In initial evaluation, which two conditions are commonly screened as secondary causes of obesity?

In initial evaluation, which two conditions are commonly screened as secondary causes of obesity?

• A. Hypothyroidism and Cushing's syndrome
• B. Hypothyroidism and sleep apnea
• C. Cushing's syndrome and sleep apnea
• D. Medication-induced weight gain

Answer: (A)

In initial evaluation of obesity, it’s important to look for reversible medical conditions that can drive weight gain, especially endocrine disorders. Hypothyroidism is a classic target because a slowed metabolism from reduced thyroid hormone can contribute to weight gain, fatigue, and other symptoms. Screening with thyroid-stimulating hormone (TSH) testing (often with free T4 if indicated) helps identify this condition, and treating it can improve energy levels and weight trends. Cushing's syndrome is another key consideration because excess cortisol leads to characteristic fat distribution—central obesity, moon faces, dorsocervical fat pad—and several other signs such as skin changes. When suspected, screening tests for hypercortisolism (such as a overnight dexamethasone suppression test or cortisol measurements) can confirm the diagnosis, and addressing the source of cortisol excess can meaningfully impact weight and metabolic health. Sleep apnea, while highly associated with obesity and contributing to clinical problems, is typically viewed as a consequence or comorbidity rather than a primary secondary cause to screen for in the initial workup. Medication-induced weight gain is a well-known contributor, but it depends on the patient’s treatment history rather than representing a distinct endocrine disorder to be screened with standard etiologic testing. Therefore, focusing on hypothyroidism and Cushing's syndrome provides the most direct, actionable initial screening for secondary causes of obesity.

In initial evaluation of obesity, it’s important to look for reversible medical conditions that can drive weight gain, especially endocrine disorders. Hypothyroidism is a classic target because a slowed metabolism from reduced thyroid hormone can contribute to weight gain, fatigue, and other symptoms. Screening with thyroid-stimulating hormone (TSH) testing (often with free T4 if indicated) helps identify this condition, and treating it can improve energy levels and weight trends.

Cushing's syndrome is another key consideration because excess cortisol leads to characteristic fat distribution—central obesity, moon faces, dorsocervical fat pad—and several other signs such as skin changes. When suspected, screening tests for hypercortisolism (such as a overnight dexamethasone suppression test or cortisol measurements) can confirm the diagnosis, and addressing the source of cortisol excess can meaningfully impact weight and metabolic health.

Sleep apnea, while highly associated with obesity and contributing to clinical problems, is typically viewed as a consequence or comorbidity rather than a primary secondary cause to screen for in the initial workup. Medication-induced weight gain is a well-known contributor, but it depends on the patient’s treatment history rather than representing a distinct endocrine disorder to be screened with standard etiologic testing. Therefore, focusing on hypothyroidism and Cushing's syndrome provides the most direct, actionable initial screening for secondary causes of obesity.