Metabolic syndrome

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