Vol 52, No 6 (2006)

Clinical endocrinology
Impaired glucose balance and seven diabetes mellitus subtypes detected by intravenous glucose tolerance test
Dreval A.V.

A new clinically suitable method has been developed to calculate the rate of blood glucose elimination and hepatic glucose production (HGP) by the results of intravenous glucose tolerance test (IGTT). A subpopulation of non-diabetic persons was identified in whom substantially increased HGP is compensated for high blood glucose elimination, which prevents the development of hyperglycemia in them. This abnormality is designated impaired glucose balance and may be referred to as an early prehyperglycemic stage of diabetes (prediabetes). The results of IGTT analysis correlate with the types of diabetes mellitus and the degree of carbohydrate metabolic disturbance, which allows one to recommend the proposed method for diagnosing diabetes and its types and assessing the degree of metabolic disturbances in diabetes. Four types of glucose imbalance may be identified from the ratio of the degree of impaired HGP to glucose elimination. As a result, a combination of 2 types of diabetes mellitus and 4 types of glucose imbalance makes it possible to divide the population of diabetes mellitus into 7 subgroups (subtypes), which may be subsequently of importance in optimizing sugar-reducing therapy. A computer program has been developed, which automatically calculates the glucose kinetics in IGTT according to the tatter's results and which is free available in the Internet at www.diabet.ru/Dreval/ivgtt_eng.exe .

Problems of Endocrinology. 2006;52(6):3-10
Platelet membrane pathology in vascular complications of type 1 diabetes mellitus
Kravets Y.В., Ryazantseva N.V., Yakovleva N.M., Chudakova O.M.

The purpose of the present study was to define a role of the impaired structural and functional organization of the platelet membrane in the mechanisms of development and progression of vascular complications of type 1 diabetes mellitus (DM). Seventy-seven type 1 DM patients (34 males and 23 females) with different stages of diabetic retinopathy and nephropathy, whose age was 18 to 55 years, were examined. Tlie patients with type 1 DM were found to have pronounced membranous structural and functional changes in the platelets (the increased microviscosity of a lipid phase, the inhibited activity of Na+,K+-ATPase), whose degree correlates with that of vascular complications. Platelet membranous structural and functional impairments are most marked in the phase of decompensation of type 1 DM. Knowledge of the pathogenetic bases of changes in the mlcrorheologlcal properties of blood cells in diabetic microangiopathies permits the use of membrane-stabilizing agents for their correction.

Problems of Endocrinology. 2006;52(6):10-14
Activa tion of the complement system by the classical and alternative pathways in prolonged type 2 diabetes mellitus
Ovsepyan M.R., Boyadzhyan A.S., Oganesyan L.P.

The study was undertaken to assess the functional activity of the classical and alternative pathways of complement activation in type 2 diabetes mellitus (DM-2) at late stages of the disease. For this purpose, the total hemolytic activity of the classical and alternative pathways of complement activation and the hemolytic activities of the complement components C1, C2, C3, and C4 were determined in the blood of patients with DM-2 and healthy individuals. According to the data obtained, patients with DM-2 at late stages of the disease have statistically significant increases in both the total hemolylical activity of the classical pathway of complement activation (by 1.5 times; p < 0 01; t = 2.54) and the hemolytic activities of individual complement components - C1 and C3 by 2.2 times (t - 2.05;p < 0 046 and t = 3.9; p < 0 0004, respectively) and C4 by 1.8 times (t - 2.05; p < 0.046) whereas the total hemolytic activity of the alternative pathway and the hemolytic activity of the complement component C2 remain in the normal range (p > 0 5). The findings suggest that the alternative pathway of complement activation is most likely to make no contribution to the activation of C3-convertase and the subsequent generation of C3d, and the further formation of the cytolytic and membrane-attacking complex

Problems of Endocrinology. 2006;52(6):14-17
Lymphocytic sensitization to antigens of viruses of the family Paramyxoviridae in diabetes mellitus
Asfandiyarova N.S., Shatrov V.V., Garipov G.K.

The purpose of this investigation was to study cellular immunity to parotiditis and measles viruses in patients with diabetes mellitus (DM). Lymphocytic sensitization to parotiditis and measles viral antigens and insulin was determined by peripheral blood lymphocytic blast-transformation reaction (a morphological method for reaction assessment) In 10 patients with measles, 18 patients with epidemic parotiditis, 52 patients with DM (23 and 29 patients types 1 and 2 DM, respectively), and 46 apparently healthy individuals. The studies revealed lymphocytic sensitization to parotiditis and measles viral antigens and insulin in most patients in the acute phase of infection with a subsequent reduction in the intensity of proliferation until the point of complete cessation during 12 months. Unlike the controls in whom lymphocytic sensitization to the viruses of the family Paramyxoviridae was detected in 3 persons, prolonged antiviral cellular immunity was found in 17 of the 23 patients with type 1 DM and in 25 of the 29 patients with type 2 DM. Thus, prolonged cellular immunity to viral antigens (measles and/or parotiditis) Is associated with diabetes melhtus. The concordance of a lymphocytic response to viral antigens and insulin suggests that the viruses of the family Paramyxoviridae in some persons initiate a cascade of immune reactions leading to the development of diabetes, the tatter's type is determined by the nature of an immune system response to viral antigens and insulin.

Problems of Endocrinology. 2006;52(6):18-21
Autonomic homeostasis and the specific features of adaptation in children with obesity
Averyanov A.P.

The autonomic nervous system and the adaptive mechanisms associated with neuroautonomic cardiac rhythm regulation were studied in obese children. The study covered 187 untreated children aged 6-16 years who had exogenous constitutional (n = 68), diencephalic (n = 20) obesity and hypothalamic puberty syndrome (n = 99). The study was conducted by computer-aided (statistic, spectral) analysis of cardiac rhythm variability. The regulatory system activity index was calculated to assess the tension of adaptive mechanisms. The results were compared with those obtained in 107 apparently healthy children matched by gender and age. The enhanced activity of subcortical nerve centers with a predominance of sympathetic effects was observed in 38.7% of children with puberty obesity. The state of adaptive processes was regarded as a pronounced functional strain, overstrain, and exhaustion of regulatory systems in 31.1% of 6-10-year-old children and 29.5% of 11-16-year-old ones with obesity.

Problems of Endocrinology. 2006;52(6):21-26
Postprandial lipemia and insulinemia in obese females with cholelithiasis
Polyarush N.A., Dvoryashina I.V., Mochalov A.A., Feliksova I.V.

The authors studied the pattern of fatty tissue distribution in the body and revealed changes In the baseline and postprandial levels of serum lipids and insulin In females with cholelithiasis (CL) obese. Ninety-five females were examined. These included 41 patients with CL and obesity, 20 patients with the normal body mass index and CL, and 34 obese females without CL. The pattern of abdominal adipose tissue distribution was determined by computed tomography. The serum levels of major lipids and immunoreactive insulin (IRI) were measured at the baseline and 3 and 9 hours after administration of fat emulsion (130 g of fat per 2 m2 of body surface). There was a significant predominance of the area of visceral adipose tissue (VFT) at the level of the gallbladder. In the groups of CL patients, the percent of VFT of the total abdominal adipose tissue was higher than that in obese patients without CL. During a dietary fat load test, a persistent postprandial hypertriglyceridemia and no increases in the levels of high-density lipoprotein cholesterol were observed in CL female patients irrespective of whether systemic obesity was present or absent. In the group of CL patients without signs of obesity, there were high baseline concentrations of IRI and no significant increase in IRI levels in response to the administration of fat emulsion

Problems of Endocrinology. 2006;52(6):26-30
Topical problems of thyroidology: prevention of iodine-deficiency diseases
Kasatkina E.P.

The medical community of our country is extremely concerned about the significant deterioration in the state of health, the decline in the intellectual potential of the population and the low birth rate in Russia. Of course, this circumstance cannot but affect the social and spiritual development of society and the state of the demographic situation in the country. As a rule, the deterioration in health is explained by the decline in recent decades, the social level and quality of life of a significant segment of the population of our country. One cannot disagree with this. At the same time, it should be recognized that in the same years in Russia the situation with endemic goiter sharply worsened: almost the entire territory of the country is currently endemic for goiter.

Problems of Endocrinology. 2006;52(6):30-33
Screening for congenital hypothyroidism in the Krasnodar Territory
Golikhina T.A., Matulevich S.A., Shumlivaya Y.O.

The paper presents the basic results of neonatal screening/or congenital hypothyroidism (СH) in the Krasnodar Territory in 1995-2004; the average degree of Iodine deficiency in this territory has been established. In the latter, the incidence of CH is 1:4106 and that of transient hypothyroidism is 1:97. The organizational and methodical principles of screening optimization are defined. The computer program "Neonatal screening" has been developed.

Problems of Endocrinology. 2006;52(6):34-36
Iodine prophylaxis and the health status of infants of the first year of life, living in a mild iodine-deficiency industrial megapohs
Samsonova L.N., Ivakhnenko V.N., Pykov M.I., Naumenko L.L., Ibragimova G.V., Ryabykh A.V., Yevdokmova Y.A., Kasatkina E.P.

Adequate iodine prophylaxis in women living in an iodine-deficiency region, startingfrom early pregnancy, positively affects its course and in their babies' neonatal period, somatic and psychoneurological status (increased the mean neuropsychological status by 4-5 scores, by Improving the parameters of cognitive functions). This necessitates the use of potassium iodine agents in a dose of at least 200 fig/day, as recommended by the WHO (2001), in all early pregnancy women living in an iodine-deficient region.

Problems of Endocrinology. 2006;52(6):36-38
For practitioners
Diagnosis of insulin resistance in children and adolescents
Vitebskaya A.V., Vasyukova O.V.

The high prevalence of obesity in children is one of the factors contributing to an increase in the frequency of development of the metabolic syndrome and related diseases. A key role in the development of the metabolic syndrome in both children and adults is played by insulin resistance - a violation of the biological effect of insulin and the reaction of insulin-sensitive tissues to it at the pre-, post- and receptor levels.

Problems of Endocrinology. 2006;52(6):39-41
Case Reports
New mutation in the CYP17 gene: description of a case
Dzeranova L.K., Tyulpakov A.N., Pigarova Y.A., Rubtsov P.M., Artemova A.M., Vorontsov A.V., Yarovaya I.S., Rozhinskaya L.Y., Dedov I.I.

Deficiency of 17α-hydroxylase is a rare variant of congenital adrenal cortical dysfunction. The defect was first described by E. Biglieri et al. in 1966 in patients with sexual infantilism, pronounced excess mineralocorticoids with salt retention and arterial hypertension.

Currently, several variants of the nonclassical course of the disease are described (with an increased level of aldosterone and without the development of hypertension and hypokalemia), the pathophysiological mechanism of which could not be explained. Cases of isolated deficiency of 17,20-lyase activity associated with mutations of R347H and R358Q in the CYP17 gene are also described.

Here is the observation of a patient with a new mutation in the CYP17 gene with 17α-hydroxylase/17,20-lyase deficiency.

Problems of Endocrinology. 2006;52(6):41-45
The etiology and pathogenesis of primary chronic adrenal insufficiency: Current aspects
Melnichenko G.A., Maryina T.L., Aleksandrova G.F.

Primary chronic adrenal insufficiency is a relatively rare disease. To date, according to various authors, the prevalence of Primary chronic adrenal insufficiency in the world varies significantly.

Problems of Endocrinology. 2006;52(6):45-50
Reasons for obesity treatment inefficiency and modes of its overcoming
Voznesenskaya T.G.

The main problem faced by doctors involved in the treatment of obesity is relapse of the disease. There are 4 main causes of relapse. The first reason is the emotional instability resulting from the use of strict diets, which is called "dietary depression." The second reason is the appearance of a "weight plateau", when the patient continues to follow the recommendations, but body weight ceases to decrease against the background of ongoing therapy. The third reason: after the course of treatment, the patient returns to his previous lifestyle and he ricochets weight gain. The fourth reason is an incorrect account of the peculiarities of eating disorders of the patient when prescribing treatment programs.

Problems of Endocrinology. 2006;52(6):51-54
Prof. Aleksandr S. Ametov (on the 65th anniversary of his birthday)

The celebrated endocrinologist Alexander Ametov, doctor of medical sciences, professor, head of the department of endocrinology and diabetology of the Russian Medical Academy of Postgraduate Education, is 65 years old.

Problems of Endocrinology. 2006;52(6):54-55
Index of papers published in this journal in 2006


Problems of Endocrinology. 2006;52(6):55-56

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