| Condition | Tests | Reason | Note |
| Early atherosclerotic cardiovascular disease | Fasting lipid profile | Hyperlipidemia, hypertriglyceridemia, cardiovascular disease risk |
|
| Hypertension | BP measurement | Multiple measurements are required to diagnose or exclude hypertension | Use appropriately sized cuffs and age-appropriate norms. Measure BP at all health care visits (and at least annually). |
| 24-hour ambulatory BP monitoring | Evaluate for "masked" hypertension; rule out "white coat" hypertension | Suggested if the diagnosis is unclear from random office measurements. | |
| CBC, metabolic panel, renin assay, urinalysis, renal ultrasound | Exclude other causes of hypertension | Suggested if hypertension is confirmed. | |
| Fatty liver disease | Serum ALT | Initial screening with serum ALT for all children with obesity starting between 9 and 11 years of age. If normal, repeat at least every 2 to 3 years*. | |
Evaluation for liver disease:
| Determine cause of elevated transaminases | Perform this evaluation if ALT is >80 units/L, persistently elevated >2 times the ULN* for 6 months, or if other signs/symptoms of advanced liver disease are present. | |
| Liver biopsy | Determine cause of elevated transaminases, assess degree of hepatitis | Perform liver biopsy if ALT >2 times the ULN for >6 months. Imaging cannot accurately determine inflammation and fibrosis. | |
| Type 2 diabetes mellitus or impaired glucose tolerance | Fasting glucose, HbA1c, or oral glucose tolerance test | Assess for insulin resistance and hyperglycemia | Perform in children ≥10 years old with overweight or obesity and 1 or more risk factors for type 2 diabetesΔ.
|
| Sleep apnea | Polysomnogram (sleep study) | Evaluate sleep-related breathing disorders | Perform in patients who have obesity and symptoms suggesting obstructive sleep apnea◊. |
| Orthopedic disease | Hip radiographs | Evaluate for SCFE | Perform in patients with unexplained aching pain in hip, groin, thigh, or knee. Use frog-leg positioning for radiograph. |
| Knee radiographs | Evaluate for genu varus (Blount disease) or valgus deformity | Perform in patients with genu varum (bow legs) or genu valgum (knock-knees). | |
| Polycystic ovary syndrome | Total testosterone (or free testosterone) To evaluate for other causes of menstrual abnormalities: TSH, prolactin, DHEAS, 17-hydroxyprogesterone (early morning) | To confirm whether hyperandrogenemia is present and exclude other causes of hyperandrogenemia and/or abnormal menses | Perform in females with irregular menses or hirsutism. If laboratory testing is abnormal, additional workup is indicated. |
| Impaired kidney function | BUN, creatinine Urine for UACR | Evaluate for impaired kidney function and albuminuria | Perform in adolescents with severe obesity, hypertension, or type 2 diabetes§. UACR >30 mg/g is abnormal. |
| Precocious puberty | LH, FSH, testosterone or estradiol, DHEAS | Early onset of obesity | Physical examination often is sufficient to evaluate. |
| Pseudotumor cerebri | Funduscopic examination, lumbar puncture | Increased intracranial pressure suggested by papilledema and confirmed by lumbar puncture | Perform funduscopic examination in patients with frequent headaches. |
BP: blood pressure; CBC: complete blood count; ALT: alanine aminotransferase; ULN: upper limit of normal; SCFE: slipped capital femoral epiphysis; TSH: thyroid-stimulating hormone; DHEAS: dehydroepiandrosterone sulfate; BUN: blood urea nitrogen; UACR: urine albumin-to-creatinine ratio; LH: luteinizing hormone; FSH: follicle-stimulating hormone; GGTP: gamma-glutamyl transpeptidase.
* For interpretation of serum ALT, use the ULN of 22 units/L for females and 26 units/L for males, as determined from healthy lean children in the National Health and Nutrition Examination Survey (NHANES)[3]. Note that these values are substantially lower than the ULNs reported in most pediatric hospital laboratories.
¶ Screening laboratory tests for suspected fatty liver disease include a CBC with hemoglobin HbA1c.
Δ Risk factors for type 2 diabetes include: family history of type 2 diabetes, high-risk race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander), signs of insulin resistance (eg, acanthosis nigricans), or conditions associated with diabetes (hypertension, dyslipidemia, polycystic ovary syndrome).
◊ Symptoms suggesting obstructive sleep apnea include persistent snoring (most nights, most sleeping positions), observed gasping or apneas, nocturnal enuresis, and morning headaches.
§ Screening for impaired kidney function is recommended for patients with type 2 diabetes[5]. UpToDate authors also suggest this screening for patients with other risk factors for developing chronic kidney disease, including severe obesity and hypertension.