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Vol 50, No 5 (2004)

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Clinical endocrinology
Physiological doses of iodine and carriage of antibodies thyroid peroxidase: an open, randomized trial
Fadeev V.V., Mel'nichenko G.A.

This prospective open randomized study explored the effects of the physiological doses of iodine on the structure and function of the thyroid in persons who were carriers of thyroid peroxidase antibodies (TPOAb). The study included 44 females with normal thyroid function and levels of TPOAb of more than 100 mU/l. By employing open block randomization using a random number tables, the patients were divided into 2 groups: 1) 22 females who received potassium iodide in a daily dose of 100 pg for 6 months (a study group) and 2) 22 patients who did not take any therapy or placebo throughout the study (a control group). Three patients (they all from the study group) were excluded from the study due to their incompliance. Following 6 months, two patients were diagnosed as having primary hypothyroidism : 1 patient from the study group had subclinical hypothyroidism with an increase in the level of TSH up to 7.2 mU/l; the other patient from the control group had obvious hypothyroidism (TSH, 67 mU/l). Evaluation of the time course of changes in the level of TSH and the volume of the thyroid revealed no difference between the study and control groups throughout and by the end of the study. A statistically significant decrease in the volume of the thyroid was found in a group of patients with the initially enlarged thyroid treated with potassium iodide. It is concluded that the physiological doses of iodine do not produce any substantial effect on the function and volume of the thyroid in ATOAb carriers.

Problems of Endocrinology. 2004;50(5):3-7
Complement-independent antithyroid cytotoxicity of sera of patients with autoimmune thyroid diseases
Krainova S.I., Kryukova I.V., Mkrtumova N.A., Kushlinskii N.E., Antonova S.S., Yushkov P.V., Kandror V.I.

The primary cultures of thyrocytes isolated from the paranodal tissue of euthyroid nodal goiter indicated that the sera from patients with Hashimoto ’s thyroiditis and Graves’ disease had complement-independent cytotoxicity. This effect was found in about 40% of the sera from patients at different stages of drug compensation of autoimmune thyroid diseases. The cytotoxic effect of the sera was not shown in the primary cultures of human skin fibroblasts. The detection rate of complement-independent cytotoxicity in the sera from patients with Hashimoto ’s thyroiditis and Graves’ disease coincided with that of elevated levels of soluble FAS-receptor ligand in the respective sera. Thyrocytes isolated from patients with Graves’ disease turned out to be resistant to the action of 60% of the cytotoxic sera. This resistance may be associated with the lowered FAS-receptor expression on these cells, which has been revealed in special studies.

Problems of Endocrinology. 2004;50(5):7-11
Seasonal Features of Transient Hyperthyrotropinemia in newborns
Sibileva E.N.

The results of a 5-year neonatal screening of thyrotropic hormone (TTH) in 51,222 neonatal infants were analyzed to evaluate the severity of goiter endemia in the Arkhangelsk Region that is an area of mild and moderate iodine deficiency and a high-latitude region. The analysis established the following regularity: the spread of elevated TTH levels > 5 m U/l in neonatal infants was much higher in summer months. The fluctuating pattern of transient hyperthyrotropinemia was found in the contrast seasons. The magnitude of these fluctuations depended on the climatic and geographic area where the infants had been bom. The seasonal contrast range of transient hyperthyrotropinemia and the increase in the severity of goiter endemia by this criterion in summer make it possible to analyze the results of neonatal TTH screening in June to August as a more precise indicator during monitoring the severity of goiter endemia and the effectiveness of iodine deficiency prevention in high-latitude regions where environmental factors make a substantial contribution to the functional activity of the pituitary-thyroid system.

Problems of Endocrinology. 2004;50(5):11-14
Isolated pubarche in girls
Malyavskaya S.I.

A comparative prospective analysis of the course of puberty was made in girls with isolated pubarche. The obtained clinical, ultrasonic, and hormonal data corresponding to the formation of ovarian polycystosis in girls with isolated pubarche supported the hypothesis that it is of predictive value in the formation of the polycystic ovarian syndrome (PCOS). In postmenarche, 85.4% of the girls with isolated pubarche were found to have the major clinical signs of PCOS (impaired menstrual cycle, hirsutism, acne disease, obesity, and excessive body weight) in combination with a PCOS-typical echogram in 74.8% of cases, which makes it possible to recommend its use as a screening marker to form groups at risk for PCOS.

Problems of Endocrinology. 2004;50(5):14-18
The effect of tanakan on microcirculation, condition peripheral nerves and retinas in patients with sugar type 2 diabetes
Strokov I.A., Gurfinkel' Y.I., Drepa O.I., Arzhimatova G.S., Dashulin I.V., Ametov A.S., Yakhno N.N.

The effects of tanakan on the clinical picture of diabetic polyneuropathy and retinopathy, on plasma and erythrocytic membranous lipid peroxidation, on nail bed microcirculation, the electromyographic characteristics of the functional status of somatic nerves, and computer-aided perimetric parameters were investigated in 58 patients with type 2 diabetes mellitus within the framework of an open multicenter study. Tanakan was shown to be highly effective in all the studied parameters of the status of peripheral nerves and retina, microcirculation, and the degree of oxidative stress. It is concluded that tanakan may be the drug of choice in treating elderly patients with type 2 diabetes mellitus and late complications.

Problems of Endocrinology. 2004;50(5):18-23
Microcirculatory disorders in patients with type 1 diabetes mellitus with nephropathy and correction
Trusov V.V., Aksenov K.V., Cheremiskina I.B.

Despite the fact that the pathophysiology of vascular events is under intensive studies, their mechanisms have not been conclusively established so far. Greater and greater emphasis is recently laid on blood coagulative changes that are responsible for the development of angiopathies in the presence of diabetes mellitus (DM), the specific features of microcirculatory disorders and ways of their correction being insufficiently studied. The purpose of this study was to detect microcirculatory hemodynamic disorders in patients with type 1 DM in relation to the stage of diabetic neuropathy (DN) and to correct it with moxonidine, by evaluating its antihypertensive and nephroprotective effects. The study included 108 patients with type 1 DM whose age was 20 to 33 years. They were divided into 3 groups by the stages of DN according the to 2000 classification recommended by the Ministry of Health of the Russian Federation. The patients of these groups were examined in accordance with a special programme. The microcirculation was evaluated by using an original unit for computer-aided digital processing of microcirculatory images (S.B. Zhuplatov, 1994) based on the Knizelly bulbar biomicroscopic procedure (1968). The study has revealed that the severity of microcirculatory disorders depends on the stage of DN. Having a pronounced antihypertensive effect, moxonidine improves microcirculation, exerts a nephrotoxic effect, diminishes insulin resistance and may be used to correct blood pressure in patients with type 1 DM concurrent with DN.

Problems of Endocrinology. 2004;50(5):24-27
Insulin resistance and impaired fat tolerance in men with coronary heart disease and ideal body weight
Dvoryashina I.V., Starkova N.T., Antonov A.B., Monogarova Y.Y.

Hormonal and metabolic disorders underlie the development of coronary heart disease (CHD). Insulin resistance, hyperinsulinemia, dyslipdemia and frequently obesity play a particular role in the pathogenesis of this disease. The purpose of this study was to characterize the basic parameters of the metabolic insulin resistance syndrome in males with CHD and an ideal body weight. A hundred and fifty-eight males were examined. They were divided into 3 groups: 1) patients with CHD and an ideal body weight; 2) those with CHD and obesity; and 3) males without CHD and obesity (a control group). The patients underwent athropometric studies; computed tomography was performed to determine the volume of abdominal fatty tissue; the blood levels of glucose, insulin, and lipids were measured. Dietary food load tests were used to study the functional activity of the lipid-transport system. Group 1 patients were found to have the major signs of the metabolic insulin-resistance syndrome: basal and stimulated hyperinsulinemia, dyslipidemia, the increased volume of visceral fatty tissue, and impaired fat tolerance.

Problems of Endocrinology. 2004;50(5):27-32
Features of paroxysmal disorders and epilepsy in patients with organic hyperinsulinism
Rudakova I.G.

The rate of misdiagnosis of epilepsy was analyzed in 87 patients with organic hyperinsulinism (OH), which indicated that 83% of them were diagnosed as having epilepsy and had been receiving ineffective therapy with anticonvulsants (ACs) for 1 to 8years. The deteriorated course of OH was found with the use of the therapeutic doses of basic ACs. There was an extremely rare combination of epilepsy and OH (a single case has been described).

Problems of Endocrinology. 2004;50(5):32-34
Pheochromocytoma in children
Bel'tsevich D.G., Kuznetsov N.S., Lysenko M.A.

The results of an examination, treatment, and postoperative follow-up of 520 patients with pheochromocytomas who were operated on at the Endocrinology Research Center, Russian Academy of Medical Sciences, in 1957 to 2002 have been analyzed. The patients’ mean age was 39.3±9.2 years; 50 (9.6%) patients aged less than 16 years. There were 213 (41.0%) males in the total group and 32 (62.0%) in the pediatric group. Bilateral adrenal lesion was detected in 68 (13.1%), including 16 (32%) of the 50 children aged less than 16 years. Extraadrenal tumors were ascertained in 36 (6.9%). The concomitance of pheochromocytoma with hereditary syndromes was observed in 36 (6.9%) cases. Two hundred and sixty patients were followed up for 4 to 25 years (mean 8.4+1.9). Recurrence ofpheochromocytoma was revealed in 49 (18.8%) patients; the genuine recurrence (a tumor at the site of primary surgery or metastasis) was found in 16 (6.15%) patients. The genuine recurrence of pheochromocytoma was seen in 6 (12.0%) of the 50 children; its main cause was organ-preserving surgery for multicenter adrenal lesion.

Problems of Endocrinology. 2004;50(5):34-38
Case Reports
Three cases of mucoromycosis in patients with diabetes mellitus (Moscow region)
Dreval' A.V., Gubkina V.A., Kamynina T.S., Loseva V.A., Mel'nikova E.V., Zenger V.G., Ashurov Z.M., Isaev V.M., Sloeva A.I., Makarenko M.F., Ryabtseva A.A., Luchkov M.Y., Kryuchkova G.S.

Mucoromycosis is an aggressive fungal infection, the so-called phytomycosis is a general term for the spectrum of diseases caused by Mucorales class fungi [2]. Mucoromycosis is rare in Northern Europe (occasionally imported from the countries of the Mediterranean or America), which often leads to fatal diagnostic errors. In the last decade, cases of mucoromycosis have been reported in the Moscow region; our experience in treating this disease may prove useful to endocrinologists.

Problems of Endocrinology. 2004;50(5):39-44
Experimental endocrinology
Effect of adrenaline and corticosterone on uptake and distribution atherogenic and antiatherogenic lipoproteins in the myocardium
Panin L.E., Maksimov V.F., Kolpakov A.R., Korostyshevskaya I.M.

An electron microscopic study of a model of the rat contracting heart perfused by the Langendorf procedure has indicated the myo¬cardial effects of epinephrine, corticosterone, high density lipoproteins (HDL), and low density lipoproteins (LDL) and revealed a role of hormones in the uptake and intercellular distribution of colloidal gold-labeled lipoproteins. Epinephrine enhanced LDL dis¬solution onto the endothelial surface, by slowing down their myocardial penetration, but failed to affect the penetration and distribution of labeled HDL that did not leave the capillary walls. Corticosterone drastically increased receptor-mediated absorption of HDL by the capillary endothelium and ensured their penetration into the interstitial macrophages, but it did not affect the myocardial pene¬tration of labeled LDL. In all experiments, corticosterone caused the lowered content of glycogen in the myocardial cells, sarcoplasmic sequestration of its residues and their interstitial release. Epinephrine and corticosterone differently affect the myocardial penetration and distribution of atherogenic and antiatherogenic lipoproteins. Under stress, it ensures mobilization of different metabolic pathways for myocardial energy supply.

Problems of Endocrinology. 2004;50(5):45-48
Steroid hormone receptors and their role in development pituitary tumors
Babichev V.N.

The process of reception of extracellular regulators occupies a special place in a complex system of biological recognition mechanisms. According to modern concepts, hormones exert their regulatory effect on competent cells due to the presence in the composition of the latter special receptor proteins that perform 2 functions: discriminated reception of the incoming signal and initiation of the corresponding cell responses.

Problems of Endocrinology. 2004;50(5):49-55

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