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Metabolic Syndrome

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Topic updated on 02/24/16 9:29pm

Introduction
  • Syndrome characterized by insulin resistance with hyperinsulinemia and obesity
  • Associated conditions
    • polycystic ovarian syndrome
Presentation
  • Physical exam
    • acanthosis nigricans
      • sign of hyperinsulinemia
    • hypertension (>130/85 mmHg)
    • obesity
      • as evaluated by waist circumference
Evaluation
  • Serology
    • hypertriglyceridemia (>150 mg/dL)
    • hyperglycemia (>110 mg/dL fasting)
    • decreased HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women)
Treatment
  • Medical with lifestyle changes
    • weight loss
      • will increase insulin sensitivity
    • diabetic medications (metformin)
    • antihypertensive agents (ACE-inhibitors or thiazides)
    • cholesterol-loweing agents (statins)
Prognosis, Prevention, and Complications
  •  ↑ risk of Alzheimers, coronary artery disease


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(M1.EC.75) A 50-year-old female with a past medical history of hypertension comes to your clinic for a refill of her lisinopril medication. She is also taking lovastatin and hydrochlorothiazide. The patient's vital signs are as follows: HR 80, BP 150/100, and BMI 40. Physical exam is remarkable for a waist-to-hip ratio of 1.0 and the presence of diffuse dark patches on her skin (Figure A). Her fasting lab results are as follows: Sodium: 145 mmol/L, Potassium: 5.0 mmol/L, Chloride: 105 mmol/L, Bicarbonate: 25 mmol/L, BUN: 10 mg/dL, Creatinine: 1.0 mg/dL, Glucose: 200 mg/dL, Triglyceride: 200 mg/dL, LDL: 250 mg/dL, Total cholesterol: 300 mg/dL, HDL: 30 mg/dL, and Hemoglobin A1C: 7.0%. The patient's history, physical exam, and laboratory findings are most consistent with which of the following? Topic Review Topic
FIGURES: A          

1. Hypothyroidism
2. Cushing's disease
3. Metabolic syndrome
4. Type 1 diabetes mellitus
5. Cirrhosis of the liver

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