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Vol 54, No 1 (2008)

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Clinical endocrinology
The effectiveness and safety of a new treatment regimen for diabetic peripheral sensomotor polyneuropathy in children and adolescents
Svetlova G.N., Kurayeva T.L., Khodzhamiryan N.L., Peterkova V.A.

α-Lipoic acid is one of the most potent natural antioxidants. Muhicenter clinical studies have provided evidence for the efficacy of α-lipoic acid for the treatment of diabetic peripheral sensomotor polyneuropathy (DPSP). Thioctacide BV is a novel a-lipoic acid formulation as tablets. The paper presents the results of a 6-month follow-up of patients treated with Thioctacide ВV (1S00 mg for 3 weeks, then 600 mg/day for 2 months) and of patients from a control group. Treatment with Thioctacide BV diminishes the manifestations of DPSP just in 3 weeks of administration and subsequent 2-month therapy with the drug In a dose of 600 mg/day improves the obtained result. The study has shown that a rather high dose of the agent is well tolerated.

Problems of Endocrinology. 2008;54(1):3-9
Correlation between the parameters of continuous blood glucose monitoring and the data of self-control
Dreval A.V., Starostina Y.G., Misnikova I.V., Redkin Y.A., Dreval O.A.

Clycemla detectable before meal during self-control correlated with the parameters of continuous blood glucose monitoring before and after meal. This indicates that glycemia determined by a glucometer before meal reflects the quality of compensation of diabetes mellitus (DM) with long- and short-acting insulin preparations, but only in the patients who carefully calculate the required dose of short-acting insulin. The clear correlation between the results of careful self-control and the data of continuous glucose monitoring points to the fact that the current self-control procedure is an adequate method for attaining the daily glucose lex-els that lead to the goal values of HbAk and, accordingly, guarantee a reduction In the complications of DM. The correlation of the results of self-control and CGMS data correlations after meals may be used for a rating of self-control quality in the persons receiving intensified Insulin therapy with short-acting insulin In particular: absence of such a correlation is Indicative of poor self-control. Both the averaged blood glucose levels and the area under the glycemlc curve may be used as an Integral estimate as they equally correlate with the resula of blood glucose level self-control.

Problems of Endocrinology. 2008;54(1):9-12
Hemodynamics in arterial hypertension concurrent with subclinical by pothyroidism
Durygina Y.M., Strongin L.G., Nekrasova T.A.

Myocardial structural changes, right and left ventricular diastolic dysfunction, and central and regional hemodynamic parameters were studied in 91 female patients with grades 1 and 2 arterial hypertension who had long received antihypertensive therapy. According to thyroid function, the patients were divided into 2 groups: 1) 51 patients with subclinical hypothyroidism (SH); 2) 40 women with euthyroidism. SН negatively affected the processes of cardiovascular remodeling: SH patients had a more pronounced ventricular septal hypertrophy, increased end-systolic and diastolic dimensions, and higher left ventricular mass. Thyroid-stimulating hormone level correlated with IVRT and other parameters of right and left ventricular diastolic function. Actually, the patients with SH are predisposed to the development of type 1 diastolic dysfunction. Vascular resistance was increased in both groups, but microcirculatory disorders were more evident in SH. Replacement therapy with levothyroxine promoted the improvement of some Intracardiac, central, and regional hemodynamic parameters.

Problems of Endocrinology. 2008;54(1):13-16
Clinicohormonal and molecular genetic diagnosis of a nonclassical form of 21-hydroxylase deficiency in women of reproductive age
Khramova Y.В., Suplotova L.A., Fomlna S.V., Prokofyev S.A., Yuzhakova N.Y.

The nonclassical form of 21-hydroxylase deficiency should be diagnosed at the stage of pregnancy planning. The stimulation test using a long acting ACTH analogue is the most effective method. The stimulated 17-hydroxyprogesterone level above SO nmol/l and concomitant gene CYP2I mutations are a reflection of impaired adrenal steroidogenesis. The nonclassical form of 21-hydroxylase deficiency does not deteriorate the course of spontaneous pregnancy.

Problems of Endocrinology. 2008;54(1):16-20
Macroprolactinemia phenomenon
Gubina Y.V., Shipilov A.A.

Prolactin (PRL) is present in the serum as different isoforms: monomolecular with high receptor and biological activities; macropro-lactin (an immune complex of a PRL molecule with autoantibodies) has a low affinity for receptors and a tow biological activity, are slowly cleared from the body, and may accumulate abundantly in the latter. The incidence of the macroprolactinemia phenomenon was explored, by analyzing the PRL isoforms studied in 160 patients with hyperprolactinemia. The study was conducted on an Elexia 2010 electric chemiluminescence analyzer at the biochemical laboratory of the Voronezh Regional Diagnostic Center. The monomolecular PRL level of 60% or more was found in 111 patients and regarded as the absence of macroprolactinemia; that of less than 40% was determined in 41 patients (macroprolactinemia) and that of 40 to 60% in 8 patients (an equivocal result). There was no linkage of the presence of macroprolactinemia to age and gender. The maximum frequency of this phenomenon (50% of cases) was recorded at the PRL level of 1000 to 2000 IU/I. In this group of patients, the concentration of PRL was 3.5 to 36% after polyethylene glycol treatment. By taking into account the sufficient spread of the signs characteristic of the hyperprolactinemic syndrome in the population, on the one hand, and the high prevalence, origin, and properties of macroprolactinemia in the population of patients having the elevated level of PRL, on the other hand, the introduction of a study of PRL isoforms into the algorithm of diagnostic search makes it possible to extend the capacities of a differential diagnosis of different forms of hyperprolactinemla, to exclude unnecessary tests, and to prevent inadequate drug therapy or surgical intervention when they are resistant to the treatment performed.

Problems of Endocrinology. 2008;54(1):20-23
Clinical diagnostic aspects of macroprolactinemia
Dzeranova L.K., Goncharov N.P., Dobracheva A.D., Kolesnikova G.S., Giniyatullina Y.N., Malysheva N.M., Dedov I.I.

Macroprolactinemia (MP) that shows a discrepancy between its clinical symptoms and the level of prolactin (PRL) has recently aroused considerable interest among physicians of various specialties since not the whole PRL is biologically active. In this connection, its diagnosis is an urgent problem. This study was undertaken to reveal high molecular-weight or big-big PRL in patients with hyperprolactinemia of various genesis and to elucidate its clinical value. A total of 3S7 patients with hyperprolactinemia (PRL > 700 m U/l), including 34 males and 353 females, were examined. In all the patients, biologically active monomeric PRL was quantified via PEG 6000 treatment. Analysis of the findings indicated that MP was present in 19% of cases. Out of them, only 17 examinees had clinical symptoms of the disease. The remaining 56 patients were observed to have no clinical symptoms of hyperprolactinemia and to require no therapy. According to the obtained results, MP occurs in 19% of the patients with hyperprolactinemia. The determination of biologically active PRL and the calculation of big-big PRL in hyperprolactinemia are of great diagnostic value. Precipitation using PEG is the most informative, accessible, and cost-effective technique for estimating biologically active monomeric PRL in clinical practice. Therapy for MP is indicated only in cases of the increased fraction of biologically active PRL.

Problems of Endocrinology. 2008;54(1):24-28
Choice of a treatment for Graves disease in children
Kiyaev A.V., Sumin M.N., Savelyev L.I.

Today there are по uniform indications for either treatment for Craves 'disease and the predictors of remission have not been identified. The influence of a combination factors on the outcomes of antithyroid therapy (ATT) was analyzed in 67 children aged 1.5 to 17.6 years by the manifestation of the disease. The group of children having a remission of less than 1 year after therapy discontinuation (n - 31) and that of those who had a recurrence (n = 36), including 17 children with a recurrence after therapy discontinuation and 19 with uncontrolled recurrent thyrotoxicosis during at least 1-year therapy, were compared. Thyrostatic therapy was ascertained to be most effective in prepubertal children as well as in those who has small goiter dimensions, as evidenced by ultrasonography. Due to the high risk of recurrent thyrotoxicosis during or after thyrostatic therapy, planning of radical treatment is more warrantable in pubertal children who had a great goiter (volume > 25 ml) and a high level of AbTPO and in young men. Negative TSH receptor antibody changes following 6 months of ATT are indicative of the high risk of a recurrence, which requires a possible revision of further therapeutic tactics in these patients.

Problems of Endocrinology. 2008;54(1):29-36
Iron metabolism in diffuse goiter in the natives of Gornyi Altai
Maklakova T.P., Appelgans T.V., Zorina V.N., Boiko O.N., Kolbasko A.V.

Iron metabolism was studied in the mongoloid natives who had diffuse euthyroid goiter and hypothyroidism and who lived at heights of 2000 and 500 m in the areas of Gornyl Altai. As compared with healthy individuals, high-altitude dwellers were found to have the lower serum levels of hemoglobin and iron, but the higher levels of young erythrocytes (reticulocytes) and bilirubin. This may be adaptive for efficient oxygen uptake. This assumption may be confirmed by the negative correlation of the serum iron values with the level of thyroid hormones and with significant associations of metalloproteins. In the dwellers of a village located at a height of 500 m, no special iron metabolic features were revealed among the persons with increased and normal TSH levels.

Problems of Endocrinology. 2008;54(1):36-40
Role of ectopied adrenal cortical receptors in the pathogenesis of non ACTH-dependent Cushing's syndrome
Marova Y.I., Belyaeva A.V., Ilovvalskaya I.A.

The article is devoted to the study of the role of ectopied adrenal cortical receptors in the pathogenesis of non-ACTH-dependent Cushing’s syndrome.

Problems of Endocrinology. 2008;54(1):40-45
The upper reference level of TSH: are there sufficient arguments for its change
Fadeyev V.V.

The article is devoted to the discussion of the issue associated with the upper reference level of TSH and the arguments for its change, being the response to the article edited by L. N. Samsonova and E. P. Kasatkina "TSH level standards: current state of the problem".

Problems of Endocrinology. 2008;54(1):46-50
Current Events
Therapy in low birth weight babies for this term of pregnancy (SGA) until they attain adult age: Consensus agreement of the International Community of Pediatric Endocrinologists and the International Society on the Study of Growth Hormone
Clayton Р.E., Cianfarani S., Czernichow P., Johannsson G., Rapaport R., Rogol A.

The article is devoted to the study of the issue of therapy in low birth weight babies for this term of pregnancy (SGA) until they attain adult age. The Consensus agreement of the International Community of Pediatric Endocrinologists and the International Society on the Study of Growth Hormone was also considered.

Problems of Endocrinology. 2008;54(1):51-55

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