Pharmateca

2024 marks the centenary of the first publication with a clinical description of endogenous hypercortisolism syndrome by Russian neurologist Nikolai Mikhailovich Itsenko. Twelve years later, American neurosurgeon Harvey Cushing expanded on this description, and since then, the disease has been named after both scientists. During this time, medicine has made tremendous progress from the first observations to modern pathogenetic drugs. This review is based on the latest international guidelines and new scientific data. It examines the evolution of approaches to the diagnosis and treatment of Itsenko-Cushing’s disease and assesses the problems and prospects for further development.

Background: Obesity and overweight are leading causes of chronic noncommunicable diseases (NCDs), posing a serious threat to public health, including children. Traditional approaches to obesity prevention and treatment are insufficiently effective, so it is necessary to explore the potential of digital technologies and artificial intelligence.

Objective: Characterization of current scientific data and clinical prospects for the application of digital technologies and artificial intelligence in the prevention, diagnosis, and management of obesity and overweight, and examination of the impact of these technologies on NCD prevention.

Methods: A systematic review and meta-analysis of 15-year studies on the use of digital technologies and artificial intelligence in the prevention and treatment of obesity was conducted. Leading international databases (PubMed, Scopus, Web of Science, Medline, and E-library) served as the primary sources of information. A qualitative data analysis identifying key achievements and limitations of existing approaches was performed.

Results: The review highlights key areas of randomized controlled cohort studies examining the role of digital technologies and artificial intelligence in obesity diagnosis, risk assessment, and the selection of personalized preventive measures. Particular attention is paid to the implementation of digital solutions in pediatrics to prevent childhood obesity.

Conclusion: Modern digital technologies and artificial intelligence demonstrate high potential for improving the prevention, diagnosis, and treatment of obesity and overweight, including in children. Their implementation can significantly reduce the risk of developing chronic noncommunicable diseases and improve the quality of life of the population.

Objective: Scientific review of current approaches to treating patients with type 2 diabetes mellitus (DM2) using the oral GLP-1 receptor agonist (GLP-1 RA) semaglutide.

Key points: Treatment of diabetes mellitus is a pressing issue in modern medicine. New formulations of GLP-1 RA are emerging, making therapy more acceptable to patients. In 2025, PROMOMED introduced Semaltara^®, an oral formulation of semaglutide, in various therapeutic doses (3 mg, 7 mg, and 14 mg), which is widely used in clinical practice.

Conclusion: Current approaches to the treatment of type 2 diabetes mellitus recommend the use of semaglutide, including in oral form, both to improve carbohydrate metabolism and to reduce the risk of developing and progressing cardiovascular diseases (CVD), chronic kidney disease (CKD), as well as in the presence of atherosclerotic CVD (ASCVD) or risk factors for it, CKD, and obesity in patients.

Telemedicine transforms approaches to diabetes management, shifting the focus to remote monitoring and personalized support. Meta-analyses demonstrate that the use of telemedicine platforms and mobile carbohydrate-counting apps not only improves glycemic control but also significantly reduces body weight, blood pressure, and LDL cholesterol. The use of such technologies in gestational diabetes improves treatment adherence and patient satisfaction without compromising perinatal outcomes. Modern smart glucometers integrated with mobile apps (e.g., the Contour Plus Elite system with the Contour Diabitis app) are becoming an effective and accessible tool for implementing telemedicine strategies, ensuring accurate measurements, convenient data analysis, and the ability to interact remotely with a doctor.

Background: The pathogenetic variability of type 2 diabetes mellitus (DM2) necessitates the use of a wide range of glucose lowering drugs (GLDs) that affect various disease mechanisms and enable the development of individualized treatment strategies by selecting different classes. To evaluate current strategies in real-world clinical practice, an analysis of the structure of DM2 therapy was conducted in a cohort of Moscow patients.

Objective: Examination of the current treatment regimen for DM2 in Moscow using data from the Moscow segment of the Clinical and Epidemiological Monitoring Database for Diabetes and the role of dipeptidyl peptidase type 4 (DPP-4) inhibitors in its treatment.

Materials and methods: A retrospective analysis of data from 355,210 diabetic patients treated in outpatient medical facilities of the Moscow healthcare system as of March 10, 2026, was conducted. Particular attention was paid to the role of DPP-4 inhibitors, in particular vildagliptin, in DM2 therapy, especially in older patients.

Results: The analysis included 355,210 patients with DM2, including 224,018 (63.1%) women. The mean patient age was 69.1±11.1 years, and the mean diabetes duration was 9.3±7.4 years. The most frequently used treatments were monotherapy [36.7% (130,236 patients)] and dual combination therapy [29.8% (105,949 patients)]. Less frequently, therapy with 3 or more GLDs was used [12.4% (43,926 patients)]. Insulin therapy was used in 19.8% of cases (70,390 patients). 1.3% of patients (4,709 people) were on diet therapy. In the structure of DM2 therapy, the most frequently prescribed drug was metformin - 77.7% (276,072 people) and sulfonylurea (SU) drugs [38.8% (137,877 people)]. DPP-4 inhibitors were used in 27.4% of cases, while in 40.5% of cases they were represented by vildagliptin. GLP-1 agonists were used in 4.8% of patients.

Conclusion: The majority of patients are elderly and senile (65+ years), with a high prevalence of comorbidities. DPP-4 inhibitors are used by 27.4% of patients, of which 40.5% use vildagliptin, indicating its clinical efficacy and safety. Vildagliptin appears to be a natural choice for a wide range of patients with type 2 diabetes mellitus, particularly in the elderly, due to its favorable safety and efficacy profile.

Background: In patients with type 1 diabetes mellitus, factors such as the development of hypoglycemic episodes, fear of hypoglycemia, and signals from CGM devices may additionally influence the qualitative and quantitative characteristics of sleep. Although the duration and quality of sleep in patients with type 1 diabetes mellitus (DM1) are comparable in polysomnographic studies and in individuals without carbohydrate metabolism disorders, DM1 patients subjectively rate their sleep as less restorative, potentially further negatively impacting quality of life in this cohort.

Objective: Evaluation of the relationship between the frequency of hypoglycemic episodes, subjective sleep quality, daytime sleepiness, and quality of life indicators in DM1 patients.

Materials and methods: An observational, cross-sectional clinical study involving 74 patients with type 1 diabetes mellitus was conducted. All patients underwent an examination that included an assessment of their history of hypoglycemic episodes, quality of life using the SF-36 questionnaire, and subjective sleep assessment using the Spiegel Sleep Rating Scale and the Epworth Sleepiness Scale.

Results: Analysis of standardized quality-of-life measures showed that the group of patients with less frequent hypoglycemia episodes had better quality-of-life scores across all SF-36 scales. Moreover, an increase in the frequency of hypoglycemia episodes did not lead to a subjective decrease in sleep quality as measured by the Spiegel Sleepiness Scale or an increase in daytime sleepiness as measured by the Epworth Sleepiness Scale. Patients with significant daytime sleepiness (more than 10 points on the Epworth Sleepiness Scale) had significantly lower total SF-36 scores and physical component scores. However, patients with lower sleep quality as measured by the Spiegel Sleep Questionnaire did not show statistically significant differences across any of the SF-36 scales.

Conclusion: In DM1 patients, hypoglycemia is an additional factor reducing quality of life: in addition to severe physical discomfort and stress, it can cause qualitative and quantitative changes in sleep. In turn, sleep disorders and associated daytime sleepiness significantly impair daily functioning and subjective well-being in patients, increasing the overall burden of the disease.

Background: Hypoparathyroidism (HypoPT) is characterized by persistent hypocalcemia, requiring lifelong therapy with active forms of vitamin D in combination with calcium (Ca) supplements. Maintaining serum Ca levels at the lower limit of normal is recommended to prevent hypercalciuria; however, safe thresholds have not been determined. In addition to hypocalcemia, HypoPT is associated with hyperphosphatemia, which is an additional risk factor for complications.

Objective: Determination of threshold blood Ca levels associated with an increased risk of hypercalciuria in children with HypoPT treated with active forms of vitamin D and assessment of the incidence of hyperphosphatemia in patients with values above and below the identified thresholds.

Materials and methods: This retrospective study with a prospective component assessed clinical and laboratory data from 262 inpatient episodes in 63 patients with congenital forms of HypoPT at the Endocrinology Research Centre (patients were examined at the center multiple times). Descriptive and comparative statistics were used, as well as ROC analysis with cut-off points determined using the Youden test.

Results: The first stage involved comparing inpatient episodes with and without hypercalciuria. Statistically significant differences in the levels of total, albumin-corrected, and ionized serum Ca in the analysis of a single urine sample (p< 0.001), as well as in the level of total serum Ca in the assessment of 24-hour urinary calcium excretion (p< 0.006) were found. Based on the ROC analysis, the following threshold values of calcemia associated with the risk of hypercalciuria in a single urine portion were determined: for total blood Ca – 2.21 mmol/L, for albumin-corrected – 2.15 mmol/L, for ionized Ca – 1.03 mmol/L. At the second stage, the frequency of hyperphosphatemia depending on the achievement of these threshold values was assessed. No statistically significant differences in the frequency of hyperphosphatemia between visits with Ca levels above and below the threshold values were found (p=0.017 after Bonferroni correction, two-tailed Fisher’s exact test). At the same time, a trend toward a higher incidence of hyperphosphatemia at Ca concentrations below established thresholds was noted.

Conclusion: The study identified blood Ca levels associated with a high risk of hypercalciuria in children with HypoPT. Hyperphosphatemia persisted both when Ca levels were maintained below and above established thresholds. The study results highlight the need to optimize therapeutic approaches for HypoPT in children.

Objective: Assessment of the impact of metabolic disorders on ovulatory function, identification of the most significant metabolic markers associated with anovulation, and development of the management algorithm for women with obesity and oligo/amenorrhea.

Materials and methods: A retrospective case-control study was conducted. The analysis included 85 patients divided into two groups: Group I (n=55) – with obesity, oligo/amenorrhea, and anovulation; Group II (n=30) – with normal body weight, regular menstrual cycles, and ovulation. The examination included anthropometry, pelvic ultrasound, and laboratory tests (blood parameters for carbohydrate and lipid metabolism, amino acids and peptides, hormonal status, cytokines, inflammatory markers, and micronutrients).

Results: The median age of patients in Group I was 28.0 (26.0–30.5) years, while in Group II it was 27.5 (25.5–29.8) years (p=0.20). Using multivariate regression analysis, the most significant markers of anovulation were identified: waist-to-hip ratio (WC/HIR, OR=5.21), insulin resistance index (HOMA-IR, OR=3.46), high levels of triglycerides (OR=2.39) and body mass index (BMI, OR=2.18), low-density lipoproteins, homocysteine, leptin, C-reactive protein, interleukins 1β and 8 (OR from 1.35 to 1.04). Low levels of 25-hydroxycalciferol, folate and high-density lipoproteins were independent risk factors for anovulation. The results showed a high diagnostic value of all markers, with leptin, BMI, WC/HIR, and HOMA-IR (AUC>0.97) being the most accurate. Based on the analysis results, a two-stage strategy for determining the risk of anovulation in women with obesity and oligomenorrhea/amenorrhea was developed, along with a management algorithm based on the likelihood of anovulation.

Conclusion: This integrated approach allows for the highly accurate identification of anovulation markers in patients with obesity and oligomenorrhea/amenorrhea. Since these indicators reflect the patient’s metabolic profile, interventions to restore ovulation should primarily focus on it’s correction.

Background: Immune related thyroid disorders (IMTDs) are among the most common endocrine side effects associated with immune checkpoint inhibitor (ICI) therapy. Several studies have demonstrated a possible association with more favorable cancer outcomes; however, these data remain heterogeneous and may depend on the tumor type.

Objective: Evaluation of the association of IVTD development with overall survival (OS) and progression-free survival (PFS) in patients with non-small cell lung cancer, melanoma, gastric cancer, and hepatocellular carcinoma receiving immune checkpoint inhibitor therapy.

Materials and methods: A multicenter, prospective, observational cohort study was conducted. The analytical sample included 182 patients: 114 with non-small cell lung cancer, 32 with melanoma, 25 with gastric cancer, and 11 with hepatocellular carcinoma. Thyroid function was monitored before the start of ICI therapy and every 4 weeks thereafter. OS and PFS were estimated using the Kaplan-Meier method; groups were compared using the log-rank test and univariate Cox proportional hazards models.

Results: IMTDs were detected in 41 (22.5%) of 182 patients and developed, on average, 7.75±2.42 weeks after the start of therapy. In a subgroup analysis, the development of thyroid disorders was associated with higher OS and PFS in patients with non-small cell lung cancer and gastric cancer. No statistically significant association between thyroid disorders and survival was found in patients with melanoma and hepatocellular carcinoma.

Conclusion: IMTDs during ICI therapy was not associated with more favorable survival outcomes in all nosological subgroups. The most significant association was found in patients with non-small cell lung cancer and gastric cancer, while no statistically significant association was found for melanoma and hepatocellular carcinoma. These results suggest that thyroidopathy may be a potential clinical marker for immunotherapy efficacy in certain patient groups.

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are prescribed for the most effective treatment of type 2 diabetes mellitus (T2DM) as an adjunct to diet and exercise, especially in cases where dietary changes and increased physical activity are insufficient. As the use of this class of drugs expands, concerns about the adverse effects of weight loss, including uncontrolled muscle loss, are growing, which is particularly relevant for patients with morbid obesity and severe insulin resistance.

This article highlights the importance of combining GLP-1 RA with a balanced diet and physical activity in the treatment of T2DM. It examines barriers to adherence to dietary recommendations and regular exercise, and provides practical advice for physicians on additional education and counseling of patients on these aspects when initiating GLP-1 RA treatment.

This article describes a clinical case of a patient with diffuse toxic goiter and thyrotoxicosis syndrome who voluntarily discontinued thiamazole, considering the medication load excessive despite symptomatic therapy prescribed for her associated complaints. Discontinuation of the pathogenetic treatment led to disease progression: the development of resistant arterial hypertension, hypertensive crisis, and a significant deterioration in quality of life, despite continued symptomatic medication. Treatment of the crisis and standard antihypertensive therapy proved ineffective. Only resumption of thiamazole therapy led to rapid stabilization of blood pressure, allowing the patient to discontinue antihypertensive medications. Subsequently, thiamazole dosage adjustment was required due to the development of iatrogenic hypothyroidism, followed by a subsequent increase in thyroid hormone levels, which ultimately led to stable euthyroidism. This case highlights the key importance of antithyroid therapy for thyrotoxicosis and the importance of adhering to doctor’s orders to prevent, primarily, cardiovascular complications.