Metabolic syndrome a lifesaver

Metabolic syndrome and lifesaver are rarely seen in the same sentence. The metabolic syndrome is a cluster of high risk conditions which greatly increases the chances of developing diabetes and heart disease. If you've got waisted fat, your silhouette more apple than pear, plus two of the following:

• Elevated blood pressure
• Low serum HDL-cholesterol
• Elevated fasting serum triglycerides
• Elevated fasting glucose

it's time to undertake serious lifestyle changes. My middle-aged patient clearly had trouble in a metabolic syndrome sort of way--she came to her appointment late last year in overalls because she'd packed so much fat round her middle that jeans were yesterday's dream. Her problem, however, was upper right abdominal pain.

There was no telling whether or not she had a mass in her abdomen as her central fat mass was as round and tense as a full-term pregnancy. Her lower right ribs were tender to touch, and I concluded that she was suffering from the same sort of ribcage discomfort as an expectant mother might have just before giving birth. But this lady was so uncomfortable that I felt we'd best do a CT scan to check for an internal problem such as gallstones.

The CT results were bad news--she had a large mass on her right kidney. A cancer was found at surgery, completely contained within the kidney, with no evidence of spread. She was cured by a nephrectomy. But a month later she was back in the office, her abdominal pain unchanged from her original visit. The pain, in fact, was from her expanding waistline pressing out on her ribs. The kidney cancer was a most fortunate 'incidentaloma' found in passing by a just-to-be-sure-we're-not-missing-something CT.