JS, a 34-year-old contractor, presented with a two day history
of a sore throat. He was noted to have become increasingly
centrally obese since his last visit – which he blamed on having
gotten married in the interim – and was known to be a smoker.
JS’ sore throat was his priority. However, a family history of
diabetes mellitus and his history of ‘borderline’ hypertension
were of more concern to his doctor.
Is this the metabolic syndrome? How should this patient
be managed?
With a name as elusive as Syndrome X, it is all too easy
to dismiss the topic as a rather exotic phenomenon for the
internists and researchers to deal with. Nevertheless, what
was described as Syndrome X in 1988 by Gerald Reaven and
is now referred to as metabolic syndrome, appears to be one
of the commonest conditions encountered in general practice.
The metabolic syndrome, being a syndrome should innately be
a collection of signs and symptoms of a pathological process
together constituting a picture of a particular clinical condition
warranting particular management. The gist of it all can be
seen to lie in different perspectives; the metabolic syndrome
can be seen as:
• ‘simply’ a clustering of cardiovascular risk factors
– possibly preventable and treatable or,
• a multiplex of metabolic risk conditions namely
atherogenic dyslipidaemia, hypertension, glucose
intolerance, a proinflammatory and a prothrombotic
state. This offers, perhaps, a more pathophysiological
description of the condition.
When it comes to the young gentleman described above,
dismissing his possible collection of risk factors or failing to give
them their due importance can result in the loss of a precious
opportunity at preventive care which is definitely neither exotic
nor beyond the scope of the primary care physician.peer-reviewe