Atlas of pathophysiology, 2 Edition

Part II - Disorders

Endocrine Disorders

Metabolic syndrome

Metabolic syndrome is a common condition in which obesity, high blood pressure, high blood glucose, and an abnormal cholesterol profile cluster together in one person. When these risk factors occur together, the chance of developing coronary heart disease, stroke, and diabetes is much greater than when these risk factors develop independently. According to the American Heart Association, almost 25% of U.S. residents are affected by metabolic syndrome.


Some studies suggest that metabolic syndrome is closely tied to an individual's metabolism. Normally food is absorbed into the bloodstream in the form of glucose, and other basic substances. When glucose levels in the bloodstream rise, the pancreas releases insulin. Insulin attaches to the body's cells, allowing glucose to enter, where it's used for energy. In some people, the body's cells aren't able to respond to insulin. As suggested by recent studies, this insulin resistance is behind the development of metabolic syndrome.


When insulin resistance occurs, the body is unable to process glucose and the pancreas responds by creating more insulin. This cycle leads to high glucose levels and hyperinsulinemia. The increase in circulating insulin causes hypertrophy and vascular remodeling. It also leads to increased cholesterol and triglyceride levels, increased serum uric acid, increased platelet adhesion, increased response to angiotensin II, and decreased amounts of nitric oxide.

Signs and symptoms

·   Abdominal obesity

·   Acanthosis nigricans (darkening of the skin on the neck or under the arms)

·   Irregular or absent menstrual periods

·   Ovarian cysts

·   Infertility

·   Acne

·   Hirsutism

·   Alopecia

Diagnostic test results

·   Measurement of waist circumference is greater than 35″ in females or greater than 40″ in males.

·   Blood tests reveal triglyceride levels that are greater than or equal to 150 mg/dl.

·   Blood tests reveal fasting blood glucose that's greater than or equal to 110 mg/dl.

·   Blood test reveals high-density lipoprotein level that's less than 50 mg/dl in females and less than 40 mg/dl in males.

·   Blood pressure 130 mm Hg/85 mm Hg or greater suggests disorder.


·   Weight loss through diet and exercise, or if needed, weight loss drugs, such as sibutramine or orlistat

·   Exercise

·   Antihypertensive medications such as diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, or beta-adrenergic blockers

·   Cholesterol-lowering medications, such as statins, fibrates, or niacin

·   Thiazolinediones or metformin to decrease insulin resistance

·   Aspirin

·   Smoking cessation

·   Reduction of saturated fats, cholesterol, and salt intake

·   Increase of high fiber foods like fruits, vegetables, and grains




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