Vol 57, No 6 (2011)

Differential diagnostics of adrenal incidentalomas
Bel'tsevich D.G., Soldatova T.V., Kuznetsov N.S., Remizov O.V., Vorontsov A.V., Rogal' E.I., Vanushko V.É., Kulezneva I.V., Kats L.E., Lysenko M.A., Mel'nichenko G.A.
Abstract
We have analysed the results of radiological investigations (USI, CT, and MRT) involving 177 patients given surgical treatment at the Endocrinological Research Centre during 2006-2010. In addition, the study included measurement of cortisol levels in the dexamethasone suppression test, fractionated metanephrins, and the relationship between aldosterone levels and plasma rennin activity (in the patients presenting with arterial hypertension). Twenty two patients underwent tumour puncture. Seventy six (55.9%) of the 136 patients having incidentalomas were found to have no indications for the surgical intervention (because of the absence of hormonal activity and low malignancy potential of the neoplasm). The follow-up period averaged 24.9±19 months. The choice of indications for the surgical treatment should be based on the results of standardized hormonal studies and the determination of malignancy potential using the native CT density above 20 UH as the principal criterion. Differential diagnostics by USI, MRT, and descriptive CT is believed to be inadequate. USI may be applied as a highly specific method for the detection of cysts and myelolopomas. Native CT density should be taken into consideration for the interpretation of the results of fractionated metanephrin measurements. Diagnosis of pheochromocytoma is very unlikely in the patients presenting with low CT density. Puncture biopsy is indicated only when the presence of metastases in the adrenal glands is suspected.
Problems of Endocrinology. 2011;57(6):3-8
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Serum adiponectin in obese children and adolescents
Peterkova V.A., Kosygina A.V., Vasiukova O.V.
Abstract
The objective of this work was to study the relationship between the serum adiponectin level on the one hand, and the age, stage of sexual development and main anthropometric characteristics of children and adolescents depending on the degree of obesity, the presence or absence of metabolic disorders on the other hand. A total of 111 children and adolescents at the age from 2.5 to 17.9 years were available for the examination including 56 presenting with "simple" constitutional exogenous obesity, 12 overweight patients, and 43 with normal body weight. The concentration of adiponectin in the serum of obese children and adolescents was lower than in those with normal body weight (p=0.009). The highest adiponectin level was documented in prepubertal children; it decreased progressively in the course of sexual development and negatively correlated with BMI, waist circumference---???---(WC), and BMI SDS. The children presenting with obesity complicated by insulin resistance, the serum adiponectin level was lower than in those having normal and stimulated immunoreactive insulin concentrations, HOMA-IR and Matsuda's ISI indices. The study revealed the relationship between serum adiponectin levels, concentrations of high density lipoprotein cholesterol and triglycerides. The data obtained give reason to conjecture that the reduction of serum adiponectin level may be a link connecting obesity, insulin resistance, and atherogenic changed in the serum developing as early as the childhood that can be used as an additional biomarker for the identification of a group of children and adolescents at high risk of complications associated with obesity.
Problems of Endocrinology. 2011;57(6):9-14
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The efficacy of insulin glargine under real clinical practice conditions: results of the LAURUS-2 observational program
Skudaev S.A., Verbovaia N.I.
Abstract
The objective of the Program is to estimate the efficacy and safety of insulin glargine (Lantus) used in routine clinical practice for the treatment of patients presenting with type 2 diabetes mellitus who failed to reach adequate compensation of the disease by therapy with two hyperglycemic agents in combination with NPH insulin and have a glycated hemoglobin level in excess of 7.0%. The data obtained by examining 2395 patients (755 men and 1640 women) were available for analysis. 2157 patients (685 men and 1472 women) were transferred to insulin glargine therapy whereas the remaining 238 ones (70 men and 168 women) continued to use NPH insulin. The patients of the former group were offered two algorithms for dose titration of glargine (Lantus). Significant improvement of the parameters of carbohydrate metabolism was achieved within 12 weeks after the onset of therapy without the risk of hypoglycemia. It is concluded that the results of the Program demonstrate a higher efficacy and safety of insulin glargine compared with NPH insulin for the treatment of the patients with type 2 diabetes mellitus. The use of a simple dose titration algorithm and glycemic self-control makes it possible to quickly, safely, and efficiently achieve optimal parameters of carbohydrate metabolism in the majority of the patients treated with insulin glargine at a low incidence of episodes of all types of hypoglycemia.
Problems of Endocrinology. 2011;57(6):15-20
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Multiple type 2 endocrine neoplasia (case report)
Iukina M.I., Goncharov N.P., Bel'tsevich D.G., Troshina E.A.
Abstract
The congenital form of pheochromocytoma is known to be fraught with high risk of post-treatment relapse, bilateral, multicentric or primarily multiple lesions. The patients presenting with the syndrome of multiple type 2 endocrine neoplasia usually have no extra-adrenal pheochromocytomas or metastases. Both examination and treatment of these patients should be performed taking these peculiarities into consideration. We describe a family with multiple type 2 endocrine neoplasia and highlight selected aspects of the management of the patients presenting with genetically determined pheochromocytoma.
Problems of Endocrinology. 2011;57(6):21-26
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A case of diffuse toxic goiter and concomitant Buschke's scleroderma
Shuvaeva F.K., Vorozhtsova E.I., Verbovoĭ A.F.
Abstract
A patient presenting with diffuse toxic goiter and concomitant Buschke's scleroderma is described.
Problems of Endocrinology. 2011;57(6):27-29
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Levitra: multiple action, prospects for application
Vertkin A.L., Morgunov L.I., Zviagintseva E.I.
Abstract
Vardenafil (Levitra) is a phosphodiesterase type V inhibitor traditionally used for the treatment of erectile dysfunction. The use of Levitra by the subjects free of a concomitant pathology (including combined therapy) is believed to be safe, however its action awaits further investigation. It is expected that Levitra will find a wider application in the future for the management of various somatic disorders.
Problems of Endocrinology. 2011;57(6):30-34
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A case of type 1 diabetes mellitus and concomitant Hajdu-Cheney syndrome
Dreval' A.V., Kamynina T.S., Volodina M.N., Kotalevskaia I.I., Demikova N.S.
Abstract
The first case of type 1 diabetes mellitus with concomitant rare genetically determined Hajdu-Cheney syndrome has been documented among the Russian population. The patient was a 26 year-old subject at the early stage of diabetes.
Problems of Endocrinology. 2011;57(6):35-38
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The role of anti-Mullerian hormone in the differentiation, development, and functioning of the reproductive system
Ustinkina T.I., Shustov S.B.
Abstract
The integral analysis of the available information concerning the role of anti-Mullerian hormone (AMH) in the differentiation, development, and functioning of the reproductive system allows to make the following conclusion. The germ cells predetermine AMH biosynthesis from beginning to end of functioning of the reproductive system. The onset of germ cell meiosis restricts biosyhthesis of anti-Mullerian hormone that is maintained at a constant level throughout the rest of the period of reproductive maturity. AMH biosynthesis becomes arrested with the decrease of gametogenesis.
Problems of Endocrinology. 2011;57(6):39-44
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Diagnostics of medullary thyroid cancer and the strategy of its management in the absence of biochemical remission
Gazizova D.O., Bel'tsevich D.G., Tiul'pakov A.N., Simakina O.V., Soldatova T.V.
Abstract
Early diagnosis greatly facilitates successful treatment of medullary thyroid cancer. The present paper is designed to report the results of analysis of the studies carried out with the use of various diagnostic techniques and the data obtained during the long-term treatment of the patients with this pathology in the absence of biochemical remission.
Problems of Endocrinology. 2011;57(6):45-51
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Oxidative stress in type 2 diabetes mellitus and methods for its correction
Ametov A.S., Solov'eva O.L.
Abstract
Recent publications concerning mechanisms of late vascular complications of type 2 diabetes mellitus lay emphasis on oxidative stress as a major factor contributing to their development. Moreover, oxidative stress induced by hyperglycemia is considered to be the main cause underlying beta-cell lesion that accelerates progression of diabetes. Modern hypoglycemic agents must have additional properties preventing the development of vascular complications. Gliclazide MV is considered to be a medicine displaying anti-atherogenic and anti-oxidative properties that promote the survival of beta-cells exposed to oxidative stress and increase the resistance of low-density lipoproteins to oxidation.
Problems of Endocrinology. 2011;57(6):52-56
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Thiazolidinediones: a long way to clinical practice
Aleksandrov A.A., Kukharenko S.S., Iadrikhinskaia M.N., Shatskaia O.A., Drozdova E.N.
Abstract
The clinical application of thiazolidinediones has an almost 12 year history. The correction of carbohydrate metabolism achieved by the treatment with hiazolidinediones is associated with the reduction of many risk factors of coronary heart disease and the improvement of prognosis for the patients presenting with type 2 diabetes mellitus. The possible mechanisms underlying complications encountered in the clinical practice in connection with the use of thiazolidinediones are discussed.
Problems of Endocrinology. 2011;57(6):57-63
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Inflammation of adipose tissue (Part 5). The relationship with physiological insulin resistance
Shvarts V.I., Kolberg B.
Abstract
This review contains the results of investigations representing insulin resistance as a physiological factor that ensures supply of macroergic substrates for the functioning organs and tissues. Physical activity promotes the development of insulin resistance in adipose and renal cells with the resulting enhancement of the secretion of glucose and lipids into blood. Simultaneously, the insulin action in muscular cells increases which facilitates utilization of these compounds. The opposite change in insulin sensitivity of different cells is mediated through a rise in interleukin-6 secretion during muscular activity. The immune processes are associated with the development of insulin resistance in adipocytes, hepatocytes, and myocytes leading to the elevation of blood glucose and lipid levels that accounts for the enhanced requirement of immune cells in these compounds. The mechanism underlying the development of insulin resistance during immune processes consists of activation of Toll-like receptors. Increased secretion of placental hormones in the course of gestation causes disturbances in the insulin action in the peripheral tissues and thereby ensures supply of energy-rich and plastic substrates for the growing fetus. Inflammation of adipose tissue is associated with physiological and pathological insulin resistance. This condition is discussed as a factor contributing to the transformation of physiological insulin resistance to pathological one.
Problems of Endocrinology. 2011;57(6):64-70
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