Vol 55, No 1 (2009)

Clinical endocrinology
Analysis of a continuous 24-hour glycemic curve by the symmetrization method
Dreval A.V., Kovachev B.P., Starostina E.G., Misnikova I.V., Dreval O.A.

The study included 18 patients (10 females and 8 males) with a not less than 2 year-history of type 1 diabetes (T1D), who had received insulin therapy since its diagnosis was established. The patients ’ mean age was 32.9± 13.0 years; the mean duration of TID was 15.1+11.5 years; the mean daily dose of insulin was 40.1+16.0 units; the mean level of glycosylated hemoglobin (HbAJ was 9.4±2.1% (the normal value 4.4-4.9%).

The glycemic curve symmetrization method proposed for statistical analysis of glycemic self-control is also quite suitable for the statistical monitoring of a continuous daily glycemic curve.

The high and low glycemic indices calculated from the symmetrized glycemic data correlate well with the level of HbAk and with the duration of hypoglycemia and hyperglycemia and hence they may be used as additional criteria for a risk of diabetes complications. The criteria, calculated from the symmetrized data of glycemia for the risk of hyper- and hypoglycemia, adequately reflect the behavior of a continuous glycemic curve and may be used as integral indices of the efficiency of glucose-reducing therapy in clinical practice.

Problems of Endocrinology. 2009;55(1):3-7
Efficiency of iodine prophylaxis in Russia: ways of optimization
Kasatkina E.P., Samsonova L.N.

The paper deals with one of the most topical problems of modern thyroidology - prophylaxis of iodine deficiency and iodine-deficiency states resulting in mental disorders in children living in the natural mild iodine deficiency regions. It also discusses the causes and degree of mental disorders in the children and gives recommendations on the optimization of the currently existing iodine prophylaxis system in Russia.

Problems of Endocrinology. 2009;55(1):8-10
Regional hemodynamic changes in nodular goiter
Ul'yanova A.E., Yarchenkova L.L.

The goal of the present study was to evaluate the clinical and diagnostic value of regional hemodynamic changes in the thyroid vessels and carotid beds in patients with different forms of nodular goiter in order to optimize further follow-up and treatment.

The study covered 120patients aged 25 to 40years (mean age 32.82±0.36 years) who had nodular goiter. A control group comprised 30 women comparable by age (mean age 32. 06±0. 44 years), who had a morphologically and functionally unchanged thyroid. After examined, the patients with nodular goiter were divided into group according to the identified morphological forms. Group 1 consisted of25 (20.8%) women (mean age 34.85±0.89 years) with signs of nodular malignancies; Group 2 included 35 (29.2%) patients (mean age 32.08±0.78years) with detected adenomas; Group 3 comprised 40 (33.3%) patients (mean age 33.6±1.08years) with colloidal nodules, and Group consisted 20 (16.7%) women (mean age 32.87±0.9 years) with signs of cysts. The study and comparison of the linear and volume parameters of arterial ducts to the euthyroid loves in nodular pathology were made, by taking into account the site of an abnormal focus and its morphological structure. The linear and volumetric bloodflow rates in the thyroid arteries ipsilaterally to the abnormal nodular of any morphological structure were found to be significantly higher (p < 0.05). Changes were revealed in blood flow parameters in the carotid bed in relation to the morphological structure of nodules.

Problems of Endocrinology. 2009;55(1):11-13
Influence of genetic factors on the result of therapy for diffuse euthyroid goiter
Galkina N.V., Troshina E.A., Mazurina N.V.

The purpose of the present study was to investigate a relationship between the distribution of genotypes of the polymorphic markers TSHR (rs3783949, A/C substitution), NIS (rs7250346, C/G substitution), DUOXI (rs2467825, A/G substitution), DUOX2 (rs71713669, G/T substitution), and TRO (rs!7091737, G/T substitution) genes and the result of treatment for diffuse euthyroid goiter (DEG) using two regimens: monotherapy with iodine preparations and combined therapy with iodine and levothyroxine.

To identify a more effective and safe treatment for DEG, the authors compared thyroid volume, the levels of pituitary thyroid-stimulating hormone and thyroid peroxidase antibodies in two groups: 1) monotherapy with KI (200 pg/day) (n = 40) and 1) combined therapy with KI (100 pg) + L-T4(lpg/kg/day) (n = 41). According to the result of treatment, each group was divided into 2 subgroups: "fair result" and "poor result" (the thyroid volume failed to achieve the normal range or continued to increase). Correlation analysis was made to assess a relationship between the polymorphism of the genes and the result of therapy for DEG.

There was a significant correlation between the distribution of genotypes of the polymorphic marker the TSHR gene and the result of treatment for DES in the monotherapy group: there were prevalent AA + AC and CC genotypes with fair and poor results, respectively. There was no significant correlation between the distribution of the genotypes of the study polymorphic markers and the result of treatment using the combined therapy. Thus, the result of treatment for DES via monotherapy with iodine preparations may depend on genetic factors.

Problems of Endocrinology. 2009;55(1):14-18
Thyroid hormone antibodies in rheumatoid arthritis
Gontar' I.P., Starova O.V., Aleksandrov A.V., Zborovskiy A.B.

The goal of the study was to investigate thyroid functional activity in rheumatoid arthritis (RA) and to identify the specific features of the generation of thyroid hormone antibodies in RA patients depending on the activity of the disease. Seventy-five patients with RA (61 (81.4%) females and 14(18.6%) males; mean age 54.1±11.6years) were examined. Physical examination and measurements of the level of thyroid hormones (free T4 and free TJ and the number of their antibodies were made. Thirty healthy individuals were examined as controls. The sera from RA patients showed antibodies to T4 and T3 in 45 and 39% of cases. There was a rise in thyroxine levels and T4 antibody concentrations with the higher activity of RA. Along with the routine clinical and laboratory parameters, the values of T3 and T4 antibodies may be used as an additional tool to characterize the activity of RA genesis.

Problems of Endocrinology. 2009;55(1):19-22
A screening algorithm for patients with adrenal incidentalomas
Mel'nichenko G.A., Ustyugova A.V., Kalashnikova M.F., Avksent'eva M.V.

Integrated clinical and economic analysis of the efficiency of screening was made in patients with adrenal incidentalomas under the established practical conditions; the average cost of screening of a patient with adrenal incidentalomas and the cost of one detected case were determined under these conditions. Based on the clinical and economic analysis, the authors have elaborated and scientifically substantiated an algorithm for screening of patients with adrenal incidentalomas, the use of which will permit, with high clinical efficacy, a significant reduction in the cost of screening.

Problems of Endocrinology. 2009;55(1):23-27
Molecular genetic verification of isolated mineralocorticoid deficiency due to aldosterone synthase deficiency
Kalinchenko N.Y., Zubkova N.A., Tyulpakov A.N.

Isolated mineralocorticoid deficiency is a rare hereditary autosomal recessive disorder that is characterized by salt wasting and that has the severest manifestations in infants. This paper is the first in the Russian literature to describe cases of isolated aldosterone deficiency. In both cases, the patients were monitored and treated for misdiagnosed congenital adrenal hyperplasia; however, the permanently low level of 17-hydroxyprogesterone could put in doubt the diagnosis and suspect isolated mineralocorticoid deficiency, by keeping in mind a history of salt wasting. By using the presented cases as an example, the authors give an algorithm for the examination and differential diagnosis of this condition and other diseases that have the similar clinical picture. Aldosterone synthase deficiency in patients was verified by molecular genetic studies - there were mutations in the CYP112 gene.

Problems of Endocrinology. 2009;55(1):28-30
Case Reports
Surgery for thyroid cancer invading into the tracheal wall
Svetitskiy P.V.

From 1997 to 2008 we ahhe cure 8 patients with papillary thyroid cancer that grows into the lumen of the trachea. All patients underwent thyroidectomy. Depending on the cancer agressiveness, 4 patients underwent circular resection of the trachea, and 4 patients underwent gradual resection. This article presents the results of treatment of patients.

Problems of Endocrinology. 2009;55(1):31-32
The severe course of hyperparathyroidism in the elderly: Clinical cases
Mokrysheva N.G., Gulyaeva S.S., Rozhinskaya L.Y., Smorshchok V.N., Lysenko M.A., Kuznetsov N.S.

Primary hyperparathyroidism (PHPT) is a disease of the endocrine system caused by excessive secretion of parathyroid hormone (PTH) and is characterized by a pronounced violation of calcium and phosphorus metabolism. More recently, in Russia, PHPT was detected extremely rarely and often hid under the mask of recurrent urolithiasis, generalized osteoporosis and other pathologies. As a result, patients did not receive adequate treatment, which in a certain percentage of cases led to the development of serious complications.
The clinical cases of severe PHPT in postmenopausal women are presented in this article.

Problems of Endocrinology. 2009;55(1):33-35
Experimental endocrinology
Antidiabetic effect of Gymnema sylvestre-based medicinal complex
Spasov A.A., Samokhina M.P., Bulanov A.E.

The paper deals with the study of the antidiabetic mechanism of action of the medicine "Diabeta". The agent has been found to have a central effect (pancreatotropic one associated with insulin secretion stimulation) and a peripheral one (extrapancreatic effect associated with intestinal carbohydrate malabsorption).

Problems of Endocrinology. 2009;55(1):36-37
Adipose tissue as an endocrine organ
Shvarts V.

The concept of adipose tissue as an inactive organ, which serves only for the accumulation and storage of energy substrates and triglycerides, has finally remained in the past. Studies of recent decades have shown that adipose tissue is very active in the metabolic aspect, and also produces many hormone-like substances, mediators, cytokines, chemokines that act at the local and systemic level, i.e., para- and endocrine. Regulatory substances produced in adipose tissue have received the general name adipokines or adipocytokines. Their study is the most actively developing area of ​​modern endocrinology. Adipokines made it possible to explain the pathophysiology of the long-known clinical phenomena of the close relationship between obesity, diabetes mellitus (DM), arteriosclerosis and insulin resistance. The list of adipokines produced in adipose tissue is very impressive and will undoubtedly be supplemented. By the beginning of 2008, the following adipokines were described: leptin, adiponectin, resistin, tumor necrosis factor a (TNF-a), interleukin-6 (IL-6), visfatin, apelin, omentine, vaspin, retinol-binding protein-4 (RBP-4) and other factors, including lipoprotein lipase, apolipoprotein E, complement factors, tissue factor, plasminogen activation inhibitor-1 (IAP-1), proteins of the renin angiotensin system (RAS). In addition, adipocytes express chemokines such as MCP-1 and RANTES.
This review schematically presents the basic physiological and pathophysiological actions of known adipokines.

Problems of Endocrinology. 2009;55(1):38-43
New evidence for the pathogenesis of obesity: adipokines are adipose tissue hormone
Kosygina A.V., Vasyukova O.V.

In recent years, the independent role of adipose tissue in the pathogenesis of obesity and related complications has been actively discussed. Adipose tissue is also a key factor in the development and progression of insulin resistance. Among adipokines secreted by adipose tissue and influencing the development of insulin resistance and metabolic disorders, the most studied are leptin, adiponectin, resistin, visfatin. These adipokines are dedicated to this review.

Problems of Endocrinology. 2009;55(1):44-50
Radioiodine therapy for Graves' disease as a risk factor of endocrine ophthalmopathy
Sheremeta M.S., Belovalova I.M., Sviridenko N.Y.

In 1973 and 1976 R. Wasnich and R. Jackson described 2 cases of endocrine ophthalmopathy (EO) that occurred after external irradiation of the anterior surface of the neck due to a tumor (Hodgkin's lymphoma). Further observations showed that treatment of Graves' disease with radioactive iodine (131I) can worsen the course of EO. So, L. De Groot et al., Observing 264 patients after exposure to 131I for Graves' disease, found progression of EO in 4% of patients after the 1st course of therapy and in 12% after subsequent sessions.

L. Bartalena et al. observed the appearance or significant progression of EO in 15% of 150 patients treated with 131I. At the same time, against the background of glucocorticoid therapy, only 10% of patients worsened the course of EO. Other studies have shown that the progression of EO after treatment with 131I without glucocorticoid administration was observed in 18-30% of cases. Along with this, it is believed that 131I does not affect the incidence of clinical symptoms in the orbit, and hypothyroidism that occurs after it does not lead to the progression of eye symptoms. The relationship between treatment and the onset or progression of EO is not clear. Nevertheless, there is evidence of an adverse effect of an elevated level of antibodies to the thyroid stimulating hormone receptor (TSH) in the blood serum after 1131I training for EO.

This review is devoted to a review of the problem presented.

Problems of Endocrinology. 2009;55(1):51-55

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