Evaluation of Obese Patient

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All obese patients

  • BP measurement & heart rate
  • Fasting blood sugar, HbA1c and lipid profile
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    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
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    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 polycythemia
  • Blood 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
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    Suspected Hypothyroidism

  • TSH
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    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)
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    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