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Vol 47, No 1 (2001)

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Clinical endocrinology
The metabolic syndrome in coronary patients with first detected abnormal glucose tolerance
Dvoryashina I.V., Rogozina I.A., Korobitsyn A.A.

A total of 154 coronary patients (men) aged 40-60 years with first detected disorders of carbohydrate metabolism (abnormal glucose tolerance and diabetes mellitus) were examined in order to define the specific features of the metabolic syndrome. The following main signs forming the metabolic syndrome were distinguished. Fat accumulation in visceral depots predominated (according to computer-aided tomography), the degree of total and abdominal obesity being the same. The optimal anthropometric marker of visceral obesity is the sagittal diameter of the trunk. Hyperinsulinemia stimulated by standard glucose loading is more manifest and long. Other probable hormone dys­functions associated with development of the metabolic syndrome are relative insufficiency of somatotropic hormone, manifesting in response to alimentary fat loading, and disordered hydrocortisone metabolism in hypoglycemia and hyperinsulinemia. Dyslipoproteinemias are characterized by the predominance of hypercholesterolemic and combined types, the pattern and degree of postalimentary lipemia being the same. Involvement of coronary vessels are more extensive and pronounced in coronary patients with first detected disorders of carbohydrate metabolism.

Problems of Endocrinology. 2001;47(1):3-7
Dynamic interphase tensiometry of the urine is a method of early diagnosis of diabetic nephropathy
Sinyachenko O.V., Kazakov V.N., Zyablitseva M.V., Yegudina E.D., Fainerman V.B., Yakubenko E.D.

Dynamic surface tension (ST) of the urine was studied in 58 diabetics without manifest clinical laboratory symptoms of nephropathy by means of computer tensiometers MRT1 and MRT2 (Lauda, Germany). A significant decrease in ST values in the median and longer surface life spans and of the angle of tensiogram curve inclination was revealed. Changes in ST parameters (<M - 3m) were observed much more often (in 51.7- 75.9% patients) than shifts in urinary concentrations (>M + 3m) of albumin (in 24.1%), p2 microglobulin (in 31%), and fibronectin (in 8.6%). Dynamic interphase tensiometry of the urine can be used for early diagnosis of diabetic nephropathy and monitoring the efficiency of treatment.

Problems of Endocrinology. 2001;47(1):7-8
Siofor (metformine) therapy of patients with disorders of carbohydrate and fatty metabolism
Morozova T.P.

Siofor in combination with sulfanylurea derivatives led to stable compensation making insulin therapy unnecessary in patients with type II diabetes mellitus with secondary resistance to treatment. In obese patients with impaired glucose tolerance siofor promoted body weight loss without changing the parameters of standard glucose tolerance test.

Problems of Endocrinology. 2001;47(1):9-11
Clinical status and behavior of patients with hyperprolactinemic hypogonadism treated by selected dopamine agonists
Melnichenko G.A., Bobrov A.Y., Romantsova T.I., Pavlova M.G., Samsonova L.S., Belyanchikova M.A., Pyatnitskiy N.Y.

Mental status and behavior were studied in 19 women aged 18-45 years with hyperprolactinemic hygonadism of different forms treated by selective dopamine receptor agonists (4 patients were treated with chinagolide and 15 with cabergolide). Appreciable improvement of the general clinical status was attained: biphasic menstrual cycle was restored, galactorrhea decreased, and prolactin level normalized. Sexual disorders and headaches reduced. Mental status improved: anxiety, depression, and severity of neurovegetative symptoms decreased. Hamilton score (anxiety) decreased from 16.5 to 9.1. Versatile personality investigation showed de creased profiles of the first, third, seventh, and eighth scales, which indicates decreased affective strain, reduction of psychological partitioning and sense of one's own inadequacy, and decreased liability to exert psychological pressure on other people by means of somatic symptoms available. However, these positive shifts in the mental status of patients were insufficiently complete and stable, despite the continuing decrease in prolactin level.

Problems of Endocrinology. 2001;47(1):11-15
Remote results of postoperative treatment of “inactive” pituitary adenoma
Vaks V.V., Kadashev B.A., Kasumova S.Y., Marova Y.I.

A retrospective analysis of 77 case histories was carried out in order to evaluate patients’ status in remote period after surgery and analyze the relapses of "inactivepituitary adenomas" (IPA) with consideration for electron microscopy findings. IPA in the analyzed patients was verified by histological, electron-microscopic, and immunohistochemical studies. The patients (39 men and 38 women) were observed for 6-16 years after surgery. Two patients presented with endosellar adenoma, the rest with endoextrasellar adenoma. Adenomectomies were performed through a transcranial access in 69 (90%) patients and through the transnasosphenoid access in 8 (10%). Computer tomographic monitoring in immediate periods after surgery was carried out only in 12% patients, and therefore a more common category "disease relapse" was used for analysis of tumor relapses. Cases when clinical symptoms progressed because of obvious growth of radically or partially removed tumor and repeated treatment (surgery or radiotherapy) was needed were considered as relapses. Relapses occurred in 38 (49%) patients (20 men and 18 women). The highest percentage of relapses occurred in the zero-cell adenoma group (58%), while oncocytomas and undifferentiated adenomas relapsed equally often (46 and 44%, respectively). The mean duration of clinical manifestation of a relapse was virtually the same in all groups (6.9 ± 3.6 years, or 1-16 years). Visual functions improved in 60% cases and pituitary functions normalized in 23%, but the number of patients with hypopituitarism increased by 38%. That is why patients with IPA should be regularly checked up after surgery, as 66% of them develop symptoms of pituitary in sufficiency in remote postoperative period.

Problems of Endocrinology. 2001;47(1):16-19
Clinical, hormonal, and molecular genetic characteristics of patients with Р450с17 (17a-hydroxylase/17,20-liase) insufficiency
Tyulpakov A.N., Kalinchenko N.Y., Kalinchenko S.Y., Rozhinskaya L.Y., Platonova P.M., Goncharov N.P., Kolesnikova G.S., Peterkova V.A., Peter M., Zippel W.

Deficiency of Р450с17 (17a-hydroxylase/17,20-liase) is а rare hereditary steroidogenesis defects disordering the synthesis of sex steroids and leading to excessive production of mineralocorticoid production. Clinical findings and results of molecular and hormonal studies in 6patients with P450cl7 deficiency are presented. All patients were born with female phenotype, 5 with male karyotype and 1 with female karyotype. Testicular feminization was erroneously diagnosed in all genetic men, and the genetic woman was treated for ovarian in sufficiency. Five of 6 patients suffered from severe arterial hypertension (up to 100/130 mm Hg). Hypopotassemia was observed in 3 patients. P450cl7 deficiency was diagnosed on the basis of increased serum corticosterone level, and in 4 patients it was confirmed by multisteroid analysis. Amplification and subsequent direct sequencing of CYP17gene revealed homozygotic mutation in exon 1 (R96Q) in 1 patient. The same mutations in exon 6 (V360L) were detected in 2 unrelated families (4 patients). Constituent heterozygosis by 2 mutations, in exon 6 (R347C) and exon 8 (R416C), was detected in 1 patient. These findings evidence the need in differential diagnosis of P450cl7 deficiency and the testicular feminization syndrome.

Problems of Endocrinology. 2001;47(1):20-25
Relationship between intestinal dysbiosis and iodine insufficiency in children with endemic goiter
Grebneva O.P., Anchikova L.I.

Seventy-eight children aged 5— 10 years with diffuse euthyroid goiter, living in a region with slight iodine deficiency, were examined. Microbiological analysis o f feces showed stubborn intestinal dysbiocenosis in all children. Group 1 (n = 48) was treated by traditional antistrumin therapy for endemic goiter supplemented by routine correction of intestinal microbiocenosis. Group 2 (n = 30) was treated by antistrumin alone. After 3-month therapy the thyroid decreased in size in 93.6 and 10% patients in groups 1 and 2, respectively. Dynamic changes in the median o f urinary iodine excretion were observed in patients on regular iodine therapy in parallel with correction of intestinal microbiocenosis. Before iodine therapy this value was 70 ug/liter, after 3—6 months o f antistrumin therapy without correction of intestinal microbiocenosis it was 68 ug/liter, while after 3 months o f therapy including restoration o f intestinal microbiocenosis it increased to 100 ug/liter. These results confirm the involvement of normal intestinal microflora in iodine absorption in the gastrointestinal tract.

Problems of Endocrinology. 2001;47(1):26-28
For practitioners
Surgical accesses to the adrenals (lecture)
Kalinin A.P., Kulikov L.K.

The lecture is devoted to the analysis of different variants of surgical accesses to the adrenals.

Problems of Endocrinology. 2001;47(1):28-30
Case Reports
Complete form of the testicular feminization syndrome with dysherminoma in one testicle combiner with prolactinoma
Dzeranova L.K., Bronstein M.E., Marova E.I., Vorontsov A.V., Pishchulin A.A., Rozhinskaya L.Y., Sazonova N.I., Yershova Y.V.

The article is devoted to the study of the complete form of the testicular feminization syndrome with dysherminoma in one testicle combiner with prolactinoma.

Problems of Endocrinology. 2001;47(1):30-34
Experimental endocrinology
Hypothalamo-pituitary-adrenocortical function in the ontogenesis in rats with hereditary stress-induced arterial hypertension
Bulygina V.V., Maslova L.N., Markel A.L.

Functional activity of the hypothalamo-pituitary-adrenocortical system (HPAS) was evaluated over time in rats with hereditary stress-induced arterial hypertension (HSIAH) and normotensive Wistar rats. Peripheral blood plasma corticosterone was measured in rats aged 2, 3, 4, 6, 8, 10, 12, and 18 weeks at rest and after 1-h immobilization in perforated cylinders by competitive protein binding. Basal corticosterone level and HPAS reaction to stress were lower in hypertensive rats than in Wistar rats of the same age. The only exclusion was the age of 4 weeks, when hypertension starts to form in HSIAH rats and their HPAS is more sensitive to emotional stress than that of Wistar rate, this sensitivity being associated with increased adrenal reaction to ACTH. Decreased HPAS reaction to emotional stress in adult HSIAH rats was not associated with disorders in adrenal sensitivity to ACTH.

Problems of Endocrinology. 2001;47(1):34-36
Simultaneous measurement of corticosterone and 11-dehydrocorticosterone in the adrenals and plasma in acute stress
Cherkasova О.P., Fedorov V.I.

Adrenal and plasma levels of corticosterone and 11-dehydrocorticosterone were measured in intact and stressed (laparotomy) rats by microcolumn high performance liquid chromatography. In contrast to humans, in rats plasma level of basic glucocorticoid is essentially higher than the level of its reversible metabolite. Acute stress (laparotomy) led to an increase in the adrenal concentration of 11-dehydrocorticosterone and plasma concentration of corticosterone, which was regarded as creation of a reserve corticosterone pool.

Problems of Endocrinology. 2001;47(1):37-39
Diabetogenic effect of xanthurenic acid
Meiramov G.G., Konert K.D., Meiramova A.G.

The article is devoted to the review of the diabetogenic effect of xanthurenic acid.

Problems of Endocrinology. 2001;47(1):39-44
Dedov I. I. (on the occasion of his birthday)

The article is devoted to the 60th anniversary of the outstanding Russian scientist, academician of RAMS, director of the Endocrinological Research Center (ENC) of the RAMS, head of the Department of endocrinology of the MMA I. M. Sechenov Dedov Ivan Ivanovich.

Problems of Endocrinology. 2001;47(1):44-45
Islambekov R. K. (on the occasion of his 75-th birthday)

The article is devoted to the 75th anniversary of the famous endocrinologist, consultant of the Endocrinological research center of the RAMS, corresponding member of the Russian Academy of Medical Sciences, Lenin Prize Laureate, honored worker of science of the Republic of Uzbekistan, doctor of Medical Sciences, Professor Rajab Kaplanovich Islambekov.

Problems of Endocrinology. 2001;47(1):45-45
Zeltser M. Ye. (on the occasion of his 70th birthday)

The article is devoted to the anniversary of Mikhail Yefimovich Zeltser - Endocrinologist, Doctor of Medical Sciences, Professor, and Academician of the Academy of Preventive Medicine of Kazakhstan.

Problems of Endocrinology. 2001;47(1):46-46
In memory to V. G. Spesivtseva

The obituary is dedicated to the memory of Professor V. G. Spesivtseva, honored doctor of the RSFSR, a prominent domestic therapist, who made a great contribution to the development of the domestic clinic of internal diseases and especially endocrinology.

Problems of Endocrinology. 2001;47(1):47-47

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