This patient's presentation of hypertension, hyperlipidemia, low HDL, and central obesity (waist-hip ratio of 1.0) is most consistent with a diagnosis of metabolic syndrome.
Metabolic syndrome is defined as a patient having at least three of the following five risk factors: 1. Large waist size (40 inches or larger in men, 35 inches or larger in women); 2. High triglycerides (above 150 mg/dL); 3. Low HDL (below 40 mg/dL in men and below 50 mg/dL in women); 4. Hypertension (above 140/80); 5. Elevated fasting glucose (above 100 mg/dL). Due to the elevated glucose levels, patients with metabolic syndrome are at a high risk for developing type 2 diabetes mellitus, a complication that the patient in this question has developed (as indicated by her elevated hemoglobin A1C level).
Rao et al. report that a waist-hip ratio of greater than 1.0 in men or 0.8 in women is strongly correlated with both abdominal obesity as well as insulin resistance and confers an increased risk of associated diseases.
Pollex et al. write that insulin resistance is one of the primary contributing factors for metabolic syndrome. An elevated waist-hip ratio is suggestive of central obesity, which is a predictor of insulin resistance.
Figure A demonstrates acanthosis nigricans, an easily identifiable skin lesion that is also associated with insulin resistance.
Answer 1: Hypothyroidism results in weight gain and hyperlipidemia; however, the presence of acanthosis nigricans is not commonly associated with hypothyroidism.
Answer 2: Cushing's disease can manifest with weight gain, high blood pressure, excessive hair growth, and red stretch marks, though this patient has a constellation of symptoms more consistent with metabolic syndrome.
Answer 4: Type 1 diabetes mellitus presents classically with polyphagia, polydipsia, polyuria, and unexplained weight loss. However, none of these symptoms were reported by the patient. Though her hemoglobin A1C (7.0%) and fasting glucose (200 mg/dL) levels are diagnostic of diabetes mellitus, based on this patient's clinical presentation (particularly her obesity) it is more likely that she has type 2 diabetes mellitus, not type 1.
Answer 5: Liver cirrhosis presents with jaundice, itching, fatigue, and easy bruising. Advanced complications include ascites, edema, hepatorenal syndrome, and liver cancer.
Rao G. Insulin Resistance Syndrome. Am Fam Physician. 2001 Mar 15;63(6):1159-63, 1165-6.
PMID:11277552 (Link to Abstract)
Pollex R and Hegele R. Genetic determinants of the metabolic syndrome. Nature Reviews Cardiology. 2006.
PMID:16932765 (Link to Abstract)