Summary
Definition
History and exam
Key diagnostic factors
- hypertension
- increased BMI
- increased waist and hip circumferences
Other diagnostic factors
- type 2 diabetes mellitus (DM)
- nonalcoholic fatty liver disease
- angina
- claudication
- sleep disturbance, excessive daytime sleepiness, snoring, gasping breaths
- hyperuricemia
- menstrual disturbances
- abdominal pain
- corneal arcus and xanthelasma
- hirsutism
- acanthosis nigricans
- acne
- hepatomegaly
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
Diagnostic investigations
1st investigations to order
- fasting blood glucose
- fasting triglycerides
- fasting total cholesterol
- fasting HDL-cholesterol
- fasting LDL-cholesterol
Investigations to consider
- oral glucose tolerance test (OGTT)
- serum BUN and creatinine
- aminotransferases
- urinalysis
- 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 luteinizing and follicle-stimulating hormones
- prolactin
- ultrasound of ovaries
- serum uric acid
Treatment algorithm
all patients
Contributors
Authors
Panagiotis Anagnostis, MD, PhD
Endocrinologist
Department of Internal Medicine
Medical School
Aristotle University of Thessaloniki
Thessaloniki
Greece
Disclosures
PA declares that he has no competing interests.
Acknowledgements
Dr Panagiotis Anagnostis would like to gratefully acknowledge Professor Faidon Harsoulis, a previous contributor to this topic.
Disclosures
FH declared that he had no competing interests.
Peer reviewers
Kent Wehmeier, MD
Chief
Division of Endocrinology
Program Director
Endocrinology Fellowship
Division of Endocrinology, Diabetes and Metabolism
University of Florida College of Medicine
Jacksonville
FL
Disclosures
KW declares that he has no competing interests.
Scott Grundy, MD, PhD
Professor
Center for Human Nutrition
The University of Texas Southwestern Medical Center
Dallas
TX
Disclosures
SG is an author of several references cited in this topic. SG has consulted for several companies (Pfizer, AstraZeneca, Merck, Merck Schering Plough, Lilly, Abbott, Sanofi-Aventis, GlaxoSmithKline) that produce lipid-lowering drugs.
Differentials
- Chronic liver disease
- Cushing syndrome
- Congenital adrenal hyperplasia
More DifferentialsGuidelines
- Standards of medical care in diabetes - 2022
- 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk
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