Vol 51, No 4 (2005)

Clinical endocrinology
Microalbuminuria in patients with type 2 diabetes mellitus and arterial hypertension: Possibilities of therapy
Ametov A.S., Demidova T.Y., Kosykh S.A.
Abstract

The study covered 30 patients with type 2 diabetes mellitus associated with mild and moderate arterial hypertension and beginning diabetic nephropathy (Stage III in accordance with the classification developed by C. Mogensen). The purpose of the study was to evaluate the therapeutic effect of the new superselective fi-blocker nebivolol (nebilet) having NO-modulating activity on the patho-genetic links of the development of angiopathies in patients with type 2 diabetes mellitus and arterial hypertension. Sixteen-week nebivolol therapy caused a significant decrease in the level of gfycemia, blood pressure, and serum atherogenicity, and the rate of lipid peroxidation and an increase in basal vascular endothelial secretion of nitric oxide, resulting in diminished microalbuminuria.

Problems of Endocrinology. 2005;51(4):2-6
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Urinary hydroxyproline excretion and glomerular location of collagen III, IV, and VI in patients with type 1 diabetes mellitus concurrent with nephropathy
Bondar I.A., Klimontov V.V., Nadeev A.P., Kim L.B.
Abstract

The study was undertaken to investigate the metabolism of collagen and the accumulation of collagens III, IV, and VI in the glomeruli in patients with type 1 diabetes mellitus (DM) and early-stage nephropathies. The urinary excretion of peptide-bound and free hydroxyproline was determined in 57 patients with DM and 15 healthy individuals. Immunohistochemical investigations of their renal biopsy specimens were performed in 17 patients, by using monoclonal antibodies to collagens III, IV, and VI. The kidneys from 70 healthy individuals who had died due accidents served as a control. A significantly increased urinary excretion of peptide-bound hydroxyproline was found in patients with DM and micro- and macroalbuminuria. There was an excessive glomerular accumulation of collagens IV and VI in 8 and 7 patients, respectively. Interstitial collagen HI was detected in the glomeruli of 9 patients while it was absent in the controls. The findings show the high rates of collagen metabolism and collagens III, IV, and VI accumulation in the glomeruli of patients with type 1 DM and early-stage diabetic nephropathy.

Problems of Endocrinology. 2005;51(4):6-10
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Thyroid-stimulating hormone receptor antibodies in the differential diagnosis of toxic goiter
Fadeyev V.V., Abramova N.A., Prokofiev S.A., Gitel E.P., Mel'nichenko G.A., Dedov I.I.
Abstract

The production of stimulating thyroid-stimulating hormone (TSH) receptor antibodies (TSHR-Ab) whose level measurement has come into clinical use underlies the pathogenesis of Graves'disease (GD). This paper deals with the diagnostic and differentially diagnostic value of measurement of TSHR-Ab levels using two first-generation techniques (with heterological TSH): radioreceptor assay ("CIS bio international", France) and enzyme immunoassay ("Medizym" T.R.A."). The levels of TSHT-Ab, as well as thyroid peroxidase antibodies (TH-Ab) and thyroglobulin antibodies (TG-Ab) were studied in 206 patients among whom 176 patients were diagnosed as having GD and 30 had clinical thyroid functional autonomy (FA) generally appeared as multinodal toxic goiter. A comparative analysis of these two assays did not reveal some advantages of them and their results showed a significantly positive correlation (r = 0.91; p < 0.001). The diagnostic sensitivity of the assays was about 80-88% and their specificity was 60-70%. The findings led to the conclusion that in the absence of significant endocrine ophthalmopathy (EOF), clinical and routine instrumental and laboratory studies fail to differentiate GD and throid FA to sufficient accuracy whereas the measurement of the levels of TSHR-Ab substantially makes diagnosis easier. Moreover, it has been shown that the determination of the level of TBII using the test systems containing heterological TSH may not be used for the evaluation of the course of EOF.

Problems of Endocrinology. 2005;51(4):10-18
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The specific features of hypothyroidism developing with the use of cordorone
Molashenko N.V., Platonova N.M., Sviridenko N.Y., Soldatova T.V., Bokalov S.A., Serdyuk S.E.
Abstract

Hypothyroidism (HT) is one of the thyroid dysfunctions occurring with the use ofcordorone. The authors examined the clinical features of this condition in 26 patients living in Moscow and its region (mild and moderate iodine deficiency areas). The blood levels of thyrotropic hormone (TTH), free thyroxine (Т4) free triiodothyronine (T3), thyroid peroxidase antibodies, and lipid spectrum were estimated. Thyroid ultrasound study and Holler ECG monitoring were performed. HT was found to develop in the presence of the abnormally changed (66%) and intact (34%) thyroid. Examining the course of cardiac arrhythmias (CA) as HT progresses has ascertained that this condition does not lead to their recurrences. As compared with the controls, the patients were found to have higher frequencies of dyslipidemias (p < 0.05). Blood lipid changes appeared as the higher levels of total and LDL cholesterol (p < 0.05); a positive correlation was also established between these parameters and the levels of TTH. The use of L-thyroxine replacement therapy, as indicated on an individual basis, during ongoing cordorone intake did not result in relapses of prior CA and it contributed to blood lipid spectrum parameters. Thus, HT is a condition that does not cause a loss of the antiarrhythmic effects ofcordarone manifests itself as the impaired blood lipid spectrum. L-thyroxine replacement therapy may be, if required, performed during the ongoing use of an antiarrhythmic agent.

Problems of Endocrinology. 2005;51(4):18-22
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The specific features of adrenal steroidogenesis in patients with congenital adrenal cortical dysfunction due to 21-hydroxylase deficiency
Serebryakova I.P., Velikanova L.I., Vorokhobina N.V., Silnitskiy P.A., Strelnikova E.G.
Abstract

Forty-two patients with classical forms of congenital adrenal cortical dysfunction (CACD) (22 patients with salt-loosing form and 20 patients with simple virile form) caused by 21-hydroxylase deficiency and 29 female with an obscure form of the disease were examined. The patients with classical CACD received therapy with gluco- and mineralocorticoids. Radioimmunoassay and enzyme immunoassay were employed to estimate the levels of 17-OH-progesterone and the activities of plasma renin and serum corticotropin, aldosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione. High performance liquid chromatography (HPLC) was used to measure the blood levels ofcortisol, cortisone, corticosterone (B), 11-deoxycorticosterone (DOC), and 11-deoxycortisol (S). There were increases in the levels of В and DOC in patients with the simple form at the decompensation stage and in those of DOC in patients with the simple form at the compensation stage, which is indicative of activation of the renin-angiotensin system. There were also rises in В and DOC in 35.8 and 33.0% of the patients with obscure CACD, respectively, as well as a significant elevation of the content of S. A study of the profiles of corticosteroids by HPLC in patients with 21-hydroxylase deficiency-related CACD is an additional method for assessing the compensation of the disease in patients with classical CACD and for diagnosing the obscure form of the disease.

Problems of Endocrinology. 2005;51(4):22-26
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The effectiveness and safety of use of a soluble recombinant growth hormone formulation in the treatment of shortness in children with retarded intrauterine development
Peterkova V.A., Fofanova O.V., Nagaeva E.V.
Abstract

The study was undertaken to investigate the effectiveness and safety of 12-week use of the recombinant growth hormone (rGH) Nor-dithropin-Simplex (NovoNordisk, Denmark) in children with retarded intrauterine development (RIUD) and significant postnatal shortness. A group of examinees comprised 15 prepubescent children with RIUD without hormone growth hormone deficiency. The evaluation criteria were growth (absolute and SDS), the rate of growth (absolute and SDS), and the time course of changes in bone maturation, hormonal and biochemical parameters. Treatment included subcutaneous daily injections of Nordithropin-Simplex, 0.067 mg/kg, at night. Control examinations were made every 3 months. Intragroup birth height SDS averaged 3.61±1.15; body mass SDS was 3.65±0.71. Before treatment, the mean chronological age was 5.46+1.65years; the bone age averaged 1.42±0.70years less than the chronological one; growth SDS was 3.24+0.81; and growth rate SDS was -1.24±1.10. After 12-month rGH treatment, growth rate SDS increased up to 4.98±2.65 (p <0.0005), growth ∆ SDS for chronological age averaged 1.02±0.39 with variations from -3.24±0.81 to -2.22+0.78 (p < 0.0005). During 12-month therapy, bone age increase by, on the average, 0.91±0.42years. Two-fold dose rGH therapy, as compared with replacement therapy, was well tolerated and produced no serious side effects. It is concluded that 12-month therapy with Nordithropin-Simplex in a dose of 0.067 mg/kg/day in children with RIUD and significant postnatal growth retardation can induce acceleration of growth rates without causing a significant adverse reactions. Long-term multicenter centers are required to analyze the impact of rGH therapy on final growth, metabolic effects and to evaluate the safety of its long-term use.

Problems of Endocrinology. 2005;51(4):26-31
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REShENNYE I NEREShENNYE VOPROSY ENDEMIChESKOGO ZOBA I YODTsEFITsITNYKh SOSTOYaNIY (LEKTsIYa)
Balabolkin M.I.
Abstract

Iodine deficiency, in addition to the development of an enlargement of the thyroid gland - goiter, leads to a number of other pathological conditions, which are commonly called iodine deficiency diseases. The spectrum of iodine deficiency diseases is wide and depends on the period of life when iodine deficiency affects the body. Iodine deficiency during pregnancy and embryonic development leads to a high prevalence of spontaneous abortion, especially in the first trimester of pregnancy; high perinatal and infant mortality, congenital malformations, congenital hypothyroidism with a lag in physical and mental development. In childhood and adolescence, iodine deficiency is accompanied by an increase in the thyroid gland, in some cases with a violation or delay in physical, mental and sexual development. In the mature period, iodine deficiency is accompanied by varying degrees of thyroid enlargement. Cretinism in iodine-deficient areas occurs with a frequency of 1 to 10%.

Problems of Endocrinology. 2005;51(4):31-37
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Rat thyrocytes under oxidative stress
Nadolnik L.I.
Abstract

Iodine is the most important regulator of the functional activity of thyroid cells; however, not only may iodine deficiency be responsible for impaired metabolic processes in the thyrocytes. The purpose of the study was to examine the impact of Fe2+/ascorbate-dependent activation ofoxidative stress on the functional activity of cultured rat thyrocytes. The 2.88-6.76-fold rise (p < 0.001) in the concen-tration of aldehyde lipid peroxidation products was shown to be followed by the decreased thyrocytic generation ofthyroxine (Т4) the latter being most pronounced 6 hours late (by 1.7-3.2 times), by a 120-250% increase in triiodothyronine (Т3) excretion and a 1.5-3.0-fold rise in Т3/T4 ratios in the culture medium. This is most likely to result from impaired thyrocytic iodine organisation under activated oxidative stress. The findings suggest that the most important stages of biosynthesis of thyroid hormones in the thyroid are significantly sensitive to the elevated concentrations of active oxygen forms, peroxides, and lipid peroxidation peroxidation products. This factor may make a certain contribution to the pathogenesis of endemic and goiter pathology of the thyroid.

Problems of Endocrinology. 2005;51(4):38-41
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Idiopathic diabetes
Dedov I.I., Tabeeva K.I., Nikonova T.V., Smirnova O.M.
Abstract

Diabetes mellitus is a group of metabolic metabolic) diseases characterized by hyperglycemia that results from defects in insulin secretion, insulin action, or both of these factors (WHO, 1999). In the last etiological classification (WHO, 1999), 4 clinical types of diabetes mellitus are distinguished: type 1, type 2, other types (infections, genetic disorders, etc.) and gestational diabetes. Type 1 diabetes mellitus includes diseases caused by destruction (pancreatic β-cells, absolute insulin deficiency and a tendency to ketoacidosis. The vast majority of such cases have an autoimmune nature of the lesion, but there are groups of patients who do not show autoimmune markers Taking this into account, according to this classification, type 1 diabetes includes 2 types: autoimmune and idiopathic. Idiopathic diabetes is also called type 1B diabetes, atypical type 1 diabetes , ketosis-prone diabetes, tropical diabetes.

Problems of Endocrinology. 2005;51(4):41-43
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Reviews
Thyroid cancer
Vanushko V.E., Kuznetsov N.S., Garbuzov P.I., Fadeyev V.V.
Abstract

The prevalence of nodular lesions of the thyroid gland (thyroid gland), according to various researchers, ranges from 3 to 7%]. The widespread introduction of ultrasound (ultrasound) in clinical practice, as well as the results of autopsy studies, showed that the prevalence of nodular lesions of the thyroid gland is much higher and is about 50%, especially at the age of over 50. In women, thyroid nodes are detected 2-4 times more often than in men. Children suffer from nodular lesions extremely rarely. The incidence of nodular goiter is directly proportional to age. The increase in the incidence of nodular goiter is approximately 0.1% per year at a young age and gradually reaches 2%. The prevalence of thyroid cancer (thyroid cancer) among nodular goiter, according to various authors, is from 1 to 6%. It should be noted that the prevalence in the population of nodular goiter is so high both in the regions of iodine deficiency and with normal iodine supply, but in the first case it is slightly higher. The incidence of thyroid cancer in absolute terms does not depend on the level of iodine supply. Thus, in a situation of a slightly higher incidence of banal nodular colloid goiter in the regions of iodine deficiency, the proportion of cancer among all cases of nodular goiter will be less. It is important to note that these data make it possible to equally use the results of studies on thyroid cancer obtained in regions with different iodine supply.

Problems of Endocrinology. 2005;51(4):43-53
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Anniversary
I.G. Akmayev (on the occasion of his 75th birthday)
 
Abstract

On August 3, 2005, Academician of the RAMS Ildar G. Akmaev turned 75 years old.

Problems of Endocrinology. 2005;51(4):54-55
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