Metabolic syndrome

Last reviewed: 26 Feb 2023
Last updated: 09 Dec 2022



History and exam

Key diagnostic factors

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

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
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

  • 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
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

Kent Wehmeier, MD


Division of Endocrinology

Program Director

Endocrinology Fellowship

Division of Endocrinology, Diabetes and Metabolism

University of Florida College of Medicine




KW declares that he has no competing interests.

Scott Grundy, MD, PhD


Center for Human Nutrition

The University of Texas Southwestern Medical Center




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 Differentials
  • Guidelines

    • Standards of medical care in diabetes - 2022
    • 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk
    More Guidelines
  • Patient leaflets

    Colon and rectal cancer: what is it?

    Colon and rectal cancer: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer