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Metabolic syndrome

Defined as at least 3 of:

  • Central obesity
  • Impaired fasting glucose / T2DM
  • Dyslipidaemia – raised LDL or triglycerides
  • Hypertension

 

Pathophysiology of metabolic syndrome relates to:

  • Insulin resistance
  • Endothelial dysfunction
  • Systemic inflammation
  • Visceral adiposity

 

Significance increases in cardiac risk – but increasing recognition of other risks such as colon cancer.

 

Kidney conditions with metabolic syndrome

CKD

  • Hypertension, diabetes and obesity all cause and increase progression of CKD

Stones

  • CaOx and uric acid stones more prevalent, hypercalciuria and slightly more acidic urine.

RCC

  • Obesity is proven risk factor and hypertension probably increases risk too.

 

Lower tract conditions with metabolic syndrome

OAB

  • Difficult to study in men with concomitant BPH; evidence from women strongly suggestive obesity is a risk factor

BPH/LUTS

  • Strong link between BPH and metabolic syndrome – complex association with hyperinsulinaemia, sympathetic overactivity, changes in androgens and inflammation
  • Men with metabolic syndrome tend to have larger prostates and more bothersome symptoms
  • Proposed link of systemic inflammation – particularly IL-8 which appears to be increased in BPH and prostatitis, and in metabolic syndrome.
  • Prostate volume, PSA and LUTS all increase with increasing waist circumference.
  • May be compounded by other associations with metabolic syndrome – OSA, DM, nocturia.

 

Prostate cancer

  • Link between risk of developing prostate cancer and metabolic syndrome/obesity is being studied – no definitive evidence though some studies suggest increased risk of diagnosis and more aggressive prostate cancer
  • ADT significantly increases risk of obesity and development of metabolic syndrome, and therefore subsequent risk of cardiac events – need concomitant prevention and awareness.

 

Andrological conditions with metabolic syndrome

Erectile dysfunction

  • Atherosclerosis associated with obesity, hypertension and dyslipidaemia
  • Microvascular and neuropathic changes associated with DM
  • Men presenting with ED should undergo cardiac assessment – strong predictor for increased    risk of cardiac events

 

Hypogonadism

  • Patients receiving ADT have higher rates of metabolic syndrome
  • Weight loss in men raises testosterone levels
  • No clear risk or benefit to cardiovascular health with TRT – debated