Vol 54, No 5 (2008)

Clinical endocrinology
Possibilities of preventing type 2 diabetes in patients with early carbohydrate metabolic disturbances
Dreval A.V., Misnikova I.V., Barsukov I.A., Tishenlna R.S.

An open comparative randomized study of the efficacy of metformin and acarbose was conducted in patients with glucose metabolic abnormalities (GMA). Croup 1 (n = 20) received metformin in a daily dose of 1700 mg along with the standard recommendations for lifestyle modification; Croup 2 (n = 16) took acarbose in a daily dose of 150 mg; Group 3 (n = 13) was control and followed only the standard recommendations for lifestyle modification. The purpose of the study was to estimate the influence of metformin and acarbose therapy in combination with lifestyle modification on the development of type 2 diabetes mellitus (DM2) in persons with early GMA, by applying a mathematical analysis of the results of the intravenous glucose tolerance test (determination of the rates of blood glucose elimination (k-index) and hepatic glucose pro-duction (It-Index). Unlike acarbose-treated and control persons, metformin-treated patients with early GMA showed a reduced insulin resistance (IR-HO-MA-2 by 29%) and lower hepatic glucose hyperproduction (It-index by 25%). Six-month use of metformin resulted in normalization of carbohydrate metabolism by 33.3% of the patients having GMA at baseline, GMA transition to DM2 being noted in 26.7%. The administration of acarose favored normalization of carbohydrate metabolism in 40% of cases, GMA transition to DM2 being seen in 20%. In the controls, there were no cases of normalized carbohydrate metabolism and GMA transition to DM2 occurring in 40%.

Problems of Endocrinology. 2008;54(5):3-7
Dysmenorrhea concurrent with insulin resistance in adolescent girls
Bondareva E.Y., Shapkina L.A., Mukhotina A.G., Morozova A.M.

Polycystic ovary syndrome (POS) is one of the most common causes of infertility in women of reproductive age. There have been recent reports on a significant role of Insulin resistance in the pathogenesis of this abnormality. The present study applying a com-prehensive diagnostic approach has revealed the specific features of clinical, hormonal, and metabolic disorders in adolescent girls in the presence of menstrual dysfunction concurrent with insulin resistance, which could identify different pathogenetic mechanisms of the above disorders. It was found that in female obese adolescents, menstrual dysfunction might be caused by compensatory hy-perinsulinemia and insulin resistance in the presence of visceral obesity. The manifestations of mixed hyperandrogenism caused by impaired steroidogenesis associated with increased p450c 17a activity come to the forefront in the group of patients with normal weight and insulin resistance.

Problems of Endocrinology. 2008;54(5):7-11
Vasoconstrictive peptide en-dolhelin-1 in children and adolescents with type 1 diabetes mellitus
Panfilova V.N., Taranushenko T.Y., Golubenko N.K., Lobanova S.M., Terentyeva O.A.

The plasma vasoconstrictive peptide endothel'in-1 that is one of the markers of endothelial dysfunction was studied in children and adolescents with type 1 diabetes. The findings suggest vascular endothelial dysfunction In patients with a 5-year history of the disease; in patients with the same duration of the disease, the level of endothelin-1 is increased in prolonged carbohydrate metabolic decom-pensation, dyslipidemia, and Increased urinary albumin excretion (particularly in macroalbuminuria greater than 300 mg/l). It may be presumed that the test peptide endothelin assumes a diagnostic value in the prolonged (more than 5 years) and poor course of type 1 diabetes.

Problems of Endocrinology. 2008;54(5):12-16
The diagnostic accuracy of fine-needle biopsy of the thyroid under ultra-sound guidance and the morphological structure of nodular goiter in children and adolescents
Kiyaev A.V., Yeliseyeva N.A., Koroleva N.P.

In 2000 to 2007, fine-needle biopsy (FNB) of the thyroid was made under ultrasound guidance in 202 children and adolescents (35 boys and 167 girls) aged 7.2 to 17.7 years (median 15.6 years). Cytological specimens proved to be of informative value in 20(9.9%) cases. If the size of nodules was less than 10 mm, the frequency of informative biopsies was significantly lower than if the size was 1 cm or more (63.2% versus 94.9%; х2 = 23.23; p = 0.000). Forty-one patients were operated on for thyroid cancer (n = 21), follicular adenoma (n - 15), and colloidal goiter (n = 5). The proportion of thyroid cancer in the morphological pattern of nodular goiter was 11.5% (21 of 182 informative FNBs). The high accuracy of FNB under ultrasound guidance in the diagnosis of thyroid tumors (97.2% sensitivity, 80% specificity, 95.1% accuracy) determines adequate treatment policy against thyroid nodules in children and adolescents.

Problems of Endocrinology. 2008;54(5):16-20
Crossover randomized clinical study of the efficacy and safety of abergin versus bromocriptine in patients with hyperprolactinemia
Marova Y.I., Dzeranova L.K., Vorontsov A.V., Goncharov N.P., Kamenskaya Y.A., Belyaeva A.V., Barmina I.I.

Hyperprolactinemia is a most common neuroendocrine disease. For the vast majority of patients, therapy with dopamine agonists Is the method of choice in treating hyperprolactinemia of varying etiology. Therefore, comparison of the efficacy of the most known and common drugs from a group of dopamine agonists is highly urgent. The aim of our investigation was to study the efficacy and safety ofabergin versus bromocriptine. The investigation covered 37 women with hyperprolactinemia. All the patients were treated by an open-labeled regimen. The random number test was used to divide the patients into 2 groups: I) 18patients first received abergin for 6 months, then bromocriptine alone for 6 months, as well; 2) 19 patients first took bromocriptine for 6 months, then the drug was substituted for abergin. Measurement of total prolactin and brain magnetic resonance imaging (MRI) were carried out in all the patients. Analysis of the findings has shown that the efficacy of abergin and bromocriptine is comparable by statistical indices (there was a more than 50% reduction in prolactin levels in above 75% of patients). The patients with prolactin-secreting pituitary adenomas treated with both abergin and bromocriptine displayed positive changes as decreased adenoma sizes as evidenced by brain MRI (55%) of patients. The findings suggest that abergin, a dopamine agonist made in Russia, is as effective, tolerable, and safe as its analogue bromocriptine. By taking into account its economic availability, abergin may be preferred in a number of clinical cases.

Problems of Endocrinology. 2008;54(5):20-25
Congenital adrenal dysfunction caused by Зр-hydroxysteroid dehydro-genase deficiency: molecular genetic diagnosis and clinical manifestations in two sibs of different sexes
Melikyan M.A., Rubtsov P.M., Tyulpakov A.N.

Зb-hydroxysterold dehydrogenase (3beta HSD) deficiency is a rare form of congenital adrenal conical dysfunction (CA CD) that accounts for not more 1% in the tatter's pattern and that is manifested by glucocorticoid and minerolocorticoid deficiencies. In this type of CACD, conversions of pregnenolone to progesterone, of 17-hydroxypregnenolone to 17-hydroxyprogesterone, and of dehydroepian-drosterone to androstenedione are impaired. HSD3B2 gene defect underlies this disease. The results of examination and treatment of 2 patients with 3beta HSD deficiency are first presented in the Russian literature. The diagnosis of3beta HSD deficiency was established in a 13-year-old girl and an 8-month boy. In both patients, the disease was manifested by the symptoms of severe adrenal insufficiency. Moderate external genital virilization had been noted in the girl since birth whereas the boy had manifestations of false male hermaphroditism. Molecular genetic study revealed earlier unknown homozygous nonsense mutation W230X in the HSD3B2 gene. Our observations emphasize it necessary to include 3beta HSD deficiency into the algorithm of differential diagnosis of CACD in patients with atypical manifestations of CACD particularly when the latter Is concurrent with false male hermaphroditism. By taking into account the fact that there are unavailable hormonal verification methods, molecular genetic studies are prominent in the diagnosis of this disease.

Problems of Endocrinology. 2008;54(5):25-29
Androgen deficiency and problems of its diagnosis by current nonisotopic testosterone assays
Goncharov N.P., Katsia G.V., Dobracheva A.D., Malysheva N.M.

Current hormonal immunoassays of blood total and free testosterone fail to provide an adequate diagnostic accuracy in most cases. The official statement mode by the International Association of Endocrinologists in 2007 on the inadmissibility of using direct im-munoassays, including all analyzers, to measure testosterone in women and children Is a result of an analysis of this problem. Tandem mass-spectrometry (TD-MS) that guarantees accuracy, specificity, and a reduction in the effect of a matrix on measurement of tes-tosterone or any other steroid should be ideally used as a reference technique. The paper reviews preanalytical and analytical factors influencing the diagnostic accuracy of evaluation of the androgen status in males, females, and children. A specific and highly sensitive (8.7 pmol/l) technology of luminescence immunoassay of salivary free testosterone, which had been introduced into diagnostic practice, considerably improved the diagnostic accuracy of determination of testosterone in both males and females and children. The paper also presents the authors' results of determination of free testosterone in salivary microvolumes in healthy and androgen-deficiency males, by taking into account physiological diurnal variations. The values of salivary free testosterone in combination with clinical symptoms are shown to be used as an objective and adequate hormonal marker of diagnosis of different forms of male androgen deficiency.

Problems of Endocrinology. 2008;54(5):30-39
Clinical guidelines
Diagnosis and treatment of differentiated thyroid carcinoma. The consensus commission's clinical recommendations
Problems of Endocrinology E.B.

These recommendations are a document uniting the opinions of members of the conciliation commission on the key and most controversial problems in the diagnosis and treatment of differentiated thyroid cancer (thyroid cancer), which have developed in domestic clinical practice. These recommendations are not an official document approved by one or another structure of the healthcare system and are advisory in nature.

Problems of Endocrinology. 2008;54(5):39-43
Experimental endocrinology
Antioxidants in experimental diabetes mellitus
Volchegorsky I.A., Rassokhina L.M., Miroshnichenko I.Y.

The effect of original antioxidants - the derivatives of 3-hydroxypyridine and succinic acid (emoxypin, reamberin, and mexidol) made in Russia on metabolic disturbances, conditioned training, and motivated behavior was studied in rats with alloxan diabetes. Seven-day use of the test drugs was ascertained to normalize ill animals'behavior in the open field and to substantially upgrade the quality of the formed conditioned reflex of active avoidance. The derivatives of 3-hydroxypyridine and succinic acid are as effective as a-lipoic acid for experimental therapy of behavioral disorders and for conditioned training in alloxan diabetes. The psychotropic effects of the test antioxidants do not depend on their action on the blood levels of lipid peroxides in ill rats. Only emoxypin and mexidol have a concomitant modulating effect on the study manifestations of cerebral dysfunction, hyperglycemia, and dysllpldemia. Mexidol shows the best combination of positive metabolic and psychotropic effects in experimental diabetes mellitus.

Problems of Endocrinology. 2008;54(5):43-49
Is pathogenetic therapy for type 2 diabetes possible?
Balabolkin M.I., Klebanova Y.M., Kreminskaya V.M.

Diabetes mellitus (DM) continues to be a heavy burden for national health services around the world. It is one of the main causes of early disability and high mortality. Moreover, despite the adoption of national diabetes control programs in most countries of the world, its prevalence and incidence continues to increase not only among people over 40, but also among adolescents and children.

Problems of Endocrinology. 2008;54(5):50-56

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