Updated: 6/13/2020

Metabolic Syndrome

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Topic
Introduction
  • Syndrome characterized by insulin resistance with hyperinsulinemia and obesity
  • Associated conditions
    • polycystic ovarian syndrome
Presentation
  • Physical exam
    • acanthosis nigricans
      • sign of hyperinsulinemia
    • hypertension (>130/85 mmHg)
    • obesity
      • as evaluated by waist circumference
Evaluation
  • Serology
    • hypertriglyceridemia (>150 mg/dL)
    • hyperglycemia (>110 mg/dL fasting)
    • decreased HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women)
  • BMI = weight in kg / (height in meters)
Treatment
  • Medical with lifestyle changes
    • weight loss will 
      • increase insulin sensitivity
      • decrease blood pressure
      • increase ghrelin level
      • decrease leptin level
    • diabetic medications (metformin)
    • antihypertensive agents (ACE-inhibitors or thiazides)
    • cholesterol-loweing agents (statins)
Prognosis, Prevention, and Complications
  •  ↑ risk of Alzheimers, coronary artery disease

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Questions (3)
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(M1.EC.15.75) A 50-year-old female with a past medical history of hypertension comes to your clinic for a refill of her lisinopril medication. She is also taking lovastatin and hydrochlorothiazide. The patient's vital signs are as follows: HR 80, BP 150/100, and BMI 40. Physical exam is remarkable for a waist-to-hip ratio of 1.0 and the presence of diffuse dark patches on her skin (Figure A). Her fasting lab results are as follows: Sodium: 145 mmol/L, Potassium: 5.0 mmol/L, Chloride: 105 mmol/L, Bicarbonate: 25 mmol/L, BUN: 10 mg/dL, Creatinine: 1.0 mg/dL, Glucose: 200 mg/dL, Triglyceride: 200 mg/dL, LDL: 250 mg/dL, Total cholesterol: 300 mg/dL, HDL: 30 mg/dL, and Hemoglobin A1C: 7.0%. The patient's history, physical exam, and laboratory findings are most consistent with which of the following?

QID: 106830
FIGURES:
1

Hypothyroidism

5%

(4/86)

2

Cushing's disease

17%

(15/86)

3

Metabolic syndrome

69%

(59/86)

4

Type 1 diabetes mellitus

7%

(6/86)

5

Cirrhosis of the liver

0%

(0/86)

M 2 D

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Evidence (1)
EXPERT COMMENTS (18)
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