Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome I Endocrine Physiology The slides will discuss the following: 1. Definition of metabolic syndrome 2. Diagnosis 3. Causes 4. Pathophysiology 5. Consequences 6. Treatment You can also watch the same topic on HM Learnings Youtube channel. You can also follow HM Learnings on facebook, instagram and twitter for daily updates

2. Overview
• Definition
• Diagnosis
• Causes
• Pathophysiology
• Consequences
• Treatment

3. Metabolic Syndrome/ Syndrome X/ Insulin
Resistance Syndrome
• The metabolic syndrome consists of a constellation of metabolic
abnormalities that confer increased risk of cardiovascular disease (CVD)
and diabetes mellitus. It includes :
• Central obesity
• Hyperglycemia
• Hypertriglycedemia
• Reduced HDL cholesterol
• Hypertension

4. Diagnostic criteria- NCEP ATP- III
Criteria- Any three of the following NCEP ATP III
1. Waist Circumference (measure of
central obesity)
≥ 80 cm (F), ≥ 90 cm (M)
2. Fasting blood glucose ≥ 100 mg/dl or specific medication
3. Serum triglyceride level ≥ 150 mg/dl or specific medication
4. Serum HDL cholesterol < 50 mg/dl (F), < 40 mg/dl (M) or specific
medication
5. Blood Pressure SBP > 130 mmHg or DBP > 85 mmHg or
specific medication

5. Causes
1. Overweight/ obesity
2. Sedentary lifestyle
3. Genetics
4. Aging
5. Diabetes mellitus
6. Cardiovascular disease
7. Visceral adiposity without overweight
7 Lipodystrophy- abnormal distribution of fat

6. Positive energy balance
Saturation of expansion of adipose tissue or abnormal fat distribution
(Lipodystrophy)
Inflammation of adipose tissue (infiltration of inflammatory macrophages M1)
Pathophysiology
Energy intake > Energy expenditure
Lipolysis ( ↑ in FFA)
Release of interleukins 1, 6,
and 18; resistin; TNF-α
Altered adipokines response ↑ in leptin,
decreased adiponectin
FFA taken up liver and form
TG (NAFLD)
VLDL release into blood
Muscle insulin
resistance
Liver insulin
resistance
Systemic
inflammation
ASCVD
LDL

8. Insulin resistance
Hyperinsulinemia
Leptin resistance Sympathetic overactivity
Hypertension
Dysfunctional adipose tissue
Hyperglycemia
Exhaustion of beta cell
T2DM
RAAS
Sodium retention

9. Consequences
• ASCVD
• Thrombosis
• NAFLD
• PCOS – Polycystic ovarian syndrome
• OSAS – obstructive sleep apnea syndrome

10. Treatment
• Lifestyle Modifications- weight reduction by caloric restriction,
increased physical activity and behavior modification
• Pharmacological interventions
1. Appetite suppressants and absorption inhibitors in obesity.
2. Statins for lowering LDL cholesterol
3. Fibrates for hypertriglyceridemia
4. Nicotinic acid for increasing HDL cholesterol
5. Antihypertensives in high blood pressure
6. OHA or insulin in T2DM