Metabolic syndrome

Last reviewed: 2 May 2023
Last updated: 01 Jun 2023



History and exam

Key diagnostic factors

  • presence of risk factors
  • hypertension
  • increased BMI
  • increased waist and hip circumferences
More key diagnostic factors

Other diagnostic factors

  • type 2 diabetes mellitus (DM)
  • non-alcoholic fatty liver disease
  • angina
  • claudication
  • sleep disturbance, excessive daytime sleepiness, snoring, gasping breaths
  • hyperuricaemia
  • menstrual disturbances
  • abdominal pain
  • corneal arcus and xanthelasma
  • hirsutism
  • acanthosis nigricans
  • acne
  • hepatomegaly
Other diagnostic factors

Risk factors

  • obesity
  • insulin resistance
  • physical inactivity
  • high-saturated-fat diet
  • high-carbohydrate diet
  • excess alcohol consumption
  • increasing age
  • ethnicity
  • smoking
  • positive family history
  • polycystic ovary syndrome (PCOS)
  • corticosteroids
  • antipsychotics
  • lipodystrophy
  • HIV infection
More risk factors

Diagnostic investigations

1st investigations to order

  • fasting blood glucose
  • fasting triglycerides
  • fasting total cholesterol
  • fasting HDL-cholesterol
  • fasting LDL-cholesterol
More 1st investigations to order

Investigations to consider

  • haemoglobin A1c (HbA1c)
  • oral glucose tolerance test (OGTT)
  • serum urea and creatinine
  • aminotransferases
  • urine albumin-creatinine ratio
  • thyroid-stimulating hormone (TSH)
  • free T4
  • abdominal ultrasound
  • ECG
  • CXR
  • serum total and free testosterone
  • serum dehydroepiandrosterone sulfate
  • androstenedione
  • serum sex hormone binding globulin
  • serum luteinising and follicle-stimulating hormones
  • prolactin
  • ultrasound of ovaries
  • serum uric acid
More investigations to consider

Treatment algorithm


all patients



Panagiotis Anagnostis, MD, PhD


Department of Internal Medicine

Medical School

Aristotle University of Thessaloniki




PA declares that he has no competing interests.


Dr Panagiotis Anagnostis would like to gratefully acknowledge Professor Faidon Harsoulis, a previous contributor to this topic.


FH declared that he had no competing interests.

Peer reviewers

Cecilia C. Low Wang, MD, FACP

Professor of Medicine

University of Colorado Anschutz Medical Campus School of Medicine




CCLW declares that she has no competing interests.

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