Metabolic syndrome: Difference between revisions

Revision as of 06:21, 23 October 2017

Background

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.

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 treamtment 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
Rarer Diagnoses
Pheochromacytoma
Glucagonoma

Evaluation

Metabolic Panel
HbA1c
Lipid panel
TSH
+/- 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.

Management

Lifestyle modification
Metformin
BP control using ACEi or ARBs
Treatment of any underlying OSA
Depending on the level of obesity, and severity of the condition bariatric surgery may be advantageous to the patient

Disposition

Discharge with outpatient follow-up

External Links

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Three or more of the following or if taking any medication to control disease.
+*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.
-**Large waist circumference — At least 35 inches (89 centimeters) for women and 40 inches for men
-**High triglyceride level — 150 mg/dL or 1.7 mmol/L
-**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==
-Patients fit the diagnostic criteria below, secondary to the increased inflammatory state and insulin resistance associated with obesity, these features put them at increased risk for BOTH Type 2 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 treamtment 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==
-<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/>
+*Rarer Diagnoses
-Glucagonoma
+*Pheochromacytoma
+*Glucagonoma
 ==Evaluation==
-Workup should include: <br/>
+*Metabolic Panel
-Metabolic Panel-assess  for renal function <br/>
+*HbA1c
-HbA1c <br/>
+*Lipid panel
-Lipid panel <br/>
+*TSH
-TSH <br/>
+*+/- 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.
-+/- 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/>
-Determine the patients ASCVD 10 year risk
 ==Management==
-Lifestyle modification<br/>
+*Lifestyle modification
-Metformin<br/>
+*Metformin
-BP control using ACEi or ARBs<br/>
+*BP control using ACEi or ARBs
-Treatment of any underlying OSA<br/>
+*Treatment of any underlying OSA
-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
 ==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==
-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.