Metabolic Syndrome

(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?