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)2 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