Stage of in-depth clinical and laboratory examination
Laboratory methods of examination
1. Biochemical blood test with the determination of cholesterol level, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), atherogenic index.
2. Hormonal blood test with the determination of the level of immunoreactive insulin (IRI) fasting and after 2 hours during glucose tolerance test (GTT).
Additional methods of examination
1. Determination of the concentration of sex hormones: estradiol, progesterone, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin – in girls during menstrual disorder, hypogonadism, acceleration of puberty; testosterone, FSH, LH – in boys with the signs of delay or acceleration of puberty.
2. Ultrasound of adrenal glands, pelvic organs, breast, testicles.
3. Ambulatory blood pressure monitoring (ABPM).
5. Computed tomography of the adrenal glands, magnetic resonance tomography of the brain (pituitary gland).
6. Consultation of an ophthalmologist (ocular fundus, visual field), neurologist, cardiologist, obstetrician-gynecologist, neurosurgeon, psychotherapist, geneticist.
Diagnosing the complicated forms of obesity in a patient in its early manifestation or in monogenic forms of the disease, clinical and laboratory signs of hypercortisolism, hypogonadism, polycystic ovary syndrome, genetic syndromes is the indication for further examination of the patient at the fourth stage.
Stage of differential diagnosis and diagnosis verification
Laboratory and instrumental methods of examination
1. Hormonal examinations:
- Determination of leptin concentration (in obesity occurrence in early childhood, in monogenic or morbid forms of obesity), adiponectin (in the risk of developing the metabolic syndrome or secondary disorders in obesity (arterial hypertension, insulin resistance, impaired glucose metabolism, dyslipidemia);
- Adrenocorticotropic hormone, circadian cortisol profile, small and large dexamethasone suppression test (in suspicion of hypercortisolism);
- Dehydroepiandrosterone sulfate (in symptoms of polycystic ovary syndrome, hypogonadism);
- Insulin-like growth factor-1, insulin-like binding protein-3 (in monogenic forms of obesity, short stature, acceleration of bone age, hypogonadotropic hypogonadism);
2. Dual-energy X-ray absorptiometry to determine body composition
Additional methods of examination
1. Revealing psychological maladjustment according to the results of psychological tests and questionnaires: a test of family education by Eidemiller (parents) and their children (food preference questionnaire (EAT-26 (Eating Attitudes Test)), used as a screening method to reveal eating disorders) by Eysenck, Spielberger, Luscher.
2. DNA-typing of patients and their parents with morbid and monogenic forms of obesity, early occurrence of the disease for a number of candidate genes (leptin gene LEP, leptin receptor gene LEPR, adiponectin gene ADIPOQ, insulin gene INS, interleukin 6 gene (IL-6), tumor necrosis factor TNF-a gene.
The optimal amount of researches is determined by anamnestic data and indicators of clinical and laboratory examination.
According to the examination results, stratification of the risk of complicated forms of the disease is conducted in patients with overweight and obesity. For the development of the factors of risk stratification of patients depending on the puberty stage: prepubertal (Tanner stage 1), early puberty (Tanner stage 2-3), late puberty (Tanner stage 4-5) were used most informative, anamnestic, clinical, metabolic and hormonal indicators.