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Cited by 188Thyroid Disorders and TreatmentsAdipokines, Inflammation, and Metabolic DiseasesOvarian function and disorders

The DOI matches its Crossref record; 204 of the 204 references it cites were found in a registry or an index; none of the 230 sources its claims cite is checked for support yet.

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Open access
Pasquali, R, Casanueva, F, Haluzik, M, van Hulsteijn, L, Ledoux, S, Monteiro, M P, Salvador, J, Santini, F, Toplak, H, Dekkers, O M·2020·European Journal of Endocrinology
DOI 10.1530/eje-19-0893
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Abstract

Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed - which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.

Overview

Integrity signals

Registry

Crossref · 10.1530/eje-19-0893

Cites

204 of 204 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 230 cited sources checked · 0 supported · 0 flagged

Show all 130 claims

  • Probably not a substantial claim. 31
  • It may state two separate claims as one. 62
84 of 84

  • The paper relies on this without support.

    Weight loss restores hormonal imbalances in obesity.

    “weight loss in obesity should be emphasized as key to restoration of hormonal imbalances”

  • The paper relies on this without support.

    For obese patients, the same normal thyroid hormonal values apply as for non-obese patients.

    “We suggest that for obese patients the same normal hormonal values are applied as for non-obese (+000).”

  • The paper relies on this without support.

    For patients with obesity, the same normal values for hypercortisolism testing apply as for non-obese patients.

    “We suggest that for patients with obesity the same normal values are applied as for non-obese (+000).”

  • The paper relies on this without support.

    Obesity is not a rare condition.

    “as obesity is not a rare condition”

  • The paper relies on this without support.

    BMI is easily calculated in clinical practice.

    “BMI is easily calculated in clinical practice”

  • The paper relies on this without support.

    In most cases, obesity is not caused by other endocrine diseases or hormonal disturbances.

    “In most cases, despite obesity being a condition of endocrine and metabolic imbalance, obesity is not caused by other endocrine diseases or hormonal disturbances.”

  • The paper relies on this without support.

    The prevalence of obesity is such that standard referral to an endocrinologist would not be compatible with available resources in most countries.

    “Furthermore, the prevalence of obesity is such that standard referral to an endocrinologist would not be compatible with available resources in most countries.”

  • The paper relies on this without support.

    The prevalence of endocrine disturbances is related to obesity severity.

    “because the prevalence of endocrine disturbances is related to obesity severity”

  • The paper relies on this without support.

    Clinical signs and symptoms of endocrine conditions can be difficult to distinguish from obesity.

    “because clinical signs and symptoms of endocrine conditions can be difficult to distinguish from obesity”

  • The paper relies on this without support.

    For most hormones (TSH, cortisol, testosterone), the proper equilibrium is usually restored following weight reduction, irrespective of therapeutic strategy.

    “For most hormones (TSH, cortisol. testosterone), the proper equilibrium is usually restored following weight reduction, irrespective of therapeutic strategy”

  • The paper relies on this without support.

    Several dietary supplements are commonly taken by patients with obesity, with the aim of facilitating weight loss or well-being, controlling glucose metabolism or preventing cardiovascular events.

    “several dietary supplements are commonly taken by patients with obesity, with the aim of facilitating weight loss or well-being, controlling glucose metabolism or preventing cardiovascular events.”

  • The paper relies on this without support.

    Hypothyroidism can be easily diagnosed by blood tests.

    “Hypothyroidism can be easily diagnosed by blood tests.”

  • The paper relies on this without support.

    Untreated hypothyroidism could blight the attempts at loosing body weight.

    “Finally, untreated hypothyroidism could blight the attempts at loosing body weight.”

  • The paper relies on this without support.

    The most common cause of hypothyroidism is chronic autoimmune thyroiditis.

    “The most common cause of hypothyroidism is chronic autoimmune thyroiditis.”

  • The paper relies on this without support.

    Thyroid antibody profiles are helpful to diagnose autoimmune hypothyroidism and to determine patients at risk of developing hypothyroidism.

    “Thyroid antibody profiles are helpful to diagnose autoimmune hypothyroidism and to determine patients at risk of developing hypothyroidism.”

  • The paper relies on this without support.

    Among women of reproductive age, subclinical hypothyroidism has been associated with infertility, an increased risk of adverse pregnancy and neonatal outcomes, and possibly with an increased risk of neurocognitive deficits in offspring.

    “Among women of reproductive age, subclinical hypothyroidism has been associated with infertility, an increased risk of adverse pregnancy and neonatal outcomes, and possibly with an increased risk of neurocognitive deficits in offspring.”

  • The paper relies on this without support.

    Autoimmune thyroiditis is often characterized by a hypoechogenic pattern on thyroid ultrasonography.

    “Autoimmune thyroiditis is often characterized by a hypoechogenic pattern on thyroid ultrasonography.”

  • The authors state this as an assumption.

    Obesity has epidemic proportions.

    “Assuming the epidemic proportions of obesity”

  • The authors state this as an assumption.

    Obesity has a multifactorial origin.

    “its multifactorial origin”

  • The paper relies on this without support.

    Adjustment of the dexamethasone dose to body weight does not substantially improve the sensitivity of the dexamethasone suppression test in individuals with obesity, particularly when near-maximal doses are administered.

    “In line, a study has shown that adjustment of the dexamethasone dose to body weight does not seem to substantially improve the sensitivity of the test, even in individuals with obesity, particularly when near-maximal doses are administered.”

  • The paper relies on this without support.

    The ability to sustain male gonadal benefits after weight loss achieved through conservative interventions is relatively small, as weight regain is also very common.

    “Besides, the ability to sustain the male gonadal benefits after weight loss achieved through conservative interventions is relatively small, as weight regain is also very common.”

  • The paper relies on this without support.

    Testosterone results depend on the assay technique used.

    “Testosterone results also depend on the assay technique used.”

  • The paper relies on this without support.

    Most available testosterone assays are immunoassays (RIA, enzyme immunoassay or fluoroimmunoassay), which are rapid, simple, and inexpensive.

    “Most available testosterone assays are immunoassays (RIA, enzyme immunoassay or fluoroimmunoassay), which are rapid, simple and inexpensive.”

  • The paper relies on this without support.

    Most reference ranges have been established using immunoassays.

    “Moreover, most reference ranges have been established using immunoassays.”

  • The paper relies on this without support.

    The accuracy of immunoassays is lower than that obtained by mass spectrometry, which is more expensive and requires regular calibration.

    “However, their accuracy is lower than that obtained by mass spectrometry, which is more expensive and requires regular calibration.”

  • The paper relies on this without support.

    Equilibrium dialysis represents the gold standard method to measure free testosterone but is expensive and technically challenging.

    “Equilibrium dialysis represents the gold standard method to measure free testosterone but is expensive and technically challenging.”

  • The paper relies on this without support.

    Most guidelines recommend direct measurements or calculation of free testosterone by a formula.

    “For practical reasons, most guidelines recommend direct measurements or calculation of free testosterone by a formula.”

  • The paper relies on this without support.

    The injectable preparation of testosterone undecanoate (1000 mg every 12 weeks) is widely used as treatment of hypogonadism because it leads to steady testosterone plasma levels.

    “The injectable preparation of testosterone undecanoate (1000 mg every 12 weeks) is widely used as treatment of hypogonadism because it leads to steady testosterone plasma levels.”

  • The paper relies on this without support.

    Testosterone replacement therapy given to men with hypogonadism is associated with weight loss and body composition improvement, but no evidence of this beneficial effect is observed in eugonadal subjects.

    “Although TRT given to men with hypogonadism is associated with weight loss and body composition improvement, no evidence of this beneficial effect is observed in eugonadal subjects.”

  • The paper relies on this without support.

    Vitamin D is essential for bone-mineral health and calcium homeostasis.

    “Vitamin D is essential for bone-mineral health and calcium homeostasis.”

  • The paper relies on this without support.

    The diagnosis of Prader-Willi syndrome can be established based on clinical features, hormonal abnormalities and genetic testing.

    “The diagnosis of this syndrome can be established based on clinical features, hormonal abnormalities and genetic testing.”

  • The paper relies on this without support.

    Hypothyroidism can be accompanied by both obesity and hypertension.

    “Hypothyroidism can be accompanied by both obesity and hypertension”

  • The paper relies on this without support.

    None of these conditions (obesity and hypertension in hypothyroidism) is usually severe.

    “although none of these conditions is usually severe.”

  • The paper relies on this without support.

    Other causes of endocrine hypertension can be present in obesity.

    “Other causes of endocrine hypertension can be present in obesity”

  • The paper relies on this without support.

    Other causes of endocrine hypertension are not characterized by increased prevalence of obesity.

    “nevertheless, these are not characterized by increased prevalence of obesity.”

  • The paper relies on this without support.

    Pregnancy induces profound changes in endocrine functions that affect the gonadotropic axis, hormones of lactation, placental hormones, and other endocrine glands such as the adrenal and thyroid glands.

    “Pregnancy induces profound changes in endocrine functions that affect not only the gonadotropic axis (increase in oestrogens, progesterone and androgens), hormones of lactation (increase in oxytocin and prolactin) and placental hormones (notably human chorionic gonadotropin: HCG), but also other endocrine glands such as the adrenal and thyroid glands.”

  • The paper relies on this without support.

    During the 1st trimester, HCG induces a transient increase in free thyroid hormones levels and a decrease in TSH.

    “during the 1st trimester, HCG induces a transient increase in free thyroid hormones levels and a decrease in TSH.”

  • The paper relies on this without support.

    Later in pregnancy, serum free hormones concentrations decrease of approximately 10-15%, and TSH returns to normal.

    “Later, serum free hormones concentrations decrease of approximately 10-15%, and TSH returns to normal.”

  • The paper relies on this without support.

    Most scientific societies recommend specific reference ranges for free thyroid hormones and TSH throughout pregnancy.

    “Thus, most scientific societies recommend specific reference ranges for free thyroid hormones and TSH throughout pregnancy.”

  • The paper relies on this without support.

    Glucocorticoids are vital for normal foetal growth.

    “Glucocorticoids are vital for normal foetal growth.”

  • The paper relies on this without support.

    During pregnancy, a number of endocrine changes induce activation in maternal hypothalamic-pituitary-adrenal (HPA) axis.

    “During pregnancy, a number of endocrine changes induce activation in maternal hypothalamic-pituitaryadrenal (HPA) axis.”

  • The paper relies on this without support.

    The foeto-placental unit produces large amounts of steroid and peptide hormones including CRH.

    “The foeto-placental unit produces large amounts of steroid and peptide hormones including CRH.”

  • The paper relies on this without support.

    Renin-angiotensin-aldosterone (RAA) axis is activated during pregnancy to compensate vasodilation and to increase extracellular fluid volume.

    “Renin-angiotensin-aldosterone (RAA) axis is activated during pregnancy to compensate vasodilation and to increase extracellular fluid volume.”

  • The paper relies on this without support.

    Alterations of RAA axis have been incriminated in the pathophysiology of preeclampsia.

    “Alterations of RAA axis have been incriminated in the pathophysiology of preeclampsia”

  • The paper relies on this without support.

    Preeclampsia is more prevalent in obese pregnant women.

    “that is more prevalent in obese pregnant women.”

  • The paper relies on this without support.

    Around 30 g of calcium is transferred to the foetus, especially in the last trimester of pregnancy, needed for bone mineralization.

    “Around 30 g of calcium is transferred to the foetus, especially in the last trimester of pregnancy, needed for bone mineralization.”

  • The paper relies on this without support.

    Ageing is associated with alterations of hormonal secretions with variable amplitude for each endocrine system.

    “Ageing is associated with alterations of hormonal secretions with variable amplitude for each endocrine system.”

  • The paper relies on this without support.

    The symptoms of endocrine disease change with aging and are often less pronounced, which can lead to missing of the diagnosis.

    “Furthermore, the symptoms of endocrine disease change with aging and are often less pronounced, which can lead to missing of the diagnosis.”

  • The paper relies on this without support.

    The consequences of endocrine diseases can change in elderly with greater health risks (notably for muscle mass and cardiovascular functions).

    “The consequences of endocrine diseases can also change in elderly with greater health risks (notably for muscle mass and cardiovascular functions).”

  • The paper relies on this without support.

    The indication to treat is different in elderly because the benefit to risk ratio may be less favourable.

    “Finally, the indication to treat is also different, because the benefit to risk ratio may be less favourable.”
50 of 50

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Subclinical hypothyroidism confidence interval has two lower bounds

    Minor

    The review summary gives 9.2% as the lower bound of the 95% confidence interval, while the later account of the same meta-analysis gives 9.4%.

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Metadata

Authors
Pasquali, R., Casanueva, F., Haluzik, M., van Hulsteijn, L., Ledoux, S., Monteiro, M. P., Salvador, J., Santini, F., Toplak, H., & Dekkers, O. M.
Affiliations
  • University of Bologna (IT)
  • Complejo Hospitalario Universitario de Santiago (ES)
  • 3Diabetes Centre and Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine and Institute of Endocrinology, Prague, Czech Republic
  • University Medical Center Groningen (NL)
  • Hôpital Louis-Mourier (FR)
  • Universidade do Porto (PT)
  • Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (ES)
  • Azienda Ospedaliera Universitaria Pisana (IT)
  • Medical University of Graz (AT)
  • Leiden University Medical Center (NL)
Corresponding author
Pasquali, R
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2020-01
Volume
182
Issue
1
Pages
G1-G32
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-19-0893
OpenAlex
W2994986481
Semantic Scholar
305b19ef98c1ddb882ff636c4548d296e5feed93
Cited by
188
References
126
Citations by year
2026: 21 · 2025: 30 · 2024: 45 · 2023: 25 · 2022: 26 · 2021: 29 · 2020: 12
FWCI
15.19
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • European Journal of Endocrinology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Leiden Repository (Leiden University) (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, other-oa)
Funders
European Society of Endocrinology
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords
obesity, thyroid function tests, hypothyroidism, hypercortisolism, male hypogonadism, body mass index, weight loss, hormonal imbalance
MeSH terms
Endocrinology, Humans, Hypothyroidism, Obesity, Thyroid Function Tests, Comorbidity, Body Mass Index, Prevalence

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