Metabolic syndrome - woodywoodpecker

[ArchivalUser]

A 35-year-old woman comes in for a routine visit.
Her past medical history is significant for poorly controlled
type 2 diabetes mellitus (HbA1C of 8.4%), obstructive
sleep apnea, hypertension, and dyslipidemia.
Her body mass index is 42 kg/m2. Blood pressure in clinic
is 154/87 mmHg and fasting plasma glucose is 130 mg/
dL. Her medications include metformin, insulin, ramipril,
hydrochlorothiazide, and atorvastatin. You have diagnosed
her with the metabolic syndrome. Based on our
current understanding of the metabolic syndrome, treating
which of the following underlying conditions is the
primary approach to treating this disorder?
A. Hyperglycemia
B. Hypercholesterolemia
C. Hypertension
D. Inflammatory cytokines
E. Obesity

[ArchivalUser]

eeeeee

[ArchivalUser]

EEE

[ArchivalUser]

_ may be EEE

[ArchivalUser]

eee

[ArchivalUser]

EEE

[ArchivalUser]

The answer is E. The most accepted hypothesis to describe the pathophysiology
of the metabolic syndrome involves an overabundance of free fatty acids and ensuing
insulin resistance. Insulin resistance is thought to be a mediator of many of the other aspects
of the metabolic syndrome, including hypertension and hyperglycemia. Free fatty acids
are derived mainly from adipose tissue. Increases in visceral obesity are thought to be
more harmful than subcutaneous stores because of the direct effect of free fatty acids on
the liver from the visceral stores. The inflammatory milieu of the metabolic syndrome is
enhanced by the overproduction of the proinflammatory cytokines by the expanded adipose
tissue. Treating hypertension, hyperglycemia, dyslipidemia, and the oxidative stress of
the proinflammatory state is important when treating metabolic syndrome. However, adipose
tissue loss is the primary approach to treating the underlying cause of the disorder.