What tests and evaluations are recommended for a weight loss hormone check?

Recommended Laboratory Tests for Weight Loss Hormone Evaluation

For patients seeking a weight loss hormone check, a comprehensive panel of laboratory tests should include thyroid function tests, glucose metabolism assessment, lipid profile, and targeted hormone evaluations to identify potential metabolic and endocrine causes of weight issues. 1

Essential Initial Laboratory Tests

• Complete metabolic panel to assess liver function, kidney function, and electrolytes 2
• Complete blood count to evaluate for underlying conditions that may contribute to weight issues 2
• Fasting lipid profile including total cholesterol, LDL, HDL, and triglycerides 2
• Thyroid function tests including TSH, free T4, and free T3 to rule out hypothyroidism 2
• Fasting plasma glucose and hemoglobin A1c to screen for diabetes or prediabetes 1, 2
• Insulin level and calculation of HOMA-IR (homeostasis model assessment of insulin resistance) to assess insulin sensitivity 3, 4

Endocrine Evaluations

• Morning cortisol level and consider overnight dexamethasone suppression test if Cushing's syndrome is suspected (central obesity, "moon face," violaceous striae) 2
• Sex hormones assessment:
  • For men: Total and free testosterone levels 1, 5
  • For women: Estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin levels, especially in those with menstrual irregularities 1
• Consider evaluating ghrelin and leptin levels, which are hormones involved in appetite regulation and energy balance 3, 6, 4

Additional Tests Based on Clinical Presentation

• Urinary free cortisol if Cushing's syndrome is suspected 2
• Plasma aldosterone/renin ratio if hypertension is present with unexplained weight gain 2
• Serum calcium and parathyroid hormone levels if hyperparathyroidism is suspected 2
• 24-hour urine test for calcium and creatinine 1
• Liver function tests to evaluate for nonalcoholic fatty liver disease, which is common in obesity 1, 2

Screening for Weight-Related Comorbidities

• Blood pressure measurement to screen for hypertension (≥130/80 mm Hg) 1
• Evaluation for metabolic syndrome (three or more of: increased waist circumference, elevated triglycerides, low HDL, elevated blood pressure, elevated fasting glucose) 1
• Screening for obstructive sleep apnea using clinical questionnaires (e.g., STOP-BANG score) and consider polysomnography if indicated 1, 2
• Assessment for nonalcoholic fatty liver disease with liver function tests and consider calculation of Fibrosis-4 Index 1

Special Considerations

• For patients with polycystic ovary syndrome (PCOS), additional testing should include androgen levels (total testosterone, androstenedione, DHEAS) and pelvic ultrasonography 1
• For patients on medications that may cause weight gain, a thorough medication review should be conducted 2
• For patients with rapid or unexplained weight loss, consider more extensive evaluation for malignancy or gastrointestinal disorders 7

Interpretation and Follow-up

• Abnormal thyroid function may indicate hypothyroidism, which can cause weight gain and should be treated appropriately 2, 5
• Elevated insulin levels and HOMA-IR suggest insulin resistance, which is common in obesity and may require lifestyle modifications and possibly medication 3, 4
• Abnormal cortisol levels may indicate adrenal disorders that require further evaluation and treatment 1
• Hormone imbalances should be interpreted in the context of the patient's clinical presentation and may require referral to an endocrinologist for specialized management 1, 2

Remember that hormone testing is just one component of a comprehensive weight management approach that should also include assessment of dietary habits, physical activity, sleep patterns, and psychological factors 1.