Vol 56, No 5 (2010)

Epidemiology of primary hyperparathyroidism
Dedov I.I., Vasil'eva T.O., Rozhinskaia L.I., Mokrysheva N.G.
Abstract
Up to the mid-1970s, primary hyperparathyroidism (PHPT) was considered to be a rare pathology. The introduction of methods for the measurement of blood calcium levels into the clinical practice substantially extended knowledge about diverse forms of PHPT and its prevalence. The present review presents results of those sparse epidemiological investigations of PHPT that were carried out in different countries.
Problems of Endocrinology. 2010;56(5):3-7
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ACTH-producing neuroendocrine chest wall tumours
Marova E.I., Kokshagina N.V., Rozhinskaia L.I.
Abstract
This paper reports data on the prevalence and pathogenesis of ectopic ACTH-producing neuroendocrine chest wall tumours, analyse their specific clinical, morphological, and immunohistochemical features, describe methods available for their diagnosis and treatment. Detailed characteristics of bronchial carcinoid, thymic carcinoid, and small-cell lung cancer are presented.
Problems of Endocrinology. 2010;56(5):8-14
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Late consequences of long-term glucocorticoid therapy in patients with congenital adrenal cortical dysfunction
Molashenko N.V., Sazonova A.I., Troshina E.A., Kalinchenko N.I.
Abstract
Novel information concerning the management of adult patients with congenital adrenal cortical dysfunction is presented. New methods for the treatment of this pathology are described along with evaluation of its outcomes. Late consequences of long-term glucocorticoid therapy of congenital adrenal cortical dysfunction are considered.
Problems of Endocrinology. 2010;56(5):15-22
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Functional state of the hypothalamic-pituitary-gonadal axis in diabetes mellitus
Shpakov A.O.
Abstract
Diabetic patients present with a wide variety of reproductive disorders supposed to be underlain by changes in the functional activity of the hypothalamic-pituitary-gonadal axis (HPGA) and sensitivity of the reproductive system tissues to the regulatory hormonal action. The objective of the present review is to analyse the literature data and the results of original studies pertinent to the biosynthesis and secretion of hypothalamic LH releasing factor, pituitary gonadotropic hormones, steroid hormones, and susceptibility of their target tissues in patients with types 1 and 2 diabetes mellitus. It is concluded that the improvement of control over blood glucose levels constitutes a most efficacious approach to the correction and normalization of reproductive function in diabetic patients.
Problems of Endocrinology. 2010;56(5):23-29
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The risk of development of prostatic hyperplasia and prostate cancer in patients presenting with acromegalia
Rozhivanov R.V., Fabrichnova A.A., Lepetukhin A.E., Dubskiĭ S.A., Kurbatov D.G.
Abstract
The objective of the present review was to consider the available data on the risk of development of prostatic hyperplasia and prostate cancer in patients presenting with acromegalia. It is shown that the incidence of prostatic diseases in acromegalic patients is significantly higher than in the general population. Prostatic hyperplasia occurs in patients of all age groups presenting with acromegalia while its treatment reduces the volume of the prostate gland. The reviewed publications do not report cases of prostate cancer.
Problems of Endocrinology. 2010;56(5):30-32
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Peculiarities of pathogenesis, diagnostics and treatment of erectile dysfunction in patients presenting with hypogonadism
Gamidov S.I., Tazhetdinov O.K., Pavlovichev A.A., Popova A.I., Tkhagapsoeva R.A.
Abstract
Different authors estimate the prevalence of hypogonadism and erectile dysfunction at 1.7% to 35%. The contribution of androgens playing an important role in regulation of erection remains the subject of extensive investigations. To date, experimental and clinical studies have demonstrated that androgen deficiency leads to degeneration and apoptosis of smooth muscle cells followed by fibrosis of cavernous bodies, impaired expression of endothelial and neuronal NO synthase, decreased arterial inflow and increased venous drainage of the cavernous bodies, enhanced sensitivity to mediators of vasoconstriction, impaired NO-mediated relaxation of smooth muscles in response to sexual stimulation, reduced expression of type 5 phosphodiesterase (PDE-5). Moreover, hypogonadism and erectile dysfunction are frequently associated with cardiovascular disorders, diabetes mellitus, metabolic syndrome, dyslipidemia, hypercholesterolemia, hypertriglyceridemia, and obesity. The main purpose of hormonal substitution therapy is to maximally normalize the physiological concentration of plasma testosterone and to eliminate clinical manifestations of androgen deficiency. The treatment with testosterone-containing preparations is indicated only for patients with clinical symptoms and laboratory findings suggestive of hypogonadism. The testosterone-based preparations for intramuscular administration currently find wide application for this purpose. Testosterone substitution therapy enhances libido, increases the frequency of morning erection, and improves sexual quality of life at large. It is worthy of note that treatment with these preparations is well tolerated by the patients. Control over hormonal substitution therapy with testosterone preparations implies evaluation of the clinical response and achievement of the target testosterone level in blood plasma. Also. it is necessary to measure PSA, perform digital rectal examination, and determine the hematocrit level prior to the initiation of the treatment, 3 and 6 months after its termination, and every 6 months thereafter. To conclude, androgens are natural stimulators maintaining sexual function in men. Patients with hypogonadism and erectile dysfunction should be managed by combined therapy with androgens and PDE-5 inhibitors.
Problems of Endocrinology. 2010;56(5):33-42
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The importance of combined glycemic control in patients with type 2 diabetes mellitus
Kononenko I.V., Smirnova O.M.
Abstract
The contribution of intensive control of glycemia to the reduction of the risk of microvascular complications of type 2 diabetes mellitus is known perfectly well whereas its influence on the development of macrovascular complications remains to be clarified and remains a subject of debates. Bearing in mind that hyperglycemia is a key pathogenetic factor triggering formation of diabetic complications, it is necessary to identify characteristics of carbohydrate metabolism to be taken into account when choosing therapeutic strategies and to determine their target values. Control of the HbA1c level remains the most accessible and informative tool for the assessment of the efficiency of long-term compensation of type 2 diabetes mellitus. However, this method is not altogether free from limitations that can hamper its clinical application. The fasting glycemia level does not completely reflect the quality of DM2 treatment. There is potential relationship between high postprandial plasma glucose levels and the development of vascular complications. Also, it has been shown that variability of glucose concentration may be an important risk factor of diabetic complications. Measurement of the full range of glycemic parameters including fasting plasma glucose level, HbA1c and postprandial glycemia gives an idea of the general picture of the course of the disease necessary for the choice of the treatment strategy.
Problems of Endocrinology. 2010;56(5):43-51
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Extension of the group of incretin-targeted preparations: Saxagliptin – a new dipeptidyl peptidase-4 inhibitor
Shestakova M.V., Sukhareva O.I.
Abstract
A new selective incretin-targeted dipeptidyl peptidase-4 inhibitor was registered in the Russian Federation in August 2010. The enzyme dipeptidyl peptidase-4 inactivates glucagon-like peptide-1 (GLP-1). A rise of GLP-1 concentration in blood plasma is known to result in the glucose-dependent stimulation of insulin secretion by pancreatic beta-cells and suppression of glucagon release. Saxagliptin is readily absorbed in the gastrointestinal tract and remains active within 24 hours after oral intake. It allows the drug to be taken once during 24 hours. Clinical studies have demonstrated that saxagliptin improves glycemic control when used as both monotherapy and in combination with other antidiabetic medicines (metformin, sulfonylureas, and thiazolidinediones). The use of saxagliptin leads to a reduction of fasting and postprandial plasma glucose level and thereby to the clinically significant decrease in glycated hemoglobin (HbA1c) concentration. The low risk of hypoglycemia following saxagliptin intake is due to the glucose-dependent mechanism of its action. The results of clinical investigations indicate that saxagliptin is safe and well tolerated by the patients and has no significant influence on their body weight; its dose does not need to be corrected for the sex and age of the patients or the presence of concomitant hepatic disorders.
Problems of Endocrinology. 2010;56(5):52-60
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Results of the observational program on the use of insulin glargine (Lantus) in combination with oral hypoglycemic agents or prandial insulins for the treatment of type 2 diabetes mellitus in routine clinical practice
Glinkina I.V.
Abstract
The objective of this observational program was to evaluate the efficiency and safety of insulin glargine used to treat patients with type 2 diabetes mellitus (DM2) who failed to achieve adequate compensation of carbohydrate metabolism during therapy with NPC insulin in combination with oral hypoglycemic agents or prandial insulins. The secondary objective was to estimate satisfaction of physicians with the results of insulin glargine therapy. The open, prospective non-randomized multicentre observational study included 7.334 patients of the mean age 58.3±9.0 years presenting with type 2 diabetes mellitus and treated using a combination of NPC insulin and oral hypoglycemic agents or prandial insulins. The mean duration of the disease was 10.5±4.7 years, HbA<inf>1c</inf> level 9.6±1.7%, fasting blood glucose level 10.3±2.5 mmol/l. The total duration of the study was 6 months. After inclusion in the program, the patients were transferred from NPC insulin to insulin glargine with subsequent titration of the dose. The HbA<inf>1c</inf> level decreased from 9.6±1.7% to 8.0±1.2% and 7.2±1.0% within 3 and 6 months after the inclusion into the study respectively (p<0.001 for both values). The fasting blood glucose levels exhibited a similar trend. The target HbA<inf>1c</inf> level of ≤ 7% was achieved within 3 months in 29.2% of the patients and within 6 months in 53.8%. Simultaneously a reduction in the incidence of mild and severe hypoglycemic symptoms was documented both during the daytime and at night. The physicians described the results of the treatment as "good" and "very good" in 80.7% and 93.2% of the patients 3 and 6 months respectively after transfer from NPC insulin to insulin glargine in combination with oral hypoglycemic agents. It is concluded that substitution of NPC insulin by insulin glargine for the treatment of patients presenting with type 2 diabetes mellitus not only improves the quality of glycemic control but also significantly reduces the frequency of mild and severe hypoglycemic symptoms.
Problems of Endocrinology. 2010;56(5):61-66
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