Vol 56, No 4 (2010)

The prevalence and clinical features of polycystic ovary syndrome in a Moscow population
Dedov I.I., Mel'nichenko G.A., Chebotnikova T.V., Il'in A.V., Davydova G.N., Kolesnikova G.S., Ivannikova E.V.
Abstract
The objective of the present study was to estimate the prevalence and and characterize clinical phenotypes of PCOS. A total of 312 women from 18 to 45 years of age working engaged in Moscow enterprises were examined in 2009. All of them were interviewed by questionnaire, underwent routine medical examination, anthropometry and blood sampling for the measurement of Prl, TSH, FSH, testosterone, 17-OP, and DHEAS levels. The degree of hirsutism was assessed using the modified Ferriman-Galway scale. Women with fewer than eight cycles during a year were regarded as having menstrual problems. All women presenting with disturbances were invited for verification of the diagnosis. PCOS was diagnosed based on the Rotterdam (2003) criteria (the presence of oligo-/amenorrhea and clinically manifest hyperandrogenism (hirsutism), with all other disorders simulating the clinical picture of PCOS being excluded). All patients with clinical signs of PCOS were examined at the Endocrinological Research Centre. They were divided into the following groups: 1. Regular menstrual cycles in the absence of hirsutism. 2. Menstrual dysfunction (oligo-/amenorrhea) without hirsutism. 3. Hirsutism without menstrual disturbances. 4. Menstrual dysfunction plus hirsutism. Mean age of the women was 30,2±7,4 years, their BMI 24±5,5, overweight patients comprised 17,3% of the total (n=54), obesity occurred in 14.7% (n=46), oligoamenorrhea in 12.8%, hirsutism in 9.3%, acne in 6.4%, infertility in 2.6%, obesity in 14%. Menstrual dysfunction without hirsutism was documented in 17/312 (5.4%) cases. The prevalence of PCOS in this phenotypical group was estimated at 17.6%. Hirsutism in the absence of menstrual dysfunction was diagnosed in 8/312 (2.6%) women (prevalence of PCOS 62.5%), menstrual dysfunction plus hirsutism in 21/312 (6.7%) patients (prevalence of PCOS 85.7%). The study has demonstrated that the overall prevalence PCOS in the given population was 6,4%, but individual symptoms of this condition were manifest much more frequently than that. It is concluded that the diagnosis of PCOS is most reliably confirmed by the presence of combination of oligo-/amenorrhea and hirsutism.
Problems of Endocrinology. 2010;56(4):3-8
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Galectin-3 expression in preoperative diagnosis of highly differentiated thyroid cancer
Semenov D.I., Koloskova L.E., Boriskova M.E., Pankova P.A., Feshchenko N.S., Filippova O.I.,  Farafonova U.V.
Abstract
Galectin-3 expression in fine-needle aspiration biopsies from 66 patients with thyroid Nodes (TN) was studied by flow fluorocytometry (FFC). Cytological study revealed 29 patients with papillary thyroid cancer, 31 with follicular tumour, and 6 with colloid nodular goiter. Galectin-3 expression was documented in 27 of the 29 patients with preoperative diagnosis of papillary cancer; in 25 (92.6%) of these cases diagnosis of highly differentiated cancer was confirmed histologically, the remaining 2 (7.4%) cases presented with benign thyroid disease. Two (6.9%) patients without galectin-3 expression had papillary cancer. In the group of patients with cytologically verified diagnosis of follicular tumour, galectin-3 expresion occurred in 2 with highly differentiated (papillary and follicular) thyroid cancer and in 2 with follicular and oncocytic thyroid adenoma. The remaining 27 patients with benign neoplasms did not show expression of galectin-3. Nor was it detected in 6 (100%) patients with colloid nodular goiter. Sensitivity of flow fluorocytometry for detection of galectin-3 expression in thyroid node aspirates was estimated at 93.1%, specificity 89.2%, diagnostic precision 90.9%. It is concluded that this method may be used as an additional tool for preoperative diagnosis of high-differentiated thyroid cancer.
Problems of Endocrinology. 2010;56(4):9-15
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Population-based genetic analysis of the prevalence of obesity in Chuvash Republic
Markova T.N., Kichigin V.A., Madianov I.V., Semenova T.N.
Abstract
The objective of the present work was to study the prevalence of obesity among 271 residents of the Chuvash Republic taking account of their sex and ethnic background. Simultaneously, genetic predisposition to obesity was assessed from the presence or absence of this condition in 955 blood relatives of the probands using Edwards' coefficient of genetic determination and coefficient of association. Results of the study suggest higher prevalence of obesity in women than in men and in Russians compared with Chuvashes. Genetic determination of obesity was found to be independent of sex and type of fat distribution. The risk of developing obesity proved to be significantly higher in the probands from families in which both parents were obese than from those with only one obese parent.
Problems of Endocrinology. 2010;56(4):16-19
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Emotional-volitional disorders in patients with type 2 diabetes mellitus, concomitant arterial hypertension and diabetic polyneuropathy
Petrova M.M., Kurumchina O.B., Pronina E.A.
Abstract
The objective of the present work was to evaluate effects of type 2 diabetes mellitus (DM2) combined with arterial hypertension (AH) and diabetic polyneuropathy (DPN) on the development of alterations in the emotional-volitional sphere. The work was comprised of two prospective studies; one of them (study 1) included 140 women presenting with DM2, the other (study 2) enrolled 80 patients with DM2 hospitalized at the Endocrinological Department of N.S. Karpovich City Clinical Hospital No 6, Krasnoyarsk. Disturbances in the emotional-volitional sphere were evaluated based on the hospital anxiety and depression scale (HADS). Their frequency proved to be as high as 67.9 and 70.7% in studies 1 and 2 respectively. The number of anxiety disorders was on the whole greater than that of depressive ones. The latter disorders in patients with AH occurred twice as often as in DM2 patients without AH (50.5 and 25.9% respectively). The frequency of anxiety disorders was not significantly different in the two groups, but they were found to be more severe in patients presenting with combination of DM2 and AH. It is concluded that DM2 is associated with frequent clinically significant anxiety and depressive symptoms depending on the duration of the disease and insulinotherapy. Patients presenting with a combination of DM2 and AH or DPN suffer significantly more pronounced anxiety and depression disordered.
Problems of Endocrinology. 2010;56(4):20-22
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Reproductive function in men presenting with Cushing's disease
Rozhivanov R.V., Kurbatov D.G., Rozhinskaia L.I.
Abstract
This paper reports results of clinical examination of 29 men having corticotropinoma. It was shown that hypogonadism occurs in more than 60% of the patients with this condition and is accompanied by disorders of sexual function and spermatogenesis. Excessive cortisol secretion in men with coticotropinoma may contribute to the development of infectious and inflammatory diseases of sexual organs and leukospermia.
Problems of Endocrinology. 2010;56(4):23-26
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A case of severe neonatal hyperparathyroidism due to defect in calcium receptors
Vitebskaia A.V., Petriaĭkina E.E., Razumovskiĭ A.I., Pavlov A.A., Tiul'pakov A.N.
Abstract
The first case of severe neonatal hyperparathyroidism in the Russian population verified by molecular-genetic testing is described. The patient presented with very high calcium and parathyroid hormone (PTH) levels and showed characteristic clinical symptoms of hyperparathyroidism in the absence of lesions in long tubular bones. Removal of all parathyroid glands resulted in normalization of laboratory parameters and general health status of the patient. Diagnosis of severe neonatal hyperparathyroidism was confirmed by sequencing the CASR gene while parents of the child were shown to suffer familial hypocalciuric hypercalcemia.
Problems of Endocrinology. 2010;56(4):27-33
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Disturbances in the hemostatic system of patients with endogenous hypercorticism and metabolic syndrome
Khodakova I.V., Arapova S.D., Sukhanova G.A., Chirkova L.D., Rozhinskaia L.I.
Abstract
Long-standing hypercortisolemia is accompanied by multiple defects of metabolic regulation. Glucocorticoids are known to affect not only metabolic processes but also the vascular wall directly influencing its remodeling and angiogenesis. Syndrome of endogenous hypercorticism is characterized by various disturbances in the hemostatic system and a tendency toward the development of hypercoagulation. Altered metabolic and hemostatic parameters in the active phase of the disease persist during a long time after the achievement of remission. It accounts for the high risk of atherosclerosis, atherothrombosis, and thromboembolic complications which necessitates correction with medicinal preparations throughout the follow-up period. According to foreign authors, thromboembolic complications are the main cause of mortality among the patients with this clinical condition and occur 4 times as frequently as in the general population.
Problems of Endocrinology. 2010;56(4):34-38
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Laboratory diagnostics of pheochromocytoma
Troshina E.A., Bel'tsevich D.G., Iukina M.I.
Abstract
Biochemical diagnosis of pheochromocytoma is based on the measurement of altered levels of normetanephrine and metanephrine in plasma or 24-hour urine samples. Plasma normetanephrine and metanephrine levels four times the upper limit of the normal value or metanephrine and normetanephrine excretion in urine above 700 and 1500 mcg/24 hours respectively makes further testing unnecessary and subsequent examination must be focused on the determination of tumour localization. In patients presenting with the above parameters elevated within the "grey zone", effect of medicinal products needs to be excluded and the diagnosis confirmed in the clonidine test or by the measurement of chromogranin A level.
Problems of Endocrinology. 2010;56(4):39-43
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Cyclic Cushing's syndrome
Marova E.I., Voronkova I.A.
Abstract
The cyclic Cushing's syndrome is a rare disease characterized by multiple episodes of elevated cortisol levels alternating with periods of its normal secretion. The so-called hypercorticism cycles may be either regular or episodic with intercycle intervals as long as a few days to several years. Most researchers agree that the reliable diagnosis of cyclic Cushing's syndrome should be based on laboratory detection of 3 peaks and 2 falls of plasma cortisol level. Cyclic Cushing's syndrome may be either ACTH dependent or independent. A review of 65 verified cases indicates that this condition may be caused by pituitary corticotropinoma (54%), ectopic ACTH-producing tumour (26%), and adrenal tumour (roughly 11%). The cause of the disease remains uncertain in 9% of the patients. Pathophysiological mechanisms of cyclic Cushing's syndrome are poorly known. In certain cases of bilateral macronodular adrenal hyperplasia or adrenal corticosteroma, it may be associated with the presence of ectopic receptors or anomalous expression of normally located receptors. The majority of the patients presenting with cyclic Cushing's syndrome exhibit symptoms of classical hypercorticism that manifest themselves either on a permanent or cyclic basis. In a small number of patients, clinical signs of cyclic Cushing's syndrome are virtually absent. Variations of the clinical picture and conflicting results of hormonal assays taken together make cyclic Cushing's syndrome difficult to diagnose. Therefore, physicians must be aware of this condition and actively search for it in all patients believed to have an enhanced cortisol production despite normal results of laboratory analysis. Frequent changes of urinary or salivary free cortisol levels are reliable and convenient criteria for cyclic Cushing's syndrome in patients suspected to have this condition. Results of cortisol stimulation or suppression tests are likely to lead to a false conclusion due to spontaneous falls and rises in serum cortisol levels at the time of analysis. Given laboratory confirmation of cyclic Cushing's syndrome, subsequent studies should be focused on the elucidation of its cause. The average life expectancy of patients with cyclic Cushing's syndrome remains to be determined.
Problems of Endocrinology. 2010;56(4):44-51
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