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Vol 47, No 4 (2001)

Diffuse nontoxic goiter. Problems in classification and taxonomy
Kasatkina Е.Р.

The article is devoted to the most urgent problem of modern thyroidology - goiter endemia. The questions of classification and basic terminology are considered.

Problems of Endocrinology. 2001;47(4):3-6
Autoimmune thyroiditis. First step to consensus
Fadeev V.V., Melnichenko G.A., Gerasimov G.A.

The article is devoted to the critical analysis of the existing in our country ideas about autoimmune thyroiditis (AIT), which can be safely called the main "myth of domestic thyroidology". The authors also propose for further discussion a working version of the algorithm for diagnosis and treatment of AIT, which is called "the first step to consensus".

Problems of Endocrinology. 2001;47(4):7-13
Clinical endocrinology
Time course of epidemiological characteristics of diabetes mellitus in the Central District of Moscow according to the State Register data
Kudryakova S.V., Suntsov Y.I., Nechaeva I.S., Bolotskaya L.L., Ivanov A.V., Baslerova Y.A.

This paper presents the results of 5-year (1994-1998) observations of the prevalence and incidence of diabetes mellitus in adult population of the Central District of Moscow (n - 662,000). In formation on diabetics was collected by local endocrinologists, introduced in the register database, and computer processed. By January I, 1999 there were 657patients with type 1 and 7666 patients with type 2 diabetes mellitus. The prevalence and incidence were 145.1 and 4.6 per 100,000 adult population for type I and 1692.5 and 125.4 per 100,000 for type 2, respectively. The prevalence of both types of diabetes significantly increased during the period of observation and varied significantly from year to year. Lower prevalence was observed during the first 3 years of observation in comparison with the 2 last years. The prevalence and incidence of type 1 diabetes increased significantly in men in comparison with women, particularly in age groups 20-29, 40-49, and 50-59years. The prevalence and incidence of type 2 diabetes increased most significantly over 5 years, the shifts being more pronounced in women than in men, particularly at the age of over 40 years.

Problems of Endocrinology. 2001;47(4):14-17
Relationship between renin-angiotensin gene system and endothelial NO synthase gene polymorphism and angiocomplications of type 2 diabetes mellitus
Sergeeva T.V., Chistyakov D.A., Kobalova Z.D., Moiseev V.S.

The insertion/deletion (I/D) polymorphism of angiotensin 1-converting enzyme (ACE) gene, T174M (threonine substitution for methionine in position 174 of amino acid sequence) polymorphism of angiotensinogen (AGT) gene, A1166C polymorphism of angiotensin II vascular (type 1) receptor (AT1R) gene, and ecNOS4a/4b polymorphism of endothelial N О synthase (NOS3) gene were studied by the polymerase chain reaction (PCR) in patients with type 2 diabetes mellitus and arterial hypertension uncomplicated (control, n = 52) and complicated with cardiovascular diseases (myocardial infarction, n = 53, and acute cerebrovascular disorders, n = 50). Protective effect of 1/1 genotype on development of myocardial infarction in diabetics was shown. The absence of significant differences in the distribution of alleles and genotypes of A GT gene in three groups of patients indicates that this gene is hardly involved in the formation of cardiovascular complications in type 2 diabetes. A strong association between A1166C polymorphism of AT1R gene and development of myocardial infarction in patients with type 2 diabetes and essential hypertension of the Moscow population was revealed; allele A and genotype AA attenuate the risk of early myocardial infarction, while allele C and genotype CC enhance it. A relationship between minisatellite ecNOS4a/4b polymorphism of NOS3 gene and cardiovascular diseases was detected in patients with type 2 diabetes and essential hypertension. Allele 4a and genotypes 4a/4b and 4a/4a are pronounced risk markers, and allele 4b and genotype 4b/4b carriership is associated with a low risk of this complication.

Problems of Endocrinology. 2001;47(4):18-23
Androgen metabolism in male patients with type 1 diabetes mellitus
Goncharov N.P., Katsiya G.V., Kalinchenko S.Y., Todua T.N., Malysheva N.M.

The purpose of this work was to study metabolism and peripheral blood content of the main adrenal and gonadal androgens (dehydroepiandrosterone (DHEA) and DHEA sulfate and testosterone, respectively) in men of different age treated by insulin. Thirty-five diabetics type I aged 15-52 years and 34 age-matched healthy controls were examined. The levels of DHEA and DHEA sulfate in the peripheral blood were decreased in the diabetics in comparison with healthy men, the differences being the most pronounced at the age of 15-45years. In parallel with this, hydrocortisone levels were increased in the patients. Opposite changes in the levels of adrenal androgens and hydrocortisone cause a drastic shift in these hormones balance in the patients with type I diabetes. The content of testosterone was normal (20.6 ± 1.2 nmol/liter) in 28 of 35patients during insulin therapy, while in 7 with higher glycaemia values the mean testosterone content was no higher than 6.3 + 1.1 nmol/liter. Presumably, the content of testosterone remains normal in diabetics during insulin therapy in the presence of adequate metabolic control, while the content of adrenal androgens decreases

Problems of Endocrinology. 2001;47(4):23-25
Time course of autoantibodies to pancreatic islet cells in relatives of patients with type 1 diabetes mellitus
Vartanyan N.L., Sominina A.A., Zarubaev V.V., Stroikova A.S., Ostretsova I.N., Kiselev О.I.

The incidence and levels of autoantibodies to Langerhans islet cell antigens (ICA) were studied in 261 children of patients with type I diabetes mellitus. ICA were detected in 14.8%) (19/128) clinically healthy siblings and 7.5% (10/133) children one of whose parents suffered from diabetes. 8.6%) children of diabetic fathers and 6.7%> children of diabetic mothers were ICA-positive. Age-associated regularities in ICA incidence in the examined groups were determined. Twenty-eight ICA-positive children were examined repeatedly after 11-21 months in order to evaluate the time course of the autoimmune process. More dynamic course of the process, which manifested by fluctuations in ICA levels, was observed in the siblings.

Problems of Endocrinology. 2001;47(4):27-29
Clusters of metabolic syndrome components in patients with type 2 diabetes mellitus
Khadipash L.A., Perova N.V., Mamedov M.N., Olferyev A.M., Metelskaya V.A., Melkina O.N., Oganov R.G.

Clinical biochemical indicators of risk of atherosclerosis-associated diseases and insulin resistance were studied in patients with DH type 2 and the clinical significance of these indicators was evaluated. A total of 100 patients with type 2 DM of slight and medium severity (70 women and 30 men) aged 40-60years were examined during the compensation stage. The following criteria were used for detecting the metabolic syndrome components: arterial hypertension (AH) was diagnosed at diastolic pressure above 90 mm Hg and/or systolic pressure above 140 mm Hg; hyperlipidemia (HL) at total cholesterol (TCS) level > 250 mg/dl and/or triglyceride (TG) level > 200 mg/dl; abdominal obesity (AO) at body weight index (BWI) > 25 kg/m2 at waist to hip circumference ratio (WC/HC) > 0.90 for men and > 0.8 for women or at BWI > 30 kg/m2. The majority (76%) of examined patients with compensated type 2 DM had a combination of 2- 3 components of the metabolic syndrome: AH, AO, and HL. Complete metabolic syndrome was diagnosed in 44%> patients, and only 5% of patients with type 2 DM had no this cardiovascular risk factors. The mean systolic pressure in AH+AO and/or HL combination was significantly higher than in patients with AH alone. Mean levels of systolic and diastolic arterial pressure, BWI, WC/HC, TCS, and very low density lipoprotein cholesterol were significantly higher in type 2 DM patients with AO+AH than in patients without these components of the metabolic syndrome or with only one of these components. Hence, the presence of 2 or 3 components of the metabolic syndrome in patients with type 2 DM is associated with high risk of atherosclerotic diseases because of the combination of risk factors and their higher level, which is presumably due to metabolic relationships between these components of the metabolic syndrome.

Problems of Endocrinology. 2001;47(4):30-34
Urinary excretion of sulfated glycosamines in patients with diabetic nephropathy
Bondar I.A., Klimontov V.V., Paul G.A., Ambrosova S.M., Korolenko T.A.

The urine content and fraction composition of sulfated glycosaminoglycanes (GA G) were studied in 55 diabetics (48 with type I and 9 with type 2 diabetes) with different stages of diabetic nephropathy (DN) and 25 donors. A marked increase (2.5 times) of GAG excretion was revealed in diabetics. Urinary GAG level and glycemic control values were in positive correlation. Urinary GAG levels were the highest in the patients with DN. GAG fraction composition depended on the nephropathy stage. In patients without DN, like in healthy controls, the basic GA G fraction was chondroitine sulfate. In patients with initial DN heparan sulfate excretion was increased in 90.3% and dermatan sulfate excretion in 23.3fo cases. In the group with proteinuria the excretion of these fractions was observed in 91.7 and 25%) patients, respectively. These results indicate essential disorders in GAG-containing proteoglycane metabolism in diabetics and suggest that these disorders contribute to development of nephropathy. Study of urinary GAG fractions can be used in early diagnosis of DN.

Problems of Endocrinology. 2001;47(4):35-38
Role of antibodies to thyrotropic hormone receptor in the diagnosis and prognosis of the course of diffuse toxic goiter and endocrine ophthalmopathy
Gerasimov G.A., Petunina N.A., Pavlova T.L., Trukhina L.V.

The article is devoted to the study of the Role of antibodies to thyrotropic hormone receptor in the diagnosis and prognosis of the course of diffuse toxic goiter and endocrine ophthalmopathy.

Problems of Endocrinology. 2001;47(4):38-40
Leptin and its role in the organism
Tereshchenko I.V.

The article is devoted to the leptin hormone and its role in the organism.

Problems of Endocrinology. 2001;47(4):40-46
In memory to B. A. Zelinsky

The article is devoted to the memory of the outstanding scientist, teacher, methodologist, doctor, head of the Department of Endocrinology of Vinnytsia State Medical University, Doctor оf Medical Science, Professor Boris Alekseevich Zelinsky.

Problems of Endocrinology. 2001;47(4):48-48

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