All obese patients
BP measurement & heart rateFasting blood sugar, HbA1c and lipid profile
Suspected Obstructive Sleep Apnea (daytime sleepiness, loud snoring, gasping or chocking episodes during sleep and awakening headaches )
Measurement of neck circumference (>17 inches in men, >16 inches in women)
Polysomnograpy for oxygen desaturation, apnea and hypo-apneic events
ENT examination for upper airway obstruction
Suspected Alveolar Hyperventilation (Pickwickian) syndrome (hypersomnolence, right sided heart failure including elevated JVP, hepatomegaly and lower limb edema
Polysomnography (to rule out obstructive sleep apnea)
CBC to rule out polycythemiaBlood gases (Pco2 often elevated)Chest x-ray (enlarged heart and elevated hemi-diaphragm)
ECG: right atrial and right ventricular enlargement
Pulmonary function test: reduced vital capacity and respiratory reserve volume
Suspected Hypothyroidism
TSH
Suspected Cushing’s syndrome (moon face, thin skin that bruise easily, severe fatigue, striae
Elevated late night salivary cortisol level (>7 nmol/l diagnostic, 3-7 nmol/l equivocal)
Repeatedly elevated measurements of cortisol secretion (late night salivary cortisol or urine free cortisol, upper normal 110-138 nmol/l)
Suspected Polycystic Ovarian Syndrome (oligomenorrhea, hirsutism, enlarged ovaries may be palpable, hypercholesterolemia, impaired glucose tolerance, persistent acne and androgenic alopecia
Morning blood draw for total testosterone, free and weakly testosterone, DHEAS, prolactin, TSH and early morning 17-hydroxyprogesteron