Metabolic syndrome: Difference between revisions
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==Background== | ==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== | ==Clinical Features== | ||
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**Waist circumference >/=102 cm in men or >/=88 cm in women | **Waist circumference >/=102 cm in men or >/=88 cm in women | ||
**Plus 3 of the following: | **Plus 3 of the following: | ||
**Fasting blood glucose >/= to 100 mg/dL or requiring | **Fasting blood glucose >/= to 100 mg/dL or requiring treatment for elevated blood glucose | ||
**HDL </=40 in men or </=50 in women | **HDL </=40 in men or </=50 in women | ||
**TGs >/=150 mg/dL | **TGs >/=150 mg/dL | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Hypertension | *[[Hypertension]] | ||
*Hyperlipidemia | *Hyperlipidemia | ||
*Hyperglycemia | *[[Hyperglycemia]] | ||
*Hypothyroidism | *[[Hypothyroidism]] | ||
*Obstructive Sleep Apnea | *Obstructive Sleep Apnea | ||
*Type 2 DM | *Type 2 [[DM]] | ||
* | *[[Pheochromocytoma]] | ||
*Glucagonoma | *Glucagonoma | ||
==Evaluation== | ==Evaluation== | ||
* | *Not an ED diagnosis! | ||
*HbA1c | *Evaluate for sequelae of associated diseases (e.g. cardiovascular disease, DM) as appropriate | ||
*Lipid panel | *Non-ED workup may include: | ||
*TSH | **BMP | ||
*+/- Polysomnography | **HbA1c | ||
**Lipid panel | |||
**TSH | |||
**+/- Polysomnography to evaluate for OSA | |||
==Management== | ==Management== | ||
*Lifestyle modification | *Lifestyle modification | ||
*Metformin | *[[Metformin]] | ||
*BP control | *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 | *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== | ==Disposition== | ||
Latest revision as of 07:24, 18 August 2022
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