A CASE OF METABOLIC SYNDROME
Rabia Khatoon MMed (FamMed, UM), Khoo Ee Ming MRCGP, FAMM
Department of Primary Care Medicine, University of Malaya Address for correspondence: Dr Rabia Khatoon, Department of Primary Care Medicine, University of Malaya, 50603 Kuala Lumpur. Tel: 03-79492602, HP: 012-6985026, Fax: 03-79577941, Email: email@example.com
This case report illustrates a 40-year-old woman who presented with chest discomfort that was subsequently diagnosed to have metabolic syndrome. Metabolic syndrome is a common condition associated with increased cardiovascular morbidity and mortality. As primary care providers, we should be detect this condition early, intervene and prevent appropriately before complications occur.
Keywords: metabolic syndrome, cardiovascular disease, diagnosis, management
Rabia K, Khoo EM. A case of metabolic syndrome. Malaysian Family Physician. 2006;1(2&3):58-61
Metabolic syndrome or Syndrome X is a cluster of risk factors associated with morbidity and mortality of cardiovascular diseases (CVD). Albeit common, it has not received the attention it has warranted, and has often been overlooked. As primary care providers, we should actively look out for these patients so that early detection, intervention and prevention can be undertaken. Described below is a Chinese lady with metabolic syndrome.
Madam LSC, a 40-year-old housewife, presented with chest discomfort of one-week duration to the primary care clinic of a tertiary hospital. She had no past history of diabetes mellitus (DM) or hypertension (HT). She had premature menopause at the age of 37 years. Her mother has diabetes mellitus and hypertension. She was an ex-smoker and had lived a very sedentary lifestyle. Physical examination showed an obese woman with a body weight of 82kg, height 165cm, with a BMI of 32 kg/m2. Her pulse rate was 78/min; blood pressure (BP) was 160/110 mmHg on both sides of the arms. She had acanthosis nigricans on her neck but the rest of the general and systemic examinations were normal. Her random blood sugar was 8.9mmol/l as measured by glucometer.Further tests were ordered to assess her cardiovascular (CV) risks, premature menopause as well as possible cardiovascular target organ damage. She was treated with non-steroidal anti-inflammatory drugs for her costochondritis.
On review a week later, her results were: Fasting blood sugar (FBS) 8.3 mmol/L, triglyceride (Tg) 2.4mmol/L, total cholesterol (TC) 8.3 mmol/L, LDL-cholesterol (LDL-C) 6.07 mmol/L, HDL-cholesterol (HDL-C) 0.98 mmol/L, serum creatinine and electrolytes were normal, liver function test (LFT) showed mildly raised AST and ALT, HbA1C was 8.46%. Her thyroid function tests, serum cortisol, oestradiol, progesterone, testosterone and DHEAS were normal. Her FSH was 57.1mU/L and LH was 27.9 mU/L, and these were in the menopausal range. She had macroalbuminuria. Her electrocardiogram, chest radiograph and Pap smear results were normal. Her blood pressure remained persistently high with a reading of 160/106 mmHg. She had all the features of metabolic syndrome with premature menopause.
She was started on metformin 850mg twice a day, simvastatin 10 mg at night, amlodipine 5 mg daily and enalapril 2.5 mg was added later. She was referred to a gynaecologist for further evaluation of premature menopause, and dietitian for dietary advice. Non-pharmacological measures (weight reduction, exercise, low salt intake, behavioral modification and diet), adherence to therapy, regular follow-up and potential side effects of medications were addressed.Over the next eight months she was regularly followed up by the author and her weight had reduced to 74 kg. She was taking high fibre, low fat and low carbohydrate diet, and had started jogging. Her post lunch random blood sugar (RBS) was 6.0mmol/l and BP was 120/70 mmHg. Repeated fasting biochemical results showed FBS 6.5 mmol/L, HbA1C 6.69%, TC 6.1 mmol/L, LDL-C 3.2 mmol/L, HDL-C 1.02 mmol/L, Tg 3.1 mmol/L and the liver enzymes remained the same. She was congratulated for being successful at reducing her weight and was encouraged to continue her measures. Her simvastatin dosage was increased to 20 mg and she was referred to an ophthalmologist for evaluation of early diabetic retinopathy. She was further advised about foot care and proper footwear.