Metabolic syndrome: Difference between revisions

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

Hypertension
Hyperlipidemia
Hyperglycemia
Hypothyroidism
Obstructive Sleep Apnea
Type 2 DM
Pheochromocytoma
Glucagonoma

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

Authors:

@@ Line 1: / Line 1: @@
-'''<big>'Background</big>'''
+==Background==
-------------------------------------------------------------------------------------------------
+*Prothrombotic, proimflammatory state
-Cluster of conditions characterize by:
+*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
-* 1. Increase blood pressure
+**Markers not shown to be of utility in the ED
-* 2. Increase body fat around the waist
-* 3. Abnormal cholesterol or triglycerides
-*Leading to Increase Risk of Heart disease, Stroke or Diabetes
+==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
-<big>'''Diagnostics'''</big>
+==Differential Diagnosis==
--------------------------------------------------------------------------------------------------
+*[[Hypertension]]
-Diagnosis is base on three or more of the following or if taking any medication to control disease.
+*Hyperlipidemia
+*[[Hyperglycemia]]
+*[[Hypothyroidism]]
+*Obstructive Sleep Apnea
+*Type 2 [[DM]]
+*[[Pheochromocytoma]]
+*Glucagonoma
-* Large waist circumference — At least 35 inches (89 centimeters) for women and 40 inches for men
+==Evaluation==
-* High triglyceride level — 150 mg/dL or 1.7 mmol/L
+*Not an ED diagnosis!
-* 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
+*Evaluate for sequelae of associated diseases (e.g. cardiovascular disease, DM) as appropriate
-* Increased blood pressure — 130/85 or higher
+*Non-ED workup may include:
-* Elevated fasting blood sugar — 100 mg/dL or higher
+**BMP
+**HbA1c
+**Lipid panel
+**TSH
+**+/- Polysomnography to evaluate for OSA
-'''<big>Treatment</big>'''
+==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==
+<references/>
-* The first line of treatment is Life Style changes
-* 2nd: Medication to control disease
-* HTN overview- http://wikem.org/wiki/Asymptomatic_hypertension
-* DM overview- http://wikem.org/wiki/Diabetes_mellitus_(main)
-* Stroke overview- http://wikem.org/wiki/Stroke_(main)
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 [[Category:Endocrinology]]