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==
Patients fit the diagnostic criteria below, these features put them at increased risk for BOTH Diabetes Mellitus and Cardiovascular disease.<br/>
''Although several diagnostic features exist, below is the most widely accepted: The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III)''
Although several diagnostic features exist, below is the most widely accepted: The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). <br/>
*'''Diagnostic Criteria''' - 3 or more of the following:
'''Diagnostic Criteria'''<br/>
**Waist circumference >/=102 cm in men or >/=88 cm in women
>3 of the following: <br/>
**Plus 3 of the following:
Waist circumference >/=102 cm in men or >/=88 cm in women<br />
**Fasting blood glucose >/= to 100 mg/dL or requiring treatment for elevated blood glucose
Plus 3 of the following:<br />
**HDL </=40 in men or </=50 in women
Fasting blood glucose >/= to 100 mg/dL or requiring treamtment for elevated blood glucose<br />
**TGs >/=150 mg/dL
HDL </=40 in men or </=50 in women<br />
**BP >/= 130/85 or requiring drug treatment for HTN
TGs >/=150 mg/dL<br />
BP >/= 130/85 or requiring drug treatment for HTN <br/>
'''Additional Markers'''<br />
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.


==Differential Diagnosis==
==Differential Diagnosis==
<br/>
*[[Hypertension]]
Differential should include other disease processes that could cause the features of Metabolic Syndrome X (i.e hypertension, hyperlipidemia and hyperglycemia.) <br/>
*Hyperlipidemia
Hypothyroidism<br/>
*[[Hyperglycemia]]
Obstructive Sleep Apnea<br/>
*[[Hypothyroidism]]
Type 2 DM<br/>
*Obstructive Sleep Apnea
Rarer Diagnoses<br/>
*Type 2 [[DM]]
Pheochromacytoma<br/>
*[[Pheochromocytoma]]
Glucagonoma
*Glucagonoma


==Evaluation==
==Evaluation==
Workup should include: <br/>
*Not an ED diagnosis!
Metabolic Panel-assess  for renal function <br/>
*Evaluate for sequelae of associated diseases (e.g. cardiovascular disease, DM) as appropriate
HbA1c <br/>
*Non-ED workup may include:
Lipid panel <br/>
**BMP
TSH <br/>
**HbA1c
+/- Polysomnography-This is becoming more widely used in recent years as OSA has a confounding effect on obesity. If patient presents with excessive daytime somnolence or partner reported nighttime pauses in respiration, this test maybe helpful to obtain.<br/>
**Lipid panel
Determine the patients ASCVD 10 year risk
**TSH
**+/- Polysomnography to evaluate for OSA


==Management==
==Management==
Lifestyle modification<br/>
*Lifestyle modification
Metformin<br/>
*[[Metformin]]
BP control using ACEi or ARBs<br/>
*BP control(e.g. [[ACEi]] or ARBs}
Treatment of any underlying OSA<br/>
*OSA treatment
Depending on the level of obesity, and severity of the condition bariatric surgery may be advantageous to the patient
*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==
Assuming the patient has not presented to the ED with any emergent concerns (Chest pain, new onset neurological deficit, limb pain with symptoms associated with possible limb ischemia, etc.), the patient can be managed by their primary care physician for appropriate medications and lifestyle modification to manage their disease.
*Discharge with outpatient follow-up


==See Also==
==External Links==
https://www.uptodate.com/contents/the-metabolic-syndrome-insulin-resistance-syndrome-or-syndrome-x?source=search_result&search=metabolic%20syndrom%20x&selectedTitle=1~150 <br/>


http://emedicine.medscape.com/article/165124-overview


==References==
==References==
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<br/>
<references/>


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 http://care.diabetesjournals.org/content/26/11/3160.long.
[[Category:Endocrinology]]
[[Category:Endocrinology]]<br/>
 
Tasali E, Ip MS. Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation. Proc Am Thorac Soc. 2008 Feb 15. 5(2):207-17. <br/>
 
Grundy SM. Metabolic syndrome: a multiplex cardiovascular risk factor. J Clin Endocrinol Metab. 2007 Feb. 92(2):399-404.<br/>
 
Heima NE, Eekhoff EM, Oosterwerff MM, Lips PT, van Schoor NM, Simsek S. Thyroid function and the metabolic syndrome in older persons: a population-based study. Eur J Endocrinol. 2013 Jan. 168(1):59-65. <br/>
 
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5. 311(5):507-20.<br/>
 
Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jul 1. 63(25 Pt B):2960-84.

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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