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and diabetes, respectively), hypertension (more than 70 % of the patients), and elevated triglyceride levels (20 % of the pa-tients). Almost two thirds of CS patients fulfill at least three criteria for MetS. The elevated incidence of diabetes and pre-mature atherosclerosis (directly related to the length of ex-posure to hypercortisolism), and the increased mortality (particularly cardiovascular mortality) relative to the general population (2 to 4 times higher) show that the predictive val-ue of MetS is also valid in CS. Effective treatment of hyper-cortisolism improves each of the five MetS components, but MetS and carotid atherosclerosis persist in most patients, and the cardiovascular risk therefore remains elevated. This calls for aggressive treatment of comorbidities and for very long-term follow-up. Copyright © 2010 S. Karger AG, Basel What Is Metabolic Syndrome? Metabolic syndrome (MetS) is defined as a complex of interrelated risk factors, including obesity (particularly central obesity), elevated fasting glucose (FG), hyperten-sion, elevated serum triglycerides (TG), and low high-density-lipoprotein cholesterol (HDL-C). The tendency of these factors to cluster was discovered many years ago. Insulin resistance is considered to be the factor linking these different metabolic abnormalities, but the patho-genesis of MetS is unclear. MetS is common in industrial