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Vol 49, No 5 (2003)

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Clinical endocrinology
Bone mineral density and calcium-phosphorus metabolism in patients with type 1 diabetes mellitus
Kosareva О.V.

Bone mineral density (BMD) and calcium-phosphorus metabolism were studied in 96 patients (44 males and 51 females; mean age 35.2years) with type 1 diabetes mellitus (DM-1) and 65 individuals (controls) matched by sex and gender were examined. The findings suggest that osteopenia and osteoporosis are complications of type 1 diabetes mellitus and their incidence depends on the degree of DM compensation and, in females, on its duration. The pathogenesis of decreased BMD in DM-1 is associated with dissociation of bone remodeling processes, such as enhanced bone tissue resorption and reduced bone formation.

Problems of Endocrinology. 2003;49(5):3-5
Daily blood pressure variations in patients with type 1 diabetes mellitus and nephropathy
Bondar I.A., Klimontov V.V., Korolyova Y.A., Zheltova L.I.

То study a relationship between systemic hemodynamic parameters, albuminuria, and autonomic dysfunction in patients with type 1 diabetes mellitus (DM-1) without obvious nephropathy, the authors examined 55 patients in the inpatient setting. Twenty-nine patients had a normal urinary albumin excretion (CAE), 26 patients had microalbuminuria. 24-hour blood pressure monitoring (24-h BPM) was occillometrically made. The average daily, average diurnal and nocturnal values of systolic and diastolic blood pressure (BP) were significantly higher in DM-1 patients with microalbuniuria than in those with normal UAE. Routine autonomic cardiovascular tests showed that the incidence and severity of autonomic neuropathy were also higher in patients with microalbuminuria. Arterial hypertension (AH) diagnosed in compliance with the 24-h BPM criteria was detected. in 17.2%) of the DM-1 patients with normal UAE and in 42.3%) of the patients with microalbuminuria. According to the data of 24-h BPM, the incidence of arterial hypertension was 1.7 times as high as that evidenced by single BP measurements. The specific feature of circadian hemodynamic variations in patients with DM-1 was a low nocturnal BP decrease. 37.9%) of the patients with normoalbuminuria and 61.5%) of the patients with microalbuminuria had no normal (>10%)) nocturnal BP lowering. Stepwise regression analysis has ascertained that in patients with DM-1 without obvious nephropathy, systemic hemodynamic disorders are associated with albuminuria, autonomic dysfunction, and glycemic monitoring quality.

Problems of Endocrinology. 2003;49(5):5-10
New approaches to treating diabetic peripheral polyneuropathy in children and adolescents
Sivous G.I.

А hundred and seven patients (56 males and 51 females) aged 8 to 21 years who had suclinical and mild diabetic peripheral polyneuropathy received pathogenetic treatment. Thirty-nine patients took a combined drug including benfotiamine and pyridoxine in a daily dose of 300 mg for 6 weeks. Twenty-three and 45 patients were given a-lipoic acid in a daily dose of 10-15 mg/kg body weight for 8 and 12 weeks, respectively. The treatment was monitored by using the Total Symptoms Score and the Neuropathy Impairment Score for the Lower Extremities, stimulation electromyography of two nerves of the leg. The therapy showed significant positive changes in subjective and objective neurological symptoms and baseline altered indices, a good tolerability of all the drugs. The findings allow one to consider a-lipoic acid and "millegamma " as tablets to be an agent for the treatment of subclinical and mild forms of diabetic peripheral polyneuropathy.

Problems of Endocrinology. 2003;49(5):11-16
Blood levels of leptin, steroid hormones Cl9, C21, and insulin in males with impaired reproductive function
Goncharov N.P., Koryakin M.V., Katsiya G.V., Kolesnikova G.S., Dobracheva A.D., Todua T.N.

Sixty-nine males aged 18-57 years, who had different impaired reproductive function and the body mass index (BMI) in the range of 20 to 40 kg/m2, were examined. In the patients, the baseline values of leptin, cortisole, corticosterone, dehydroepiandrosterone (DHA) and dehydroepiandrosterone sulfate (DHAS), progesterone, 17-hydroxyprogesterone, testosterone, and insulin were measured by using current radioimmunoassay and enzyme immunoassay. In the examinees, the mean values of all the hormones varied in the physiological normal range with deviations being in some patients. The patients with higher leptin levels were found to have also elevated adrenal hormones, such as corticosterone, cortisole, DHA and DHAS vice versa. This was not accompanied by differences in BMI and in the levels of insulin and testosterone. Analysis of the content of hormones in relation to the level of insulin indicated that there is a positive correlation of the level of insulin and leptin. However, this relationship was multifactorial, which had a possible modifying effects of BMI and the level of testosterone.

Problems of Endocrinology. 2003;49(5):17-20
Specific features of leptin secretion in children and adolescents with obesity
Borodina O.V., Odud Y.A., Timofeyev A.V., Kasatkina E.P.

The purpose of the study was to examine baseline leptin secretion and its association with insulin secretion in children and adolescents with obesity and in those having normal body weight. Sixty- six children and adolescents aged 11-16years, including 48 individuals with obesity, were examined. Anthropometric indices, fasting serum leptin concentrations, and the time course of changes during a three-hour oral glucose test were assessed. In obese children and adolescents, the baseline level of leptin was significantly higher than in normally weighing children and adolescents of the same age. Abdominovisceral obesity showed a higher level of leptin than gluteofemoral obesity. Age- and gender-specific features of leptin production were revealed in obese children and adolescents. There was an association of leptin production with anthropometric indices. Children and adolescents with obesity showed a positive correlation of the baseline level of leptin with overall insulin secretion during the oral test and a negative correlation of the baseline level of leptin with the insulin sensitivity index.

Problems of Endocrinology. 2003;49(5):20-23
Thyroid function in pregnant females carrying thyroid peroxidase antibodies
Fadeyev V.V., Lesnikova S.V., Melnichenko G.A.

То define risk factors for gestational hypothyroxinemia in females carrying thyroid peroxidase antibodies (TPO Ab) during preg­nancy, a study was performed, which included 73 females at dif­ferent periods of pregnancy in accordance with the following cri­teria: the lack of impaired dysfunction of the thyroid gland (TG) on primary examination; elevated TPO Ab levels (more than 100 mEU/l; no history of TG pathology. The control group comprised 128 pregnant females without TG pathology. Evaluation of TG function in females with TPO Ab who received and did not the physiological doses of iodine revealed that the function did not differ by the end of pregnancy. The odds ratio for hypothyrox­inemia in pregnant females with more than 100 mEU/l of TPO Ab was 3.14. In a subgroup of females with TPO Ab and the en­larged TG in the second trimester, the level of fT4 was signifi­cantly lower and that of thyroid-stimulating hormone (TSH) was significantly higher than those in the control group. Logistic re­gression analysis indicated that a relatively high level of TSH in early gestation was most significant in females with TPO Ab. It is concluded that it is expedient to consider whether preventive levothyroxine therapy is performed in females who carry TPO Ab with the enlarged TG and with TSH level that is relatively high (more than 2 mMe/l) for early pregnancy.

Problems of Endocrinology. 2003;49(5):23-29
Transient neonatal hypothyroidism: Children’s history of thyroid status
Kiseleva Y.V., Samsonova L.N., Ibragimova G.V., Ryabykh A.V., Kasatkina E.P.

The paper deals with evaluation of the follow-up of the thyroid status in children with prior transient neonatal hypothyroidism (TNH). Under examination were 42 children aged 5-7 years, born in Moscow, who had, according to the screening for congenital hypothyroidism, a thyroid-stimulating hormone level (TSH-1) of > 20 mU/l which spontaneously became normal by the moment of re- or serum testing. A control group comprised children (n = 21) who had normal birth TSH levels and were on a par with all signs. The findings indicate that the children with prior TNH are a group at risk for thyroid insufficiency and are to be followed up. The revealed features of the size and structure of the thyroid in children with prior TNH (thyroid volume was equal to and below 10 percentiles in 19% of cases and malformations were encountered in every 5 patients) could exert a negative effect on the functional activity of the hypothalamus-pitu- itary-thyroid system in neonatality.

Problems of Endocrinology. 2003;49(5):30-32
Platelet activity in patients with hyper- and hypoparathyroidism
Kirichuk V.F., Arefyev F.G.

Platelet aggregatory activity was studied in a patient with hyperparathyroidism before and after parathyroid adenomectomy and in 3 patients with hypoparathyroidism. In these patients, changes in the aggregation activity of platelet were evaluated after their incubation with parathyroid hormone. The patient with hyperparathyroidism was found to have activated platelets, their high readiness for an aggregation response, increased and a highly effective aggregatory activity and insignificantly decreased stability of formed platelet aggregates. After parathyroid adenomectomy there was a partial recovery ofplatelet functional activity. The patients with hypoparathyroidism had a lower platelet functional activity as compared with the controls. Preincubation of platelet-rich plasma from the patients with hypoparathyroidism with parathyroid hormone caused a varying recovery of platelet functional activity.

Problems of Endocrinology. 2003;49(5):32-38
Endothelial hemostatic properties in diffuse toxic goiter
Vasina L.V., Mitreikin V.F., Petrishchev N.N.

Changes in endothelial functional activity and lesion were studied in 38patients with diffuse toxic goiter (DTG) in the presence of thyrotoxicosis. There was an increase in CD4/CD8 ratios and the count of cells carrying CD+ and HLA-DRA. The blood levels of tumor necrosis factor-a (TNF-a) and IL-8 were also significantly higher in thyrotoxicosis than those at remission. There was a significant correlation between the blood levels of thyroid hormones and the higher blood concentration of PAI-1 and a negative correlation with the content of PAI-1, which is indicative of an increase in the blood fibrinolytic potential. There was a considerable rise in the count of circulating endotheliocytes in hyperthyroidism, which was associated with enhanced endothe- liocytic lesion due to the development of immunopathological changes and to the higher blood levels of thyroid hormones. The changes in the blood levels of t-PA, PAI-1, and circulating endotheliocytes may be used as markers of the severity of endothelial lesion, in characterizing the activity of an immunopathological process, and in predicting the development of vascular diseases in DTG.

Problems of Endocrinology. 2003;49(5):39-41
Altered lipid peroxidation and antioxidative plasma activity in patients with severe diffuse toxic goiter
Rodionova T.I., Kostenko M.A.

Lipid peroxidation (LPO) and antioxidative plasma activity (APA) were examined in 96 female patients with severe diffuse toxic goiter (DTG, Graves "disease) whose age was 20 to 40years and in a control group of healthy individuals, matched by age. The patients with DTG were found to have enhanced LPO and APA (p < 0.05). There was a correlation between the degree of impaired APA and the incidence of some symptoms of DTG, primarily the signs of cardiovascular lesion. Clear relationships were found between the duration of DTG and the status of LPO and APA. All the patients were divided into 3 groups. In addition to the conventional therapy, trimethasidine, 60 mg/day, was given to Group 1 patients (n = 32) for a month. Group 2patients (n = 34) took a-tocopherol for a month. Group 3 patients (n - 30) received the routine thyrostatic therapy with mercaptoimidazole drugs. The use of drugs with antioxidative mechanism of action was found to result in the normalization of the levels of LPO products and APA in patients with DTG and to ensure earlier disappearance of the clinical signs of cardiovascular lesion than in the controls. Trimethasidine showed an earlier effect (on the average, by 3-4 weeks of therapy) than did a-tocopherol.

Problems of Endocrinology. 2003;49(5):42-45
For practitioners
Sporadic and familial types of medullary thyroid carcinoma
Ilyin A.A., Rumyantsev P.O., Isayev P.A., Medvedev V.S., Vtyurin B.M., Drozdovsky B.Y., Garbuzov P.I.

This article focuses on sporadic and familial variants of medullary thyroid cancer.

Problems of Endocrinology. 2003;49(5):45-47
Experimental endocrinology
Decreased glucorticoid sensitivity as a factor of stressogenic shifts in the activity of monoamine oxidase, lipid peroxidation, and behavior in rats
Volchegorsky I.A., Tseilikman V.E., Smirnov D.S., Ship S.A., Borisenkov A.V.

Four episodes of immobilization stress cause a decrease in the sensitivity to glucocorticoid hormones, followed by anxiogenic be­havioral disorders, enhanced monoamine oxidase-В (МАО-В) activity and simultaneously increased lipid peroxidation (LPO) in the brain tissue of rats. Concurrently, there is an increase in renal МАО-В activity, as well as renal and hepatic accumulation of LPO products. Administration of kenalog (2 mg/kg), a phar­macological analogue of glucocorticoid hormones, prevents the poststress МАО-В activation and LPO and attenuates anxiogen­ic behavioral disorders in the rats.

Problems of Endocrinology. 2003;49(5):48-51
Factors of educational efficiency in patients with diabetes mellitus
Dvoinishnikova O.M., Surkova Y.V., Drobizhev M.Y., Antsiferov M.B.

This article focuses on the effectiveness of diabetes education.

Problems of Endocrinology. 2003;49(5):51-55
Evidence-based medicine

The article is devoted to evidence-based medicine and domestic medical science.

Problems of Endocrinology. 2003;49(5):55-60
From the Editorial Board

Congratulations to Ivan Ivanovich Dedov on his election as a full member of the Russian Academy of Sciences.

Problems of Endocrinology. 2003;49(5):61

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