Metabolic syndrome: Difference between revisions
 
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==Background==
==Background==
*Three or more of the following or if taking any medication to control disease.
*Prothrombotic, proimflammatory state
**Large waist circumference — At least 35 inches (89 centimeters) for women and 40 inches for men
*May be associated with elevated CRP, IL-6, and tissue plasminogen activator, which may be associated with increased risk of cardiovascular disease and type 2 diabetes
**High triglyceride level — 150 mg/dL or 1.7 mmol/L
**Markers not shown to be of utility in the ED
**Reduced high-density lipoprotein (HDL) cholesterol — less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women of this "good" cholesterol
**Increased blood pressure — 130/85 or higher
**Elevated fasting blood sugar — 100 mg/dL or higher


==Clinical Features==
==Clinical Features==
'''Diagnostic Criteria'''<br/>
''Although several diagnostic features exist, below is the most widely accepted: The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III)''
Waist circumference >/=102 cm in men or >/=88 cm in women<br />
*'''Diagnostic Criteria''' - 3 or more of the following:
Plus 3 of the following:<br />
**Waist circumference >/=102 cm in men or >/=88 cm in women
Fasting blood glucose >/= to 100 mg/dL or requiring treamtment for elevated blood glucose<br />
**Plus 3 of the following:
HDL </=40 in men or </=50 in women<br />
**Fasting blood glucose >/= to 100 mg/dL or requiring treatment for elevated blood glucose
TGs >/=150 mg/dL<br />
**HDL </=40 in men or </=50 in women
BP >/= 130/85 or requiring drug treatment for HTN <ref name="UpToDate">[https://www.uptodate.com/contents/the-metabolic-syndrome-insulin-resistance-syndrome-or-syndrome-x?source=search_result&search=metabolic%20syndrome%20adult&selectedTitle=1~150].</ref><br />
**TGs >/=150 mg/dL
'''Additional Markers'''<br />
**BP >/= 130/85 or requiring drug treatment for HTN
MSX is considered to be a prothrombotic, proimflammatory state. As such, it may be associated with elevated CRP, IL-6 and tissue plasminogen activator. The elevated inflammatory markers may be associated with increased risk for CVD and Type 2 Diabetes Mellitus. However, these markers have not been shown of any benefit in the ED. Rather, they should be used for evaluation of risk of CVD in the outpatient setting. Page text.<ref name="UTD reference 2">[https://www.uptodate.com/contents/the-metabolic-syndrome-insulin-resistance-syndrome-or-syndrome-x/abstract/41]</ref>


==Differential Diagnosis==
==Differential Diagnosis==
 
*[[Hypertension]]
*Hyperlipidemia
*[[Hyperglycemia]]
*[[Hypothyroidism]]
*Obstructive Sleep Apnea
*Type 2 [[DM]]
*[[Pheochromocytoma]]
*Glucagonoma


==Evaluation==
==Evaluation==
 
*Not an ED diagnosis!
*Evaluate for sequelae of associated diseases (e.g. cardiovascular disease, DM) as appropriate
*Non-ED workup may include:
**BMP
**HbA1c
**Lipid panel
**TSH
**+/- Polysomnography to evaluate for OSA


==Management==
==Management==
 
*Lifestyle modification
*[[Metformin]]
*BP control(e.g. [[ACEi]] or ARBs}
*OSA treatment
*Depending on the level of obesity, and severity of the condition bariatric surgery may be advantageous to the patient
*Possible referral to obesity management clinic


==Disposition==
==Disposition==
*Discharge with outpatient follow-up


 
==External Links==
==See Also==




==References==
==References==
1. Grundy, S. M. (2005). Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement: Executive Summary. Circulation, 112(17). doi:10.1161/circulationaha.105.169405
<references/>


2. Genuth, S. (2003). Follow-up report on the diagnosis of diabetes mellitus. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus , 26(11). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed?term=14578255.
[[Category:Endocrinology]]
[[Category:Endocrinology]]

Latest revision as of 07:24, 18 August 2022

Background

  • Prothrombotic, proimflammatory state
  • May be associated with elevated CRP, IL-6, and tissue plasminogen activator, which may be associated with increased risk of cardiovascular disease and type 2 diabetes
    • Markers not shown to be of utility in the ED

Clinical Features

Although several diagnostic features exist, below is the most widely accepted: The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III)

  • Diagnostic Criteria - 3 or more of the following:
    • Waist circumference >/=102 cm in men or >/=88 cm in women
    • Plus 3 of the following:
    • Fasting blood glucose >/= to 100 mg/dL or requiring treatment for elevated blood glucose
    • HDL </=40 in men or </=50 in women
    • TGs >/=150 mg/dL
    • BP >/= 130/85 or requiring drug treatment for HTN

Differential Diagnosis

Evaluation

  • Not an ED diagnosis!
  • Evaluate for sequelae of associated diseases (e.g. cardiovascular disease, DM) as appropriate
  • Non-ED workup may include:
    • BMP
    • HbA1c
    • Lipid panel
    • TSH
    • +/- Polysomnography to evaluate for OSA

Management

  • Lifestyle modification
  • Metformin
  • BP control(e.g. ACEi or ARBs}
  • OSA treatment
  • Depending on the level of obesity, and severity of the condition bariatric surgery may be advantageous to the patient
  • Possible referral to obesity management clinic

Disposition

  • Discharge with outpatient follow-up

External Links

References

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