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As literature has proven the importance of being earnest, it is time that the medical society, and especially the endocrine societies worldwide, focus on how important it is to fi nally defi ne our diseases, as this is an obligatory step in the diagnostic work-up, not to forget treatment, and foremost – prevention of any disease. Dedicated involvement in the essence of pathophysiology is a prerequisite for actually fi guring out what is hidden beyond the poorly defi ned syndromes that we desperately look for in our routine clinical practice. In the past several decades physicians have followed their intuition in the management of patients at risk of developing diabetes mellitus type 2. They would perceive the invisible interaction between insulin resistance, non-alcoholic fatty liver disease, obstructive sleep apnea (these have never been included in the defi nition of the metabolic syndrome), dyslipidemia, elevated fasting blood glucose and diabetes mellitus type 2. In fact, insulin resistance never got the opportunity to acquire a defi nition [1]. Defi ning insulin resistance would readily recall the need for measuring waist circumstance (a method known for its unreliability due to lack of standards regarding methodology of measurement and uncertainty in its reproducibility [2]). A simple but applicable defi nition would allow researchers to unify inclusion criteria used in clinical trials and make results more comparable. Diagnostic criteria for insulin resistance may differ from the cut-off where medical treatment is needed or the cut-off may be lower when other endocrine disorders are present. High risk individuals prone to developing prediabetes or diabetes should be identifi ed in light of their co-morbidities and then accordingly treated. Since the last scientifi c statement for establishing the diagnosis of the metabolic syndrome came into force in 2009 [3], and was widely accepted thereafter, there was not a single organization to propose a more sensitive tool in identifying patients at risk. In 2014, the members of the American Association of Clinical Endocrinologists fi nally raised their voices to tell the world that it’s just not that simple, proposing a quite complicated, but very comprehensive classifi cation of obesity [4]. Just as a reminder, obesity was also recently defi ned as a disease, in June, 2013 [5]. One might think that our aim, as physicians, is to increase the number of diseases, and LETER TO THE EDITOR

acta medica bulgarica/acta medica bulgarica

Metabolic Syndrome, Polycystic Ovary Syndrome and the Importance of Being Earnest in Defining the Most Common Endocrine Diseases. and Let’s Not Forget About Men – They Are Also Important!