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Vol 50, No 6 (2004)

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Clinical endocrinology
Long-term results of conservative and surgical treatment of toxic goiter
Fadeev V.V., Buziashvili I.I., Abramova N.A., Brekhunenko T.F., Mel'nichenko G.A.

The study covered 154 patients with different forms of toxic goiter: 143 patients were diagnosed as having Graves' disease (GD) and 11 had thyroid functional autonomy (FA). Among the patients with GD, 111 had received conservative thyrostatic therapy of varying duration; of them 23 patients were subsequently operated on for its recurrence. Furthermore, in 32 patients with GD, operation was undertaken as primary treatment. A permanent remission of GD occurred only in 29.7% of the patients receiving thyrostatic therapy. The risk factors of recurrent GD included young age (under 30 years), a large size of goiter (more than 30 ml), and the absence of a decrease or an increase in the volume of the thyroid during therapy. The presence of endocrine ophthalmopathy and its development after the initiation of therapy did not affect the likelihood of recurrent thyrotoxicosis. The "block-and-replace" scheme (co-adminis- tration of a thyrostatic and L-thyroxine) proved to be preferable to thyrostatic monotherapy (the "block" scheme) in the context of a greater probability of remission after completion of therapy. In the outcome of surgical treatment of toxic goiter (subtotal thyroidec­tomy), hypothyroidism, recurrent thyrotoxicosis, and euthyrosis developed in 77.3, 15.2, and 7.5%) of cases, respectively; in this con­nection it is concluded that permanent hypothyroidism that is achieved virtually by complete thyroid removal (maximally subtotal resection, thyroidectomy) should be considered to be a favorable predictor of surgical treatment for toxic goiter.

Problems of Endocrinology. 2004;50(6):3-9
Genetic predisposition to the development of diffuse toxic goiter in the population of Moscow
Savost'yanov K.V., Chistyakov D.A., Petunina N.A., Trukhina L.V., Balabolkin M.I., Nosikov V.V.

Thyroid pathology ranks first in the incidence of endocrine diseases (0.5% of the general population), by passing ahead of even diabetes mellitus (0.4%). The most common thyroid diseases include diffuse toxic goiter (DTG) - Graves' disease. In this study, polymorphic markers were developed for some possible gene candidates and the association of these markers with the development of DTG was studied in a Russian population. A group of 78patients with DTG and a group of 153 healthy volunteers were examined. Examining the association of the polymorphic microsatellite markers D6S2414 and D6S1271 located on chromosome 6 amongst the genes of the major histocompatibility complex (MNS locus) indicated that both markers are associated with DTG.

The use of the polymorphic marker Ala 17Thr of a cytotoxic T-lymphocytic serine esterase gene (CTLA4) also could detect the marked association of this marker with DTG. The allele Ala and the genotype Ala/Ala increase a risk for the pathology (OR = 2.94 and 3.57, respectively) whereas the carriage of the allele Thr and particularly its homozygosis are linked with a lower risk for DTG (the relative risk (RR) is 0.34 and 0.28, respectively). In case of the polymorphic marker His60Arg if the gene encoding for the /3-subunit of a large multifunctional proteosome (LMP2), there was no association with DTG in a Moscow population. Comparing the distribution of the alleles and genotypes of the polymorphic minisatellite marker arranged in the intron 2 of an interleukin-1 receptor antagonist gene in the groups of healthy volunteers and patients with DTG showed significant differences in the occurrence of allele 2 and gen­otypes 2/4 and 4/4. Thus, the findings suggest that the MNS locus, the cytotoxic T-lymphocytic serine esterase gene (CTLA4), and the interleukin-1 receptor antagonist gene (IL1RN) play an important role in the development of DTG in the population of Moscow.

Problems of Endocrinology. 2004;50(6):10-13
Dynamics of the incidence of type 1 diabetes among children and adolescents of the Republic of Belarus living in various environmental conditions
Mokhort T.V.

The epidemiological surveys made in different countries suggest that there has been an increase in the incidence of type 1 diabetes mellitus (DM1) in the past decades. The reports made at the General Assembly of the United Nations Scientific Committee on the Effect of Atomic Radiation (2001) stated that the influence of a radiation factor might initiate an autoimmune reaction and genetic changes. The purpose of this study was to define the trend of DM1 in children and adolescents from different regions of the Republic of Belarus.

To study the trend of DM1 in children and adolescents, two regions were selected. These were the Gomel Region that had been mostly suffered from the Chernobyl accident and the Minsk Region as a relatively "pure" region. This stage of the study used computer databases for registration of patients with DM1, analyzed the 1980-2001 final statistical reports and archival data on the Minsk and Gomel Regions and the Republic of Belarus as a whole.

The study revealed a significant rise in morbidity among the children and adolescents of the Gomel Region in 1987-2001 as compared with 1980-1986, which was not observed in the Minsk Region. At the same time the incidence of DM1 was statistically significantly higher in the Gomel Region than in the Minsk Region in 1987 to 2001 without significant differences being found in the period before the accident.

Problems of Endocrinology. 2004;50(6):14-18
Diagnosis and treatment of primary hyperaldosteronism
Podzolkov V.I., Ippolitov L.I., Rodionov A.V., Polunin G.V., Sotnikova V.A.

Sixty-two patients (mean age 45.1±9.3 years) with primary hyperaldosteronism (PHA), including 37patients with aldosterone-pro- ducing adenoma (APA) and 25patients with idiopathic hyperaldosteronism (IHA), were examined. The patients’ daily urinary ex­cretion of adrenal hormones (aldosterone, cortisol, epinephrine, norepinephrine) and the peripheral blood levels of hormones (aldos­terone, renin) were determined. Topical diagnosis was made by ultrasonography, computed tomography, magnetic resonance imaging, angiography, including that with selective blood sampling from the supraadrenal veins. Some patients underwent daily blood pressure (BP) monitoring. The combined antihypertensive therapy included spirolactone, calcium antagonists, that for patients with IHA in­volved angiotensin-converting enzyme (ACE) inhibitors and angiotensin I (ATJ receptor blockers. Surgery was made in 47 (77.4%) patients, including 37 (59.7%)) and 11 (17.7%) patients for APA and IHA, respectively. In all the cases, the result of a pathohistological study corresponded to the preoperative diagnosis. In all the patients (those with APA received preoperative preparation and those with IHA had constant conservative therapy), target blood pressure was achieved by a combined antihypertensive therapy using spiro­lactone, 100-250 mg/day and dihydropiridine calcium antagonists. There was evidence for the efficacy of the ACE inhibitor lysinopril, 10-20 mg/day, and ATt receptor blocker losarthan, 50-100 mg/day, used in combined therapy for IHA

Problems of Endocrinology. 2004;50(6):18-26
Comparison of bone mineral density measurements in patients with endocrinopathies
Vlasova I.S., Berketova T.Y., Fadeev V.V.

Mineral bone density (MBD) was estimated in 25 patients with chronic adrenal insufficiency (CAI), 38 with diffuse toxic goiter (DTG), and 37 with hyperprolactinemic hypogonadism (HH), by using quantitative computed tomography (QCT) and double-energy X-ray ab­sorption study (DEXA). Analyzing the findings have led to the conclusion that to estimate MBD, it is sufficient to examine the bones containing the high levels of spongy substance in patients with CAI, by using QCT or DEXA, and the skeletal regions that consist of both trabecular and cortical tissue in patients with DTG, DEXA being more suitable for these purposes. In females with HH, MBD should be measured in the skeletal regions, which mainly consists of spongy substance, as well as in their study, preference should be given to QCT.

Problems of Endocrinology. 2004;50(6):26-29
For practitioners
Aldosterone and cardiovascular function (to the 50th anniversary of the discovery of aldosterone)
Goncharov P.P.

T. Addison [3], published 100 years before the discovery of aldosterone (1954), described a fatal syndrome caused by destruction of the adrenal cortex caused by the tuberculosis process. It was an incentive for an intensive study of the physiology of the adrenal glands. The end of the 30s was crowned with fundamental success: a glucocorticoid group of steroids was isolated from the cortical layer of the adrenal glands and their chemical structure was deciphered. Recognition deserves first of all the Swiss group of scientists - prof. Reichstein and its employees Wettstein, Neher and Euw. Group prof. Kendall (USA) also successfully carried out similar work and published similar results a little later.

Problems of Endocrinology. 2004;50(6):29-32
Case Reports
Cushing's syndrome in a patient with medullary thyroid cancer glands
Severskaya N.V., Il'in A.A., Chebotareva I.V., Isaev P.A., Medvedev V.S., Popuchiev V.V., Rumyantsev P.O.

Cases of Cushing's syndrome in patients with medullary thyroid cancer (MTC) are rare. The cause of excessive production of adrenal steroids can be either the medullary carcinoma itself, which secretes ACTH, pro-opiomelanocortin (POMK) or corticoliberin (KRG), or concomitant pituitary and adrenal tumors [5, 6, 8, 10, 15-17, 19]. We represent a patient with MTC, in whom 11 years after the manifestation of MTC, a picture of hypercorticism developed.

Problems of Endocrinology. 2004;50(6):33-35
Experimental endocrinology
Indole and oligopeptide fractions of rat pineal gland tissue with osmotic stress
Sibarov D.A., Kovalenko R.I., Shatik S.V., Nozdrachev A.D.

The paper deals with peptide formation in the epiphysis during daylight hours when the metabolic activity of pinealocytes, which is associated with the synthesis of indoamines (melatonin), is not high, and the changes in this gland's secretion of other agents, par­ticularly those of peptide nature are in the foreground. The high stress-protective activity of epiphyseal peptide hormones and the successful experience in their clinical use made a study of the involvement of the epiphysis, along with the hypothalomopituitary system, into the common adaptation syndrome highly promising. The epiphyseal peptide extracts from intact rats and from the rats exposed to 48-hour water and food deprivation were studied, by using high performance liquid chromatography. Under stress, there was a higher epiphyseal serotonin production, which was associated by the authors with the corticosterone-induced decrease in the activity of N-acetyl transferase, as well as an increase in the fraction of high molecular-weight peptides. Moreover, the elevated levels of vasopressin were recorded in the epiphysis under stress, which is likely to be of regulatory value.

Problems of Endocrinology. 2004;50(6):36-38
The circadian rhythm of adrenal and thyroid hormones in adult dogs and puppies
Pronina T.S., Shitov L.A.

The blood concentrations of cortisol, aldosterone, thyroxine, triiodothyronine were studied in adult dogs and 3-month puppies every 2 hours during 32 hours. The circadian variation of these hormones was shown to differ in the mean daily level, the amplitude of variations, and the time of acrophases in two age groups of animals. The findings suggest that the diurnal chronotype changes with age

Problems of Endocrinology. 2004;50(6):39-42
Somatostatin analogues in the treatment of neuroendocrine system tumors
Dedov I.I., Vaks V.V.

In recent years, significant progress has been made in understanding the biology and functional significance of somatostatin receptors (rCST) in various human tumors. The presence of functional rCST in tumors has clinical significance, which includes the ability, first, to control hormonal hypersecretion and the corresponding clinical symptoms through treatment with somatostatin analogues (SST); secondly, to conduct CCT scintigraphy, allowing in vivo to establish CCT-positive tumors and their metastases, and thirdly, to carry out pct-targeted radiotherapy using radiolabeled CST analogues.

Problems of Endocrinology. 2004;50(6):42-48
The effect of estrogen-progestogen therapy on blood lipid composition and the possibility of preventing cardiovascular disease in postmenopausal women
Zhusheva N.Y., Rozhinskaya L.Y., Kryzhova N.S.

Blood plasma lipids are mainly represented by cholesterol (cholesterol) and triglycerides (TG). Cholesterol has a complex heterocyclic steroid nucleus and performs the following physiological functions. Firstly, it is a plastic material, as it is an obligatory structural component of any cell membranes, ensuring their stability. Secondly, bile acids are synthesized from cholesterol in the liver, which are necessary for emulsification and absorption of fats in the small intestine. Thirdly, cholesterol is a precursor of steroid hormones of the adrenal cortex (hydrocortisone and aldosterone), as well as sex hormones (estrogens, androgens).

Problems of Endocrinology. 2004;50(6):48-54

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