Review Question - QID 106830

This patient's presentation of hypertension, hyperlipidemia, low HDL, and central obesity (waist-hip ratio of 1.0) is most consistent with a diagnosis of metabolic syndrome.

Metabolic syndrome is defined as a patient having at least three of the following five risk factors: 1. Large waist size (40 inches or larger in men, 35 inches or larger in women); 2. High triglycerides (above 150 mg/dL); 3. Low HDL (below 40 mg/dL in men and below 50 mg/dL in women); 4. Hypertension (above 140/80); 5. Elevated fasting glucose (above 100 mg/dL). Due to the elevated glucose levels, patients with metabolic syndrome are at a high risk for developing type 2 diabetes mellitus, a complication that the patient in this question has developed (as indicated by her elevated hemoglobin A1C level).

Figure A demonstrates acanthosis nigricans, an easily identifiable skin lesion that is also associated with insulin resistance.

Incorrect Answers:
Answer 1: Hypothyroidism results in weight gain and hyperlipidemia; however, the presence of acanthosis nigricans is not commonly associated with hypothyroidism.
Answer 2: Cushing's disease can manifest with weight gain, high blood pressure, excessive hair growth, and red stretch marks, though this patient has a constellation of symptoms more consistent with metabolic syndrome.
Answer 4: Type 1 diabetes mellitus presents classically with polyphagia, polydipsia, polyuria, and unexplained weight loss. However, none of these symptoms were reported by the patient. Though her hemoglobin A1C (7.0%) and fasting glucose (200 mg/dL) levels are diagnostic of diabetes mellitus, based on this patient's clinical presentation (particularly her obesity) it is more likely that she has type 2 diabetes mellitus, not type 1.
Answer 5: Liver cirrhosis presents with jaundice, itching, fatigue, and easy bruising. Advanced complications include ascites, edema, hepatorenal syndrome, and liver cancer.