Vol 42, No 3 (1996)

Clinical endocrinology
Clinical and laboratory characteristics of the renoretinal syndrome in diabetics
Balabolkin M.I., Mamayeva G.G., Evgrafov V.Y., Lyudina L.I., Bishele N.A.

A total of 107 diabetics were examined using general clinical methods, assessment of microalbuminemia, Rehberg’s test for renal function, coagulogram, thromboelastogram, lipid spectrum of the serum, and ophthalmological examination. The stages of diabetic nephropathy and retinopathy and degree of the major pathological changes in the retina were found to be in direct correlation. Initial diabetic retinopathy was found to develop earlier than nephropathy in the majority of patients, and preproliferative and proliferative retinopathy was appreciably more incident in the presence of diabetic nephropathy. Changes in the fundus oculi were more expressed in patients with type I diabetes and nephropathy than in those with type II condition. At the same time, the development of diabetic nephropathy was associated with deterioration of the fundus oculi parameters only in diabetics with type II condition, whereas in those with type I disease it influenced only the number of microaneurysms. The progress of diabetic nephropathy with increase of proteinuria may be caused by such risk factors as microcirculatory disorders and changes in the lipid spectrum of the blood serum.

Problems of Endocrinology. 1996;42(3):3-6
Intrathyroid stable iodine level and thyroid tumors
Tomashevsky I.O., Troshina Y.A., Gerasimov G.A., Bronstein M.E., Serpukhovitin S.Y., Alexandrova G.F., Figge J.

Intrathyroid iodine level was measured in 126 patients with different thyroid tumours in Russia and in 37 ones in the USA by X-ray fluorescent analysis in vitro. A decrease of intrathyroid iodine concentration was found to be associated with a stepwise loss of differentiation of thyroid tumours. In colloid goitre tissue from Russia, the intrathyroid level of iodine was increased. It was markedly increased in microfollicular adenomas and colloid goitre tissue from American patients, which fact may reflect a higher iodine supply in the USA. X-Ray fluorescent analysis together with clinical studies may be used in preoperative examinations of patients with thyroid nodules.

Problems of Endocrinology. 1996;42(3):6-8
Volemic changes associated with heparin administration to patients with thyrotoxicosis before plasmapheresis
Lukomsky G.I., Alexeyeva M.Y., Godzhello M.A.

The time course of plasma volume was followed up in patients with thyroid diseases injected heparin before plasmapheresis which was carried out as a measure of preparation to surgery. A tendency to normalization of circulating plasma volume after heparin injection was detected and statistically confirmed.

Problems of Endocrinology. 1996;42(3):8-10
Somatotropic insufficiency in children and antip1tu1tary antibodies as characteristics of humoral immunity in patients and their parents
Fofanova O.V., Peterkova V.A., Kryukova I.V., Keda Y.M., Kandror V.I., Bulatov A.A., Goncharov N.P., Osipova T.A., Yelizarova G.P., Pankov Y.A.

Antibodies to adeno-pituitary cell surface antigen (PCSA) were studied in 40 untreated children with idiopathic growth hormone (GH) deficiency to elucidate the role of autoimmune disorders in the pathogenesis of GH deficiency. Antibodies to rat PCSA were assayed by ELISA. PCSA was detected in 15% of patients with GH deficiency, in contrast to that in healthy children and children with autoimmune thyroid diseases. The authors consider that in some cases GH deficiency may be caused by autoimmune hypophysitis. A family study revealed PCSA in 25% of mothers of patients with GH deficiency. In a population of healthy women PCSA was detected in 5.7% cases. Hence, a hereditary background of autoimmune abnormality cannot be completely ruled out.

Problems of Endocrinology. 1996;42(3):10-15
Increased contrast magnetic imaging in the diagnosis of hypophyseal adenoma
Belichenko О.I., Dedov I.I., Marova Y.I., Zenkova T.S., Shariya M.A.

Magnevist (Schering, Germany) was tried for magnetic imaging using Magnetom-P63 (Siemens) superconducting magnetic resonance system at a magnetic field intensity of 1.5 T. Magnetic imaging of the brain was carried out in 24 patients with hypophyseal adenomas before and after intravenous injection of Magnevist. Use of this agent helped more distinctly differentiate between adenoma tissue and the adjacent parasellar structures of the brain, thus appreciably improving the quality of diagnosis of hypophyseal adenoma by magnetic imaging. Recommendations on the use of Magnevist for examination of the sellar region by magnetic imaging are offered.

Problems of Endocrinology. 1996;42(3):15-19
Secretion of growth hormone in children with familial dwarfism
Kasatkina E.P., Ibragimova G.V., Soltakhanov E.M.

Thirty-two patients with familial dwarfism were examined. Stimulated and spontaneous secretion of growth hormone was studied in all of them. Stimulated secretion was assessed in two standard pharmacologic tests, spontaneous one was examined during the first 3 h of night sleep. Analysis of the results showed an irregular pattern of growth hormone secretion. Disorders of the hormone secretion of the neurosecretory dysfunction type with a partial deficit of growth hormone were revealed in the majority (20 out of 32) patients, which may be the cause of growth retardation. In twelve patients the levels of both stimulated and spontaneous secretion were normal.

Problems of Endocrinology. 1996;42(3):19-21
Clinical and karyotypical characteristics of the Shereshevsky-Turner syndrome
Tarskaya L.A., Prytkov A.N., Trubnikov V.I., Patyutko R.S., Kasatkina E.P., Kozlova S.I.

The incidence of 18 phenotypical signs was analyzed in 82 patients with the Shereshevvky-Turner syndrome. The minimal diagnostic signs occurring with at least 50% incidence have been singled out. Comparative analysis of the distribution of clinical signs in groups with different variants of karyotype disorders showed that the group of patients with the mosaic karyotype (45,X/40,XX) was the least loaded with pathological signs. Groups with karyotype 48,X and structural disorders are similar in the distribution of phenotypical signs. Multidimensional statistical cluster analysis of the matrix of summary phenotypical distances was carried out and a cluster singled out which permitted unification of 4 groups of patients with different karyotype disorders. The results are compared with published data of molecular cytogenetic studies.

Problems of Endocrinology. 1996;42(3):22-24
Chorionic gonadotropin test in the diagnosis of hermaphroditism variants caused by congenital disorders of testosterone biosynthesis
Samsonova L.N.

The study is devoted to search for the optimal modification of chorionic gonadotropin test which permits timely assessment of the function of gonads and, hence, diagnose the variants of hermaphroditism caused by disordered biosynthesis of testosterone. Two modifications of the test: three-day and two-week with measurements of basal and stimulated testosterone levels in the serum were used in 18 patients aged 10 months to 10 years. Both modifications were diagnostically valuable in assessing the function of the gonads in patients with male pseudohermaphroditism. However, the three-day test with its 83% sensitivity may be used only as a screening method in the diagnosis of the above condition.

Problems of Endocrinology. 1996;42(3):24-26
Case Reports
The case of histiocytosis X (Hand - Schüller – Christian disease) with thyroid gland lesion
Bronstein M.E., Melnichenko G.A., Bukhman A.I., Starostina T.A., Ivanov O.L., Pronin V.S., Pavlova M.G., Oranskaya A.N.

Histiocytosis X, which is a rare disease, combines 3 related but different in clinical manifestation, course and prognosis of the syndrome: eosinophilic granuloma (Taratynov’s disease), Hand – Schüller – Christian disease (syndrome) and Letterer – Siwé disease (syndrome). The clinical picture of Hend – Schüller – Christian disease was first described by Hand in 1893, then by Schüller in 1915 and Christian in 1920. The term “histiocytosis X” was first proposed in 1953 by Liechtenstein, who combined all 3 of the aforementioned diseases under this name. on the basis of the similarity of the clinical picture, the possibility of a mutual transition from one state to another and typical morphological manifestations consisting in the proliferation of histiocytes and the accumulation of various lipids in their cytoplasm. In 1965, this concept was confirmed in all three diseases, there are no special pentalaminar markers in the cytoplasm of histiocytes that are detected in Langerhans cells (hence the name of these inclusions - "Langerhans cell granules"), the origin and biological significance of which remains unclear. Histiocytes have no signs of atypia, although they infiltrate many organs and tissues retain their normal properties. Histiocytic proliferation can develop in various organs and tissues, causing them to corresponding functional and morphological changes.

Problems of Endocrinology. 1996;42(3):26-29
For practitioners
Non-invasive method for determining the level of stable intrathyroid iodine in the diagnosis and control of treatment of thyroid diseases (lecture)
Tomashevsky I.O.

The technology of non-invasive determination of the level of intrathyroid stable iodine (ISI), called X-ray fluorescence analysis or X-ray fluorescence scanning, began to be used since 1968 and is currently used in approximately 10 radiological laboratories around the world as a unique research methodology. Only in recent years have the technical difficulties of this diagnostic method been overcome, and it is gradually becoming more accessible. Since 1974, the efforts of the staff of the Radiological Scientific Center of the Russian Academy of Medical Sciences (Obninsk) and the clinical hospital of the Central Health Unit No. 119 of the Federal Administration for Biomedical and Extreme Problems at the Ministry of Health of the Russian Federation (Khimki) carried out the necessary scientific research and created an analyzer, a method for determining the level ISI and interpretations of the results obtained, allowed for use in Russia as serial laboratory technologies. The specified diagnostic method over the past few years has been successfully used in these institutions when examining more than 3,000 patients with various thyroid diseases (thyroid gland) and continues to be used in the comprehensive diagnosis of thyroid pathology. The purpose of this lecture is to familiarize endocrinologists with the diagnostic capabilities of this method.

Problems of Endocrinology. 1996;42(3):29-32
Experimental endocrinology
Effect of blood plasma components on human serum albumin glycosylation
Lebedeva Y.A.

Glycosylation of human serum albumin (HSA) with ascending glucose concentrations was studied. The incubation medium contained 5% HSA and glucose in concentrations 11, 22, 44, and 88 mmol/liter. The degree of glycosylation was assessed by the end product, fructosamine. A linear correlation between glucose concentration and fructosamine was detected. Addition to incubation medium of human native plasma of a normal subject or diabetic with type I disease (50% of the initial volume) reliably inhibited glycosylation. Thermostable low-molecular substances were identified, which cause a delay of glycosylation: creatinine, uric acid, and arginine. Addition of these compounds in physiological concentrations reliably reduced glycosylation of HSA. Hence, we found the components of blood plasma defense system which prevent the formation of fructosamine in hyperglycemia.

Problems of Endocrinology. 1996;42(3):32-34
Histofluorometric assessment of insulin content in the endocrine tissue of the rat pancreas in the postreanimation period
Kikimbayeva A.A., Andreyeva A.P., Aubakirov A.B., Bazhanov A.N., Lebedev A.S.

Histofluorometric measurement of insulin was carried out in В cells of the rat pancreas after pseudoisocyanine staining of slices in various terms of the postreanimation period following 10-min clinical death after V.G. Korpachev. The studies showed that the reanimation factor enhanced insulin release into the blood and changed the morphology of islet endocrine tissue of the gland. Hypoxia promoted transformation of mixed acinar insular, acinar glandular, and ductal epithelial cells into insulin-producing cells in experimental animals. Histofluorometric analysis of assessing insulin content in histological preparations gives reliable data on the production of this hormone in the glandular B-cells.

Problems of Endocrinology. 1996;42(3):35-37
Isolipan (dexfenfluramine) and its place in the treatment of obesity
Ginzburg M.M., Kozupitsa G.S.

Obesity is the most common disease in the population of economically developed countries. 16-25% of the inhabitants of these countries have a body weight exceeding the norm by more than 15%. The increase in the incidence of obesity over the past 20 years is evident. The connection between obesity and such formidable diseases as hypertension, coronary heart disease, and type II diabetes is well known.

At the same time, the current state of the problem of obesity therapy is far from perfect. Most patients, realizing the need for treatment, nevertheless cannot start it because of fear of the need to follow a half-starved diet for a long time. And although drugs that can reduce hunger, belonging to the group of amphetamine derivatives (ampheramone, fepranone, desopimon, etc.), have been known for more than 40 years, their use is limited due to frequent side effects (agitation, insomnia, palpitations, increased blood pressure, the development of drug dependence) and a large number of contraindications (hypertension, impaired carbohydrate tolerance, coronary heart disease, etc.).

In this regard, the appearance of anorexigenic drugs of central serotonergic action, phenofluramine and later isolipan, IL (dexfenfluramine), which do not give such pronounced side effects and have relatively few contraindications, caused great interest. IL is a dextrorotatory isomer of fenfluramine and determines the anorexigenic effect of the latter.

Problems of Endocrinology. 1996;42(3):38-40
Stromal ovarian tecomatosis
Maltseva M.F., Pishchulin A.A., Bronstein M.E.

In 1942, S. Geist and J. Geines were the first to publish the unusual results of a histological examination of ovarian tissue in patients with Stein-Leventhal syndrome. They found foci of "luteinized" tecal cells, similar to theca interna folliculi cells, scattered along the ovarian "stroma" outside the follicles. The following year, L. Fraenkel in his work called these histopathological changes in ovarian hypertosis. In 1949, A. Culiner and S. Shipel used the term "hypertension syndrome" to refer to conditions in which foci of "tekomatosis", consisting of 10-30-60 individual hypertrophic and luteinized tecal cells in the ovarian "stroma", combined with the clinical picture of defemini ation and virilization. In subsequent years, due to the lack of a unified terminology in the literature, synonyms such as hypertosis, cortical stromal hyperplasia, stromal proliferation, stromal tecosis, and tecomatosis were used. R. Feinberg proposed dividing hypertosis into 3 groups, based on the predominance of cystic follicles and a thickened white membrane (mixed tecosis) with increased proliferation of the actual cells of the interstitial tissue or without it (internal tecosis). The presence of "stromal" proliferation in the absence of phenomena of cystic atresia of the follicles, he defined the term "stromal tecosis" (tekomatosis). I.V. Golubeva for the first time in our country drew attention to the clinical and hormonal features of stromal tecomatosis (ST), which was previously considered in the framework of polycystic ovary syndrome, and after 3 years M.E. Bronstein proved that this is an independent morphological form and gave a definition concepts of ST. Ovarian CT is understood as hyperplasia of the interstitial tissue of the ovaries and the appearance in it of groups of hypertrophied epithelioid cells that form foci of various sizes without any connection with follicles. The subject of this review is the consideration of the clinical and morphological picture of this disease, the features of hormonal homeostasis, modern hypotheses of the pathogenetic mechanisms of its development, as well as possible treatment options.

Problems of Endocrinology. 1996;42(3):40-45

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