Syndrome X

Abstract

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.