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Vol 45, No 4 (1999)

Clinical endocrinology
Oxidative stress: clinical and metabolic parameters and a polymorphic marker of the catalase gene in the development of retinopathy in patients with type II diabetes
Bulatova O.S., Kondratiev Y.Y., Milenkaya T.M., Balabolkin M.I., Mamaev G.G., Chistyakov D.A., Turakulov R.I., Nosikov V.V., Dedov I.I.

General clinical and ophthalmological parameters, serum lipids and lipid peroxides are studied in 43 patients with type 2 diabetes mellitus (non-insulin-dependent diabetes NIDDM). The activity of erythrocyte superoxide dismutase (SOD) and incidence of alleles of catalase (CA T) gene polymorphous marker, two key enzymes in antioxidant defense, are assessed. The patients were divided into 2 groups: with and without diabetic retinopathy (DR+ and DR-). The DR+ group was characterized by a longer duration of diabetes, a shift of the lipid spectrum towards a higher atherogenicity, and a disproportion between serum level of malonic di aldehyde and SOD activity. No notable differences in the distribution of 7 alleles of CA T gene were noted. Division of patients into groups with different duration of NIDDM (more or less than 10 years) showed more pronounced differences between the DR+ and DRgroups. Maximal and significant differences in the metabolic (blood lipid spectrum) and genetic parameters (prevalence of a CAT gene allele) were observed between the DR+ subgroup with NIDDM duration of less than 10 years and the DRsubgroup with NIDDM longer than 10 years. Hence, consideration for diabetes duration as a factor of DR risk and use of the case-control "polar" clinical phenotype confirmed the contribution of oxidative stress to development of angiopathy and demonstrated the potentialities of CA Tgene polymorphous marker in studies of the genetic liability or resistance to disease depending on the balance between free radicals and antioxidant defense.

Problems of Endocrinology. 1999;45(4):3-7
Immunogenetic characteristics of diabetic microangiopathies
Rasovsky B.L., Severina T.I., Akhmedyanova L.G.

lmmunogenetic studies were carried out in 103 diabetics with type I condition (40 men and 63 women aged 37.1+3.2 years) with disease standing of 7.6±2>3 years. Nonproliferative diabetic retinopathy was detected in 78 (75.7%)) and staring diabetic nephropathy in 88(85.4%)). The incidence of DR4, DR8, and DQ2 antigens is increased and that of Cw6 and DQ1 antigens decreased in diabetic retinopathy. В16, DR3, DR4, and DQ3 antigens predominated in diabetic nephropathy, while Cw6 and DQ7antigens were rarely detected. DR4 and DQ3 were the most incident in the patients with a combination of diabetic retinopathy and diabetic nephropathy (67.2%o of all cases). There were no notable differences in the spectrum of HLA antigens in the groups with diabetic retinopathy and diabetic nephropathy, which agrees with the reno-retinal syndrome concept. Afunctional status-metric model of individual recognition of the diabetic reno-retinal syndrome is created. A special register of patients with type I diabetes carrying immunogenetic markers of diabetic microangiopathies is proposed to be created for more stringent metabolic control and early preventive measures aimed at delay of microvascular complications.

Problems of Endocrinology. 1999;45(4):8-9
Induction and maintenance of remission of insulin-dependent diabetes mellitus in repeated courses of hyperbaric oxygenation
Dreval A.V., Gubkina V.A., Kiselev S.O., Tishenin R.S., Molchanov G.S., Cheskidov G.F.

The efficacy of hyperbaric oxygenation (HBO) is studied in diabetics with newly detected or lasting for less than 1 year disease. The possibility of inducing and/or prolonging diabetes remission by HBO and the efficacy of repeated courses of HBO are evaluated. Fifty-three patients with insulin-dependent diabetes mellitus (IDDM) (28 men and 25 women) aged 15-39 years, suffering from the disease for up to 12 month without apparent complications, were administered intensive insulin therapy with human insulin preparations and 10-day HBO courses. HBO courses repeated every 4 months promoted compensation of carbohydrate metabolism by stimulating residual insulin secretion in patients with IDDM lasting for up to one year, the effect of HBO progressively decreasing with each course. Manifest positive effect of HBO persisted for 2 months. After the first course of HBO, remission of IDDM ensued in 41.5% cases. Patients aged over 25 years with intact insulin secretion on an empty stomach were more disposed to remission. Remissions were equally incident in patients with diabetes duration of up to 6 months and in those with diabetes duration of 6-12 months. A history of ketoacidotic coma episodes does not rule out the induction of a remission.

Problems of Endocrinology. 1999;45(4):10-13
The use of metformin IUD in patients with type II diabetes mellitus with vascular lesions of the retina
Milenkaya T.M., Bessmertnaya E.G., Dedov I.I.

Retinal microvascular lesions, maculopathy are found in elderly patients with type II diabetes mellitus (DM) significantly more often than in patients without diabetes. Diabetic retinopathy (DR) is diagnosed in 16-21% of cases in patients with newly diagnosed type II diabetes [10].

An important problem remains the identification of initial changes in the retina and their treatment in the early stages [2, 3, 8]. The results of studies by many authors [1, 5, 8] showed that poor compensation of diabetes contributed to the adverse course of retinopathy, rather than the patient’s age or duration of the disease [4, 9]. Long-term hyperglycemia leads to early anatomical and functional disorders in the blood vessels of the eyes - a thickening of the basement membrane, a decrease in the viability of endothelial cells, and loss of pericytes. These structural changes increase retinal capillary permeability, as a result of which the protein seeps into the surface and deep layers of the retina, contributing to the formation of soft and hard exudates.

Regardless of the level of glycemia, elevated serum lipoproteins are a risk factor for the development of DR in middle-aged and older patients [6].

Problems of Endocrinology. 1999;45(4):13-15
The effectiveness of Altiazem PP in patients with non-insulin-dependent diabetes mellitus in combination with mild and moderate arterial hypertension according to daily blood pressure monitoring
Ametov A.S., Gubina E.V.

Althiazem РР is a selective blocker of slow calcium channels belonging to long-acting benzodiazepines, used for treating arterial hypertension. The efficacy and tolerance of 3-month monotherapy with althiazem PP in a daily dose of 180-360 mg was studied in 20 patients with non-insulin-dependent diabetes mellitus (NIDDM) combined with mild and moderate arterial hypertension. Acute drug test with daily arterial pressure (AP) monitoring showed that the number of the drug doses was determined by the severity of arterial hypertension and the circadian rhythm (r^0.68 and r—0.83, respectively). Daily monitoring of AP showed a significant decrease in the mean 24-h, mean daily, and mean nightly AP values. Diastolic AP normalized in 75%opatients and decreased by 10 mm Hg and more in 25%. "Pressure loading” in the daytime and at night decreased by 29.1 and 31.3%o, respectively. Increased variability of systolic AP for 24-h period decreased by 12.5%) during awakening hours and by 9.8% during sleeping. Heart rate virtually did not change. The drug exerted no negative effects on normal biphasic AP rhythm. Althiazem PP decreased the morning APpeak without notably changing the extent and rate of AP rises during the early morning hours. The drug had no negative effects on carbohydrate and lipid metabolism. Althiazem PP therapy had to be discontinued in only one female patient because of strong headaches. These data confirm high efficacy and good tolerance of althiazem PP as monotherapy for arterial hypertension in patients with NIDDM.

Problems of Endocrinology. 1999;45(4):15-18
Combination of hormone replacement therapy with natural metabolite preparations (glycine and limontar) in the treatment of menopausal syndrome
Dreval A.V., Marchenkova L.A., Tshienin R.S., Minchenko B.I., Onoprienko G.A., Shumsky V.I., Komissarova I.A., Narcissov Y.R.

Clinical efficacy of two drugs, natural metabolites glycine and limontar, alone and in combination with substitute hormone therapy (SHT), is studied in patients with menopausal disorders. The clinical efficacy was assessed from the time course of neurovegetative, psychoemotional, and urogenital menopausal symptoms and from changes in mineral compactness of bone tissue and biochemical parameters of calcium-phosphorus metabolism and osseous metabolism.

The results confirmed the efficacy of SHT in all types of climacteric disorders (neurovegetative, psychoemotional, urogenital, and in postmenopausal osteopenia).

Combination of SHT with glycine and limontar did not affect the time course of the neurovegetative syndrome in general, but facilitated the arrest of arterial pressure differences and giddiness by estrogens. Moreover, glycine and limontar effectively relieve headaches.

Combination of glycine with limontar is effective in asthenoneurotic syndrome in general and in individual psychoemotional symptoms: irritability, labile spirits, sleep disorders. In general asthenia and urogenital disorders glycine and limontar accelerated the clinical effect of SHT and in case of low spirits and decreased libido extend the spectrum of positive effects of SHT. The combination of glycine with limontar had no positive effect on the mineral compactness of bones. Combination of both drugs with SHT attenuated the process of bone formation, increased calcium excretion with the urine, and increased the hypocalcemic effect, and hence, they should not be prescribed in postmenopausal osteopenia or osteoporosis.

Problems of Endocrinology. 1999;45(4):19-24
The condition of goiter endemic in the Republic of Tuva
Osokina I.V., Manchuk V.T.

The prevalence of iodine deficiency diseases and grave iodine deficiency in the Chaa-Hol region of the Tyva Republic were studied. Children and adult population were examined by the random sampling method. Enlargement of the thyroid was diagnosed by palpation and ultrasonic examination. Thyroid function was assessed by measuring serum thyrotropic hormone, thyroxin, and thyroglobulin by standard kits and urinary iodine levels. The severity of iodine deficiency was assessed using the classification proposed by ICCIDD and WHO. The prevalence of goiter among prepubertal children is 42.1%), among adolescents 98.5%), and among adults 39.8%. Iodine deficiencies are highly prevalent, including endemic neurological cretinism, congenital and acquired hypothyroidism, and giant multinodular goiters. Iodine deficiency was detected in 100%) examinees, ioduria median was 1.6 pg/%o. Hormonal studies showed hypothyroidism in 30% examinees (in 41% children and in 26.4%) adults). The median of serum thyroglobulin is a criterion of severity of endemic goiter. TH median in the examinees was 86.1± 19.3 ng/ml, which corresponds to severe endemic goiter. These data indicate the presence of severe iodine deficiency and endemic goiter in the ChaaHol region of the Tyva Republic. Hence, the study has for the first time revealed a focus of severe endemic goiter in Russia. Measures to liquidate the focus are taken.

Problems of Endocrinology. 1999;45(4):24-27
The state of the reproductive and somatic cells of the testicles with primary hypogonadism in men
Ustinkina T.I.

The course of male hypogonadism is analyzed in the dynamic functional system including gametogenesis and the endocrine hypothalamo-pituitary-gonadal cycle. Gametogenesis was assessed by the results of cytomorphological analysis of the ejaculate. The hypothalamo-pituitary-gonadal cycle was assessed by measuring FSH, LH, testosterone, and prolactin in the blood. A total of 343 men were examined, 314 of these with spermatogenesis disorders. The continuity of changes in the gametogenesis hypothalamopituitary-gonadal cycle system in the pathogenesis of hypogonadal and primary testicular insufficiency is determined.

Problems of Endocrinology. 1999;45(4):28-30
Bone mineral density in patients with primary chronic adrenal insufficiency
Fadeev V.V., Vlasova I.S., Melnichenko G.A.

Forty-four patients (11 men and 33 women) with primary chronic adrenal insufficiency (CAI) treated by substitute synthetic glucocorticoids (GC) prednisolone and dexamethasone and 9a-fluorohydrocortisone (cortineff) were examined in order to investigate the effects of various factors on changes in mineral compactness of bone tissue (MCB). In men the disease duration was 10.33±1.4 years, in women 11.64±3.49 years. Twenty (60%) women were postmenopausal, ten of these (50%) for more than ten years. None of these women was treated by estrogens. Bi-energy x-ray absorptiometry (BRA) of forearm bones was carried out in all 44 patients and quantitative computer-aided tomography (CAT) of L2, L3, and L4 vertebrae was carried out in 25 patients. Plasma levels of dihydroepiandrosterone sulfates (DEA-S) were measured; in men plasma testosterone was measured. A decrease of MCB to less than —1 SD by the T index was detected by BRA in 72.7±13.4 men and in only 42.4±8.6%o women, and by the Z index in 45.5±15.01 men and 33.3±8.2% women. CAT of the spine showed MCB decrease by the T index in 83.3±15.23% men and 63.15±11.07%o women and by the Z index in 16.7±15.23%o men and 26.3±10.1 women. Despite an appreciably high incidence of osteopenia and osteoporosis in men, the difference between men and women by these parameters is insignificant. Among women at least 80% osteopenias and osteoporosis occurred in postmenopausal women. In women with decreased MCB (Z<—1) the duration of the postmenopause was significantly (p<0.05) higher than in women with normal MCB. No significant differences in the disease duration, patients’ age, and plasma levels of DEA-S and testosterone between groups with normal and decreased MCB were observed in both men and women. Analysis of correlations of the results of both osteodensitometry methods showed a strong inverse correlation between MCB and duration of postmenopause. In four men CAT of the spine revealed a strong positive correlation between MCB and testosterone level. Hence, a characteristic feature of the osteopenic syndrome in patients with CAI treated by substitute synthetic GC is its increased incidence in men, compatible to that in women; the duration of postmenopause is a significant factor of risk of osteopenia in women with CAI.

Problems of Endocrinology. 1999;45(4):31-36
For practitioners
Features of metabolic disorders and hormone replacement therapy in pre- and postmenopausal patients with non-insulin-dependent diabetes mellitus
Stekolshchikova O.D.

Currently, the world is witnessing an aging population and an increase in the number of diseases characteristic of the elderly. These include cardiovascular disease (CVD), atherosclerosis, osteoporosis, type 2 diabetes mellitus (DM) (non-insulin-dependent diabetes mellitus - NIDDM). Increasing life expectancy requires improving the quality of life of patients. Given the angioprotective effect of hormone replacement therapy (HRT), there is an increasing interest in its use in postmenopausal women for the prevention and treatment of menopausal disorders, atherosclerosis, and osteoporosis. Among the huge contingent of patients with hyperglycemia, almost 80% are patients with NIDDM, of which 65-70% are women. This fact provides a great scientific and practical interest in the features of metabolic disorders (hyperglycemia, hyperlipidemia) in postmenopausal women.

Problems of Endocrinology. 1999;45(4):37-40
Repaglinide is a new oral sugar-lowering drug in the treatment of type II diabetes mellitus
Balabolkin M.I.

Sulfonylureas are the main group of drugs used to treat type II diabetes mellitus. These drugs belong to insulin secretogens and their main hypoglycemic effect is associated with stimulation of the formation and release of insulin from pancreatic islets.

Problems of Endocrinology. 1999;45(4):40-45
Michael T. Mack Dermott. Secrets of endocrinology. Per. with English, ed. Yu. A. Knyazev. - M .: ZAO Publishing House ’’ BINOM, 1998.
Melnichenko G.A., Serebryansky O.Y.

Russian readers are invited to translate the famous book by Michael T. Mac Dermott ’’ ’Секрет Secrets of Endocrinology’, edited by prof. Yu. A. Knyazev at the publishing house ’’ Binom ’In 1998, the authors of the book used the’ ’Socratic’ method of questions and answers, which in Europe became one of the genres of didactic literature after being translated into Latin ’’ dialogues of Plato’s. This form of presentation is one of the most popular in Western literature in the preparation of teaching aids for a wide range of readers. In the field of endocrinology, publications in Russian using the ’’ Socratic method of presenting material can still be counted on the fingers. In this regard, we also decided to build a review of such an original book in the style of ’’ questions and answers. ”

Problems of Endocrinology. 1999;45(4):45-47

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