiency, which can cause hair loss and dizziness 1
• Vitamin B12 and Folate levels to rule out deficiencies that could contribute to dizziness 1
• Vitamin D level to assess for deficiency that may contribute to hair loss 1

Endocrine Evaluation

• Reproductive Hormone Panel including:

  • LH and FSH (drawn between days 3-6 of menstrual cycle) to assess for PCOS or other ovarian disorders 1
  • Estradiol and Progesterone (mid-luteal phase) to evaluate for anovulation 1
  • Total and Free Testosterone to assess for hyperandrogenism 1
  • DHEAS to rule out adrenal causes of androgen excess 1
  • Androstenedione to evaluate for ovarian or adrenal disorders 1

• Prolactin level to rule out hyperprolactinemia, which can cause menstrual irregularities 1

  • If elevated, assess for macroprolactin 1

Gastrointestinal Evaluation

• Celiac Disease Screening with anti-tissue transglutaminase antibodies 1
• Fecal Calprotectin to screen for inflammatory bowel disease, especially with abdominal pain and bloating 1, 2
• H. pylori Testing if upper GI symptoms are prominent 2

Vestibular/Neurological Evaluation

Given the patient's severe dizziness and family history of vestibular migraines:

• Serum Magnesium levels, as deficiency can contribute to vestibular symptoms 1
• ESR and CRP to assess for inflammatory conditions 1

Additional Considerations

• Autoimmune Screening if clinical suspicion for autoimmune disorders:

  • ANA, anti-centromere, anti-Scl70 antibodies to screen for scleroderma and other connective tissue disorders 1
  • Anti-neuronal antibodies if paraneoplastic syndrome is suspected 1

• Pelvic Ultrasound should be considered (though not a lab test) to evaluate for polycystic ovaries given the menstrual irregularities 1

Priority Testing Based on Clinical Presentation

For this patient with multiple symptoms following semaglutide use, the highest priority tests are:

1. Thyroid function tests (TSH, Free T4)
2. Complete blood count and comprehensive metabolic panel
3. Iron studies and vitamin levels (B12, D, folate)
4. Reproductive hormone panel (LH, FSH, estradiol, testosterone)
5. Celiac disease screening

Important Considerations

• The timing of reproductive hormone testing is critical - LH, FSH, and testosterone should be measured between days 3-6 of the menstrual cycle, while progesterone should be measured during the mid-luteal phase 1
• Given the patient's uninsured status until December, prioritizing the most likely diagnostic tests is essential
• The patient's previous use of semaglutide and subsequent symptoms suggests potential metabolic or hormonal disturbances that should be thoroughly evaluated 1

By systematically evaluating these laboratory parameters, the underlying cause(s) of the patient's complex presentation can be identified and appropriate treatment initiated.