Metabolic syndrome

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

• Hypertension
• Hyperlipidemia
• Hyperglycemia
• Hypothyroidism
• Obstructive Sleep Apnea
• Type 2 DM
• Pheochromocytoma
• Glucagonoma

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