Tests
1st tests to order
fasting blood glucose
Test
Essential for the diagnosis of metabolic syndrome.
Normal fasting blood glucose is <100 mg/dL.
Diabetes is diagnosed if fasting blood glucose is >125 mg/dL on two occasions.
When fasting blood glucose is 101-125 mg/dL, a hemoglobin A1c should be performed. An oral glucose tolerance test (2-hour glucose determination after a 75 g glucose load) may be considered.
Result
normal values <100 mg/dL
fasting triglycerides
Test
Patient must fast for 12 hours for optimal results.
Acute physiologic stress, including infections and acute coronary syndromes, can raise levels.
Result
normal values <150 mg/dL
fasting total cholesterol
Test
Patient must fast for 12 hours for optimal results.
Result
normal values depend on the patient’s cardiovascular disease risk
fasting HDL-cholesterol
Test
Patient must fast for 12 hours for optimal results.
Result
normal values: >40 mg/dL in men, <50 mg/dL in women
fasting LDL-cholesterol
Test
Patient must fast for 12 hours for optimal results.
Result
normal values depend on the patient’s cardiovascular disease risk
Tests to consider
hemoglobin A1c (HbA1c)
Test
When fasting blood glucose is 101-125 mg/dL, HbA1c should be performed.
Result
≥6.5% (≥48 mmol/mol) is diagnostic of type 2 DM
oral glucose tolerance test (OGTT)
Test
When fasting blood glucose is 101-125 mg/dL, OGTT (2-hour glucose determination after a 75-g glucose load) should be considered.
Result
glucose ≥200 mg/dL in type 2 DM, <200 and >140 mg/dL in impaired glucose tolerance
serum BUN and creatinine
Test
Nephropathy and renal impairment are common clinical features in metabolic syndrome, especially in those with impaired glucose levels.
Result
elevated in renal impairment
aminotransferases
Test
Metabolic dysfunction-associated steatotic liver disease is a comorbidity commonly associated with metabolic syndrome.
Result
elevated alanine aminotransferase and aspartate aminotransferase in metabolic dysfunction-associated steatotic disease
urine albumin-creatinine ratio
Test
Indicates diabetic or hypertensive nephropathy.
Result
increased albumin excretion in nephropathy
thyroid-stimulating hormone (TSH)
Test
Hypothyroidism is often associated with dyslipidemia and should be excluded at initial assessment.
If TSH is elevated, free T4 should be assessed.
Elevated TSH associated with low free T4 indicates primary hypothyroidism.
Result
elevated in hypothyroidism
free T4
Test
Hypothyroidism is often associated with dyslipidemia and should be excluded at initial assessment.
Measured if TSH is elevated. Elevated TSH associated with low free T4 indicates primary hypothyroidism.
Result
decreased in hypothyroidism
abdominal ultrasound
Test
May show evidence of steatotic (fatty) liver disease.
Undertaken if aminotransferases are elevated, to exclude other causes of abnormal liver function tests.
Cannot distinguish alcoholic from nonalcoholic steatotic liver disease.
Result
increased hepatic parenchymal echotexture and vascular blurring in metabolic dysfunction-associated steatotic liver disease
ECG
Test
Cardiovascular disease is common in metabolic syndrome. ECG may show ischemic changes or evidence of a previous myocardial infarction, such as inverted T waves or Q waves greater than one fourth the height of the R wave and >0.04 seconds, as well as atrial fibrillation and left ventricular hypertrophy (suggesting unrecognized chronic hypertension). A normal ECG does not rule out coronary artery disease. Patients with an abnormal resting ECG may require further cardiac investigation.
Result
inverted T waves, Q waves, atrial fibrillation, left ventricular hypertrophy in cardiovascular disease
serum total and free testosterone
Test
Polycystic ovary syndrome (PCOS) and male hypogonadism are comorbidities commonly associated with metabolic syndrome. Metabolic syndrome is two times more prevalent (about 43% to 47%) in women with PCOS than in women in the general population.[44]
Metabolic syndrome may be associated with male hypogonadism and it may, therefore, be reasonable to assess the levels of total and free testosterone and sex hormone binding globulin in male patients with metabolic syndrome.[48][49]
Result
elevated in PCOS; decreased in male hypogonadism
serum dehydroepiandrosterone sulfate
Test
Polycystic ovary syndrome (PCOS) is a comorbidity commonly associated with metabolic syndrome. Metabolic syndrome is two times more prevalent (about 43% to 47%) in women with PCOS than in women in the general population.[44]
Result
elevated in PCOS
androstenedione
Test
Polycystic ovary syndrome (PCOS) is a comorbidity commonly associated with metabolic syndrome. Metabolic syndrome is two times more prevalent (about 43% to 47%) in women with PCOS than in women in the general population.[44]
Result
elevated in PCOS
serum sex hormone binding globulin
Test
Polycystic ovary syndrome (PCOS) and male hypogonadism are comorbidities commonly associated with metabolic syndrome. Metabolic syndrome is two times more prevalent (about 43% to 47%) in women with PCOS than in women in the general population.[44]
Metabolic syndrome may be associated with male hypogonadism and it may, therefore, be reasonable to assess the levels of sex hormone binding globulin in male patients with metabolic syndrome.[48][49]
Result
decreased in PCOS
serum luteinizing and follicle-stimulating hormones
Test
Polycystic ovary syndrome (PCOS) is a comorbidity commonly associated with metabolic syndrome. Metabolic syndrome is two times more prevalent (about 43% to 47%) in women with PCOS than in women in the general population.[44]
Female hypogonadism (menopause and premature ovarian insufficiency) is also associated with an increased incidence of the components of metabolic syndrome (abdominal obesity, hyperglycemia, arterial hypertension, and dyslipidemia). Measurement of serum follicle-stimulating hormone may be considered. Serum luteinizing hormone can be used to support a diagnosis of premature ovarian insufficiency.
Result
ratio of serum luteinizing hormone to follicle-stimulating hormone is elevated in PCOS; follicle-stimulating hormone is elevated in menopause and premature ovarian insufficiency; luteinizing hormone is elevated in premature ovarian insufficiency
prolactin
Test
Polycystic ovary syndrome (PCOS) is a comorbidity commonly associated with metabolic syndrome. Metabolic syndrome is two times more prevalent (about 43% to 47%) in women with PCOS than in women in the general population.[44]
Result
elevated in PCOS
ultrasound of ovaries
Test
Polycystic ovary syndrome (PCOS) is a comorbidity commonly associated with metabolic syndrome. Metabolic syndrome is two times more prevalent (about 43% to 47%) in women with PCOS than in women in the general population.[44]
Result
polycystic ovaries in PCOS
serum uric acid
Test
Serum uric acid levels are increased in metabolic syndrome.
Result
elevated
serum estradiol
Test
Female hypogonadism (menopause and premature ovarian insufficiency) is also associated with an increased incidence of the components of metabolic syndrome (abdominal obesity, hyperglycemia, arterial hypertension and dyslipidemia). Measurement of serum estradiol may be considered.
Result
low
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