Vol 41, No 1 (1995)

Clinical endocrinology
Endogenous secretion of insulin and its relationship with immunogenetic markers in infants with insulin-dependent diabetes mellitus
Osokina I.V., Scherbacheva L.N., Lebedev N.B., Belovalova I.M., Knyazeva A.P., Yazdovsky V.V., Dedov I.I.

The level of C-peptide is a marker determining the clinical course of insulin-dependent diabetes mellitus (IDDM). The factors influencing the volume of residual endogenous secretion of insulin in IDDM patients are not yet well known. In order to elucidate the effect of HLA-phenotype on the residual function .of pancreatic beta-cells and the course of diabetes, 114 children, 55 boys and 59 girls aged 8 months to 6.5 years, suffering from IDDM, were examined. HLA phenotype was detected by the standard microlymphocytotoxic test. Fifty-nine HLA antigens of classes I and II, locuses A, B, DR, DQ were taken into consideration. Basal and radial C-peptide was assessed by radioimmunoassay. The pancreatic insulin-secretory function was found reduced in young patients with IDDM. The mean values of C- peptide were 0.13 ± 0.01 nmol/liter. Residual secretion of insulin was revealed in 56.2% of children. HLA markers of high risk of IDDM development in the first yeais of life were revealed: DQw3. DR3/4. DR4, DR3, B8 antigens. The markers of high risk of diabetes DR3 and DR4, and moreover, DR3/4. as well as the age by the disease onset and duration of IDDM were found to influence the size and duration of functioning of beta-cells.

Problems of Endocrinology. 1995;41(1):4-6
Platelet functional activity in patients with insulin-dependent diabetes mellitus
Balabolkin M.I., Kubatiyev A.A., Rudko I.A., Golega Y.N., Sushkevich G.N.

Platelet aggregability and the reaction of isolation of thrombocytic granules were studied in 17 patients with type 1 diabetes mellitus with and without vascular involvement over the course of therapy with human insulin preparations (Lilly, France). Platelet aggregation in response to low concentrations of ADP and adrenalin was found increased; in patients with angiopathies no changes were induced by 5 mcM of ADP and collagen. In the patients without vascular involvement platelet aggregation was the same as in donors. The content of ATP released in the course of ADP or collagen-included aggregation reduced in the diabetics in comparison with donors irrespective of the presence of vascular complications, the lower level of ATP observed, however, in the patients without angiopathies. Our data indicate platelet hyperactivation and devastation of platelet granules in uncomplicated diabetes mellitus. Therapy with Lilly insulins was conducive to recovery of the functional activity of platelets which normalized 6 weeks after therapy was started, no matter what types of insulin were administered. The detected changes seem to be largely due to the effects of insulins proper but not so much to the compensation of glucose level, because they were unidirectional in the groups of patients with subcompensated and compensated diabetes.

Problems of Endocrinology. 1995;41(1):6-9
Humoral and cellular immune factors in autoimmune thyroiditis
Potyomkina Y.Y., Rafibekov D.S., Fomina Y.Y., Pesheva N.V., Kalinin A.P.

Special immunological methods of investigation were used in the examinations of 102 patients with autoimmune thyroiditis. Group 1 were 43 patients with euthyrosis, group 2 18 subjects with compensated, and group 3 41 patients with decompensated hypothyrosis. Humoral, cell-mediated, and phagocytic factors of the immunity were assessed by 16 parameters, and the findings interpreted in correlation with the findings of similar examinations of 35 donors. Marked changes in the T-cellular and humoral components of the immunity system were revealed, which depended on the function of the thyroid. These changes were the most expressed in decompensated hypothyrosis. Individual analysis showed that euthyrosis and compensated hypothyrosis are more often associated with increased immunologic reaction. The absence of E- receptor hyperreactivity in compensated hypothyrosis and a sharp reduction of T-gamma lymphocyte subpopulation may be explained by the development of adaptation mechanisms. The authors necessitate simultaneous use of the cytotoxic test and E-RFC test for the assesstment of T-cell populations. They emphasize the importance of immunologic monitoring over the course of treatment of patients with autoimmune thyroiditis.

Problems of Endocrinology. 1995;41(1):9-12
Use of dexamethasone for the differential diagnosis of dwarfism
Pankova S.S., Buraya Т.I., Goncharov N.Р.

The capacity of somatotrophs to respond with secretion of growth hormones to dexamethasone administration was studied in children with different forms of dwarfism. In cases of growth delay caused by deficiency of growth hormone the content of STH during dexamethasone test was at the basal level. In the rest cases blood plasma (serum) STH levels increased at the 180th min after dexamethasone administration. A 6 to 50-fold increase of blood STH level was observed in the presence of intact somatotropic function of the hypophysis. Dexamethasone is recommended for the assessment, of the function of somatotrophic state in practical medicine.

Problems of Endocrinology. 1995;41(1):12-13
Potentialities of computer-aided tomography and magnetic imaging in the diagnosis of hypophyseal prolactinomas
Kirpatovskaya L.Y., Akhadov T.A., Dzeranova L.K., Marova Y.I., Kravtsov A.K., Sneghiryova R.Y., Makarovskaya Y.Y., Ilovaiskaya I.A.

Fifty-seven women with the hyperoprolactinemic syndrome coursing from 6 months to 13 years were examined. Total blood serum immunoreactive prolactin was measured, and craniograms made in all the patients, computer-aided tomography of the head was carried out in 49, and magnetic imaging in 38 patients. A total of 29 micro-, 16 macroadenomas, 1 chaniopharyngiomas, and 2 cases of “empty sella turcica” were revealed. Efficacy of prolactinoma detection by computer-aided tomography and magnetic imaging was 63.2 and 78.9%, respectively. Hence, these methods may effectively diagnose hypophyseal prolactinomas, but magnetic imaging is preferable for the detection of microprolactinomas and in cases with suspected volumic processes of the brain.

Problems of Endocrinology. 1995;41(1):14-18
Clinicobiochemical correlations in patients with the predominance of high-molecular prolactin in the blood serum
Makarovskaya Y.Y., Ilovaiskaya I.A., Martynov A.V., Marova Y.I., Melnichenko G.A., Bulatov A.A.

A new rapid method for assesment of the ratio of immunoreactive prolactin forms with high and low molecular mass has been developed, which permits screening of large groups of patients. It was used in examinations of 44 women with hyperprolactinemea of various origin and with normoprolactinemic galactorrhea. High-molecular immunoreactive prolactin predominated in the blood serum of 25% of patients. This predominance did not depend on the origin of hyperprolactinemia, clinical picture of the disease, or level of total immunoreactive prolactin in the blood. Heterogenous clinical symptoms of the disease were characteristic of these patients: a typical symptom complex was absent in moderate hyperprolactinemia, whereas in patients with manifest hyperprolactinemia of a tumorous origin a classical clinical picture of persistent galactorrhea-amenorrhea was observed. A follow-up showed the predominance of high-molecular prolactin irrespective of the changes in the level of total immunoreactive prolactin in the blood, disease course, onset of pregnancy and labor.

Problems of Endocrinology. 1995;41(1):19-22
Case Reports
A clinical case of Cushing’s syndrome caused by an ectopic cortisol-producing tumor
Serpuhovitin S.Y., Marova Y.I., Bazarova E.N., Mamaeva V.G., Panteleyev I.V.

It is known a surgeon operating on the adrenal glands, should be aware of the possibility of the presence of ectopic adrenal tissue. According to the literature, there are relapses of Cushing's disease due to hyperfunction of adrenal accessory tissue. Its location may be the perinephric tissue, testicles, mediastinum, kidneys, urinary tract, broad ligament of the uterus, vagina, scrotum. The inclusion of adrenal tissue in the ovaries, liver, pancreas is also described. There is some evidence that additional adrenal tissue can be a source of tumors, including hormonal-active ones. O. I. Nikolaev (1970) cites a case of ectopia of a tumor in the kidney, 4 cases of ectopia in one of the ovaries, which, in addition to symptoms of hypercorticism, was accompanied by severe virilization. However, this pathology is extremely rare, therefore, there are few publications in the literature. In this regard, it seems appropriate to us to make such an observation.

Problems of Endocrinology. 1995;41(1):23-24
A case with an erroneous diagnosis of chronic adrenal insufficiency in a patient with male transsexualism
Kozlov G.I., Kalinchenko S.Y.

Transsexualism - gender identity disorder, consisting in the mismatch of the feeling of one's gender identity with the nature of the external genitalia. The only method of treatment of this disease is surgical correction of sex followed by lifelong replacement therapy with sex hormones. Recently, due to the exclusion of transsexualism from the category of mental diseases, as well as the change in the attitude of society and doctors to this pathology, the possibility of appearance at the reception of such a patient is not excluded, especially for therapists, endocrinologists, gynecologists, urologists and surgeons. Until now, transsexualism refers to poorly studied diseases, hence the high frequency of erroneous management of these patients. Here we give a case from our practice.

Problems of Endocrinology. 1995;41(1):25-25
For practitioners
Present-day methods of therapy of pituitary adenomas
Serpuhovitin S.Y., Kirpatovskaya L.Y., Komolov I.S.

Pituitary tumors often called adenomas, mainly come from the anterior pituitary and in about 90% of cases secrete large quantities of one or more pituitary hormones, which leads to changes in homeostasis and the occurence of specific endocrine diseases such as acromegaly, a lactorrhea-amenorrhea syndrome, a Cushing's disease, etc. The clinical picture of both hormone-secreting and non-secreting pituitary tumors can also be caused by their germination of their interconnected structure of the pituitary gland, parasellar areas with impaired brain function.

The etiology of pituitary tumors is still unknown. This is largely due to the difficulties in choosing a method of treatment of a tumor. Although most pituitary adenomas are benign and relatively slow-growing formations, it should be remembered that about 50% of tumors can grow quite quickly, penetrating through the Dura mater into the parasellar region. Quite rarely, pituitary tumors are malignant. In this case, they metastasize to the subarachnoid space, brain and other organs.

The emergence of new methods of topical diagnosis and biochemical studies makes it possible to verify the presence of pituitary tumors at the stages of microadenoma.'This, in turn, allows for a more effective impact on them until the patient is completely cured, including the termination of hypersection, restoration of pituitary function and prevention of relapse of the disease. The main methods of treatment of pituitary adenomas are medication, radiation therapy, adenomectomy, as well as their combined use.

Problems of Endocrinology. 1995;41(1):26-29
Experimental endocrinology
Effects of low dehydroepiandrosterone doses on the development of the gonadal hormonal function of young monkeys
Goncharov N.P., Butnev V.Y.

The effect of prolonged administration of dehydroepiandrosterone (DHEA) to young male Papyo hamadryas on the subsequent course of sexual maturation was studied. Blood levels of testosterone, hydrocortisone, corticosterone, and 11-deoxyhydrocortisone were radioimmunoassayed over the course. of DHEA administration and after it. No appreciable changes in the said steroid compounds were observed during DHEA administration and soon after it. One year after DHEA administration, when the animals were in the pubertal stage, they had higher testosterone levels in the blood and a statistically higher mass in comparison with age-matched control monkeys. The most marked differences in testosterone levels were observed 2 years after DHEA administration, when the animals grew adult. Their testosterone levels surpassed the normal value by 4.7 times. The authors consider the effect of physiologic doses of DHEA the gonadal hormonal function from the “neurosteroid" concept viewpoint.

Problems of Endocrinology. 1995;41(1):30-32
The role of hormonal-cytokine interactions in the formation of humoral immune response
Shirshev S.V.

The functional activity of splenocytes of CBA mice was investigated in a syngeneic transfer system by the level of formation of antibody-producing cells (APC). Splenocytes were preincubated for 1 h in vitro with chorionic gonadotropin and type I recombinant interferons, as well as in hormonal-cytokine combinations. Chorionic gonadotropin in doses 10 and 50 MU/ml depressed APC formation, whereas alpha-interferon (250 MU/ml) stimulated it, and beta-interferon in the same concentration did not influence the level of humoral immune response. Chorionic gonadotropin, if added to splenocyte culture in combination with alpha-interferon, completely lost its immunodepressive properties. However, if together with alpha-interferon in a dose of 10 MU/ml it had a costimulating effect, in contrast to that, in combination with beta-interferon in the tested concentrations it was conducive to only a statistically reliable increase in the number of APC.

Problems of Endocrinology. 1995;41(1):32-34
Effect of repeated stress exposures on body sensitivity to glucocorticoids and insulin
Tseilikman V.Y., Volchegorsky I.A., Kolesnikov O.L., Vyazovsky I.A., Ghiyenko I.A., Kolesnikova A.A., Afanasyev O.A., Lifshits R.I.

Effects of repeated stress exposures on the sensitivity to exogenous glucocorticoids and insulin were studied. The reaction to glucocorticoids was assessed by the sensitivity of lymphoid organs and peripheral blood in response to administration of a synthetic long-acting glucocorticoid analog kenalog. Insulin sensitivity was assessed from the latency of development of insulin coma. Repeated stress exposures were found to appreciably limit the changes in the thymus and spleen caused by exogenous glucocorticoids. This permitted a conclusion about the capacity of repeated stress exposures to reduce the sensitivity of an organism to the effects of exogenous glucocorticoids. Moreover, these exposures reduced the latency of insulin coma development, this indicating an increased insulin sensitivity of the body. Combination of repeated stress exposures with drug blocking of adrenoreceptors with obsidan in a dose of 0.05 mg per animal increased the latency of insulin coma development.

Problems of Endocrinology. 1995;41(1):34-36
Hyperinsulinemia in rats with alloxan diabetes after oral administration of insulin-containing negatively charged liposomes
Akhrem A.A., Vorobyov M.S., Kisel M.A., Tsybovsky I.S., Zaborovskaya Z.V., Kholodova Y.A.

The effect of oral administration of insulin-containing negatively charged liposomes on the immunoreactive insulin level and glucose concentration in the blood of rats with alloxan diabetes was studied. Liposomes were formed from equimolar mixtures of either natural phosphatidylcholine and phosphatidylinositol or semisynthetic dipalmitoyl phosphatidylcholine and dipalmitoyl phosphatidylethanol. More than 70% of insulin was encapsulated in liposomes at initial molar lipid to insulin ratio 100:1. Oral administration of both liposomal species results in hyperinsulinemia. Hyperinsulinemia induced by liposomes from semisynthetic phospholipids is attended by a decrease of blood glucose concentration. No correlation between insulin level and glucose concentration in the rat blood after oral intake of phosphatidylinositol-containing liposomes is observed.

Problems of Endocrinology. 1995;41(1):37-39
The central nervous system and experimental diabetes mellitus
Shvyrkova H.A.

After the publication of data on the detection of insulin in brain tissue, interest in studying the role of insulin in the central nervous system (CNS) and changes in the central nervous system in diabetes mellitus increased sharply. In patients with diabetes, a high frequency of mental disorders has been established. Complications of the nervous system in children whose mothers were pregnant with diabetes during pregnancy are described in literature. The role of insulin in the development and differentiation of neurons, potentiation of synaptic activity, the exchange of catecholamines, transcription of genes in nerve cells has been identified, which allows a better understanding of the mechanism of diabetic encephalopathy. This review analyzes the results of experimental studies of the central nervous system in diabetes.

Problems of Endocrinology. 1995;41(1):39-45

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