Vol 55, No 6 (2009)

Clinical endocrinology
New understanding of the problem of management of type 2 diabetes mellitus - novel prospects (ADA/EASD consensus, 2008)
Biryukova E.V.
Abstract

Type 2 diabetes mellitus is a severe progressive disease associated with the high incidence of complications. The worldwide incidence of type 2 diabetes mellitus is known to be steadily growing which makes the management of this disease a topical medical problem. The majority of the patients all over the world fail to achieve recommended treatment end-points. The scientifically-sound choice of an adequate pharmacotherapeutic modality based on the available data on type 2 diabetes pathophysiology is of utmost importance under conditions of real clinical practice. The new updated ADA/EASD consensus of 2008 provides a well-grounded practical algorithm for the initiation and further adjustment of drug therapy in patients with type 2 diabetes mellitus. The HbA1c level of 7.0% or higher at any stage of the treatment should be regarded as a signal for active correction of the previous therapeutic regime. The early prescription of basal insulin contributes to the efficacious glycemic control and decreases the risk of long-term diabetic complications. Treatment with a combination of insulin and metformin is a highly effective approach to the management of patients with hyperglycemia and simultaneously slows down weight gain. The present algorithm enables clinicians to choose the most adequate hypoglycemic agents and combine different therapeutic modalities to the benefit of each individual patient.

Problems of Endocrinology. 2009;55(6):3-7
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Significanvce of dysfunction of vascular endothelium for the evaluation of episodes of myocardial ischemia in type 2 diabetes mellitus
Tatarchenko I.P., Pozdnyakova N.V., Mordovina A.G., Morozova O.I., Kolomiets E.V.
Abstract

The objective of this study was to evaluate the vasculomotor function of endothelium in patients with type 2 diabetes mellitus and assess the role of its functional state in the development of ischemic episodes. A total of 93 patients (52 men and 41 women) of the mean age of 58.3+-4.8 years were involved in the study. Group 1 comprised 47 patients with coronary heart disease (CHD) and type 2 diabetes, group 2 included 46 patients with CHD in the absence of disturbances of carbohydrate metabolism. Patients of the two groups were matched for age, gender, and major risk factors. Their comprehensive examination included 24 hour ECG monitoring, veloergometry, echocardiography, and reactive hyperemia test (ultrasound evaluation of endothelium-dependent dilation of the brachial artery). The patients of group 2 showed longer total duration of episodes of myocardial ischemia, the elevated number of painless (PMI) episodes, and greater maximum depression of ST-segment compared with CHD patients having no disturbances of carbohydrate metabolism. Correlation analysis demonstrated significant negative relationship between endothelial dysfunction, the number and duration of PMI episodes, and delay of pain syndrome with respect to ischemic depression of ST-segment in patients of group 1.

Problems of Endocrinology. 2009;55(6):7-11
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The first experience with selective blood collection from the inferior petrosal sinuses in Russia (case reports)
Dedov I.I., Sitkin I.I., Belaya Z.E., Marova E.I., Przhiyalkovskaya E.G., Remizov O.V., Rozhinskaya L.Y.
Abstract

This paper reports two clinical cases of ACTH-dependent hypercorticism. Difficulties encountered in differential diagnosis of this condition were due to poor informative value of routine diagnostic methods. The use of selective blood collection from the inferior petrosal sinuses (for the first time in Russia) greatly facilitated the choice of the adequate treatment strategy. A detailed description of clinical features of ACTH-dependent hypercorticism in two young women is presented along with the results of laboratory and instrumental studies. Technical aspects of selective blood collection from the inferior petrosal sinuses in conjunction with the desmopressin stimulation protocol are considered. Indications for the use of this diagnostic method under real clinical conditions are proposed. Results of the study are discussed with reference to the treatment strategy chosen for the management of ACTH-dependent hypercorticism and the outcome of surgical intervention.

Problems of Endocrinology. 2009;55(6):11-16
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Postpartum thyroiditis: risk factors, differential diagnosis, clinical features
Fadeyev V.V., Topalyan S.P., Lesnikova S.V., Mel'nichenko G.A.
Abstract

Postpartum thyroiditis (PT), one of the commonest causes of disturbed thyroid function (TF), is believed to occur in 5% of the women. The present study involving 57 patients with PT was designed to study risk factors and clinical features of this pathology as well as approaches to its diagnosis. Two control groups comprised female carriers of anti- thyroid peroxidase antibodies (TPO-AB) without PT and women having symptoms of Graves disease (GD) in the postpartum period, respectively. Patients with PT were shown to have significantly elevated TPO-AB levels during pregnancy compared with controls. Postpartum GD manifested itself later than PT, it was associated with a significantly higher freeT4 level and a greater thyroid volume. In twenty of the 57 women with PT, it was manifest in the thyrotoxic phase and in the remaining 37 in the hyperthyroid state. The TSH level in the first half of pregnancy was significantly higher in the women that eventually developed a monophasic hypothyroid variant of PT. In the same group, the TPO-AB level at the time of PT diagnosis was significantly higher than in the biphasic variant of PT. Forty (70%) of the 57 women with PT recovered to an euthyroid state by the end of the study whereas in 17 (30%) hypothyroidism persisted. The biphasic variant of PT was manifest starting from the thyrotoxic phase and more frequently ended in the recovery to the euthyroid state (90%) than the monophasic one, the difference being statistically significant. In contrast, the monophasic hypothyroid variant more frequently resulted in persistent hypothyroidism (40%).

Problems of Endocrinology. 2009;55(6):16-22
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Iodine availability, thyroid structure and function in residents of the city of Mirny, Republic of Sakha (Yakutia)
Selyatitskaya V.G., Lel'kin M.K., Gerasimova I.S., Lutov Y.V., Pal'chikova N.A., Kuz'minova O.I.
Abstract

Iodine availability for residents of the city of Mirny, Republic of Sakha (Yakutia), was estimated from urinary iodine and creatinine levels and their calculated ratio. Median of iodine/creatinine ratio in the groups of children and adults included in the study was 167.2 and 110.5 mcg/g respectively. Goiter was diagnosed by ultrasound in 0.4% of men and 4.9% of women. Diffuse and focal changes of the thyroid echographic pattern were revealed in the overwhelming majority of the examined subjects (91.7% of the adults and 66.1% of the children). The frequency of thyroid nodules was 5.0% and 20.3% in men and women respectively. Serum TSH level exceeded the respective reference values in 10.9% of the men and 18.2% of the women.

Problems of Endocrinology. 2009;55(6):23-25
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Gender-specific features of hyperprolactinemia syndrome
Mel'nichenko G.A., Dzeranova L.K., Barmina I.I., Giniyatullina E.N., Rozhivanov R.V., Dobracheva A.D., Goncharov N.P.
Abstract

The objective of the present work was to study specific clinical features of hyperprolactinemia in men and women. A total of 148 men and 138 women with hyperprolactinemia of tumorous and non-tumorous etiology were examined. Analysis of medical histories demonstrated that the period between the appearance of the first clinical symptoms and the establishment of diagnosis of hyperprolactinemia in men was longer than in women. The frequency, size, and invasiveness of macroprolactinomas were also different in the two sexes. Prolactin-secreting pituitary tumours in men showed more aggressive growth than in women. All the patients included in the study were examined for the measurement of monomeric prolactin (PRL) by separation of individual fractions in the precipitation reaction with 25% polyethyleneglycol. Macroprolactinemia occurred more frequently in women than in men. Total and monomeric PRL levels were higher in men with hyperprolactinemia of tumorous origin compared with women.

Problems of Endocrinology. 2009;55(6):26-31
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Hematological and urological aspects of the safety of androgen substitution therapy using long-acting testosterone undecanoate in patients with hypogonadism
Rozhivanov R.V., Kurbatov D.G.
Abstract

The objective of this work was to evaluate hematological and urological safety of androgen substitution therapy by retrospective analysis of 40 medical histories of patients with hypogonadism. It was shown that treatment with testosterone undecanoate resulted in a significant increase of hemoglobin concentration and packed cell volume that did not however cause serious adverse events and did not require withdrawal of therapy. No statistically significant changes in prostate size or prostate specific antigen (PSA) level were documented in patients receiving androgen therapy. Clinically significant elevation of PSA was apparent in 12.5% of the patients in whom its initial level exceeded 2.5 ng/ml and also in patients with acromegaly. To conclude, the data obtained in this study point out to hematological and urological safety of androgen substitution therapy.

Problems of Endocrinology. 2009;55(6):31-35
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Reviews
Significance of the method of selective blood collection from the inferior petrosal sinuses for differential diagnosis of ACTH-dependent hypercorticism
Dedov I.I., Belaya Z.E., Sitkin I.I., Marova E.I., Przhiyalkovskaya E.G., Remizov O.V., Rozhinskaya L.Y.
Abstract

This review paper was designed to discuss the accumulated worldwide experience with selective collection of blood from the inferior petrose sinuses for the purpose of differential diagnostics of ACTH-dependent hypercorticism. The history of the development of the method is described, principal indications and contraindications to its clinical application are considered with reference to the informative value of this diagnostic tool. Possible causes of false positive and false negative results as well as complications ever reported as associated with the diagnostic procedure are discussed. Much attention is given to the comparative analysis of advantages and disadvantages of alternative techniques for blood collection and to the use of pharmaceutical agents that may increase efficiency of the method under consideration.

Problems of Endocrinology. 2009;55(6):35-40
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Inflammation of adipose tissue. Part 3. Pathogenetic role in the development of atherosclerosis
Shvarts V.
Abstract

Obesity is a factor contributing to the development of atherosclerosis and cardiovasular diseases. A key pathogenetic mechanism of obesity-associated atherosclerosis is inflammation of the adipose tissue concomitant with mild systemic inflammation, altered secretion of adipokines and cytokines, and insulin resistance. This review is focused on the role of hypoadiponectinemia, enhanced secretion of leptin, resistin, TNF-alpha, IL-1, IL-6, interferon-gamma, and activation of renin-angiotensin system in pathogenesis of atherosclerosis. The stimulatory action of insulin resistance accompanying inflammation of the adipose tissue on evolution of atherosclerosis is mediated through the development of dyslipidemia, hyperglycemia, and arterial hypertension. Other important factors involved in pathogenetic mechanisms of atherosclerosis are inflammation of perivascular fatty tissue and paracrine activity of cytokines and chemokines it releases.

Problems of Endocrinology. 2009;55(6):40-45
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Interactions of estrogens, progesterone, and dopamine in regulation of prolactin secretion
Akhkubekova N.K.
Abstract

This paper reviews pathologic conditions associated with disturbances of prolactin secretion. The author analyses results of experimental and clinical investigations published in the literature with special reference to the role of estrogens, progesterone, and dopamine in control of prolactin secretion and its regulation under normal and pathological conditions.

Problems of Endocrinology. 2009;55(6):46-48
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Statistical methods for the analyses in clinical practice. Part 2. Survival analysis and multivariate statistics
Rumyantsev P.O., Saenko V.A., Rumyantseva U.V., Chekin S.Y.
Abstract

Statistical analysis is an integral component of clinical studies. The objective of the present paper is to assist clinicians in getting deeper insight into basic principles underlying different methods available for the statistical treatment of medical data without a detailed description of relevant mathematical calculations. The most popular and widely used methods of statistical analysis are considered with special reference to their practical application in clinical and experimental medicine. Part I of the review was devoted to foundations of descriptive statistics and univariate analysis. Part II is focused on the principles of survival analysis and multivariate methods.

Problems of Endocrinology. 2009;55(6):48-56
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