Vol 28, No 4 (2021)

A number of studies examining the new coronavirus infection COVID-19 (COronaVIrus Disease 2019) have demonstrated the most severe course of the disease in patients with diabetes mellitus (DM). Hyperglycemia combined with other risk factors can potentiate immune and inflammatory responses, aggravating the course of COVID-19 with potential fatal outcome. Most of these findings are preliminary and require further research. The high mortality rate in patients with COVID-19 and diabetes mellitus determines the relevance of the analysis of risk factors for unfavorable outcomes of the disease to justify the tactics of managing patients of this category.

Background. Acromegaly is a syndrome that combines various histological subtypes of somatotrophic adenomas, which differ in their pathologic structure, clinical course, and sensitivity to drugs. Therefore, the effectiveness of the treatment manual depends on the timely implementation of tumor-oriented diagnostics with the clarification of the clinical, morphological and phenotypic features of somatotrophic tumors. Objective. A retrospective analysis of the results of long-term drug therapy, taking into account the selective sensitivity to somatostatin analogues of the 1st generation (SA1) among patients with acromegaly included in the Moscow registry, with the identification of possible predictors of an effective drug benefit. Methods. The paper presents the results of 545 patients (162 men, 383 woman) receiving long-term primary or secondary drug therapy SA1. Results. According to the gradient of decrease in the level of insulin-like growth factor-1 (IGF-1) after 3 months from the start of treatment, it was possible to distinguish groups of patients that differ in clinical, morphological features, the nature of receptor expression and the effectiveness of therapeutic measures. The cut-off points proposed by the authors at 3 and 12 months from the start of treatment can be used to decide whether to maintain or change the treatment tactics. A complete lack of sensitivity to SA1, detected by an evaluation test or the results of short-term treatment (3-12 months), may be a sign of the presence of a high-risk tumor that requires the use of radical methods of treatment. Conclusion. Based on the clinical picture of the disease, age-sex and morphological features, as well as the results of short-term therapeutic use of SA1, it is possible not only to predict the effectiveness of further medical treatment, but also to presumably judge the pathohistological subtype of a somatotrophic tumor. Patients ‘ adherence to treatment depends on the effectiveness of the treatment, the availability of the drug, the minimization of side effects, the tolerability and low injury rate of injections.

Background. The original article deals with the main somatic diseases and psychological problems of patients with morbid obesity seeking bariatric surgery. Objective. Evaluation of the anamnestic, physical, laboratory-instrumental, psychological characteristics of patients seeking bariatric surgical care. Methods. The study was carried out at the premises of the Pavlov University with detailed clinical, laboratory-instrumental and psychological examination, which made it possible to compile a peculiar portrait of a Russian patient with morbid obesity. The study included 44 patients - 20 (45.5%) men and 24 (54.5%) middle-aged women (44,3±12,1 years), who subsequently underwent baritric surgery (longitudinal gastrectomy or gastric bypass). Results. The vast majority of patients (86%) independently find information about bariatric surgery on the Internet or learn about this treatment option from friends, rather than being sent to a bariatric center by doctors of other specialties. Gastroenterological complaints are dominant in patients with morbid obesity, and gastroesophageal reflux disease is the most common gastroenterological pathology. In most patients with morbid obesity, deviations in eating behavior such as bulimic disorder, emotional and impulsive overeating are revealed, and there are also disturbances in the circadian rhythm of food intake. Patients with morbid obesity have personality characteristics, mainly the presence of moderate personal and reactive anxiety, as well as the maximum limitation of the quality of life associated with role limitation due to physical and emotional state. Conclusion. There is no practice of referring patients to specialized surgical centers for the effective treatment of morbid obesity in the Russian Federation. The frequent presence of gastroesophageal reflux disease and sliding hiatal hernia in patients with morbid obesity requires further study of the efficacy and safety of major bariatric surgical procedures, in particular, longitudinal gastrectomy. The presence of personality traits, as well as deviations in eating behavior, can potentially have a negative impact on the long-term results of bariatric surgical interventions, which makes it necessary to study the course of the postoperative period in such patients in more details.

Background. The results of clinical and laboratory evaluation of the effectiveness of the use of Pharmadont II collagen plates for oral cavity inflammation in patients with type 2 diabetes mellitus (DM2) with partial removable plate prostheses are presented. Methods. Pharmadont II was included in the treatment protocol for 32 DM2 patients and 26 somatically healthy patients during the first 10 days of adaptation to partial removable acrylic dentures. Results. The positive dynamics of changes in the parameters of the periodontal index and the level of sialic acids in mixed saliva with the use of collagen plates confirmed a pronounced anti-inflammatory effect in the periodontal tissues, oral mucosa and prosthetic bed. Conclusion. The effectiveness of the use of the Pharmadont II in the period of orthopedic dental rehabilitation of DM2 patients with partial removable plate prostheses has been justified.

Background. The possibility of using chromatographic methods to determine a wide range of steroid hormones of the adrenal cortex in the blood and urine made it possible to reveal the features of steroid metabolomics in patients with Cushing’s syndrome (CS) with unilateral and bilateral adrenocortical pathology and to compare the data obtained with the features of the course of the disease. Objective. Evaluation of the steroid metabolomics in patients with CS with unilateral and bilateral adrenocortical pathology to optimize diagnosis and management tactics. Methods. The state of the pituitary-adrenal cortex and renin-aldosterone systems was assessed by the immunochemical methods using functional tests. The steroid metabolomics in biological fluids was studied using the methods of high performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS). Statistical analysis was carried out using the Statistica software package for Windows (version 10). Results. 36 patients with CS were examined: 8 - with bilateral macronodular adrenal hyperplasia (BMAH), 9 - with bilateral adrenocortical adenoma (BAA), and 19 - with solitary (unilateral) adrenocortical adenoma (SAA). According to ELISA and GC-MS, 21-hydroxylase deficiency was revealed in patients with CS and BMAH; furthermore, an increase in androgenic, mineralocorticoid and a decrease in glucocorticoid functions of the adrenal cortex (CA) were detected compared with those of patients with SAA. In CS patients with BAA, urinary excretion of the main androgens, progestogens, tetrahydrometabolites of cortisol, cortisone, and corticosterone did not differ from those of patients with CS and SAH, and urinary excretion of tetrahydro-11-deoxycortisol (THS) was reduced., According to HPLC and GC-MS data, pronounced signs of type 2 11β-hydroxysteroid dehydrogenase (11β-HSDH) deficiency were revealed in patients with CS and SAA, which indicates the production of active glucocorticosteroids to a greater extent than in patients with BMAH. The clinical picture of CS develops faster and is more pronounced in patients with CS and SAA compared with those of other CS groups. A significant increase in urinary THS excretion (more than 485 pg/day), the signs of 11ß-HSDH deficiency suggest the presence of a malignant potential in a number of CS patients with BMAH. Conclusion. Chromatographic methods revealed significant differences in the metabolism of androstenedione, tetrahydrometabolites of cortisol and corticosterone in patients with SC and unilateral and bilateral adrenocortical pathology. In CS patients with BMAH, signs of 21-hydroxylase deficiency, as well as an increase in the mineralocorticoid function of the adrenal cortex, and the highest urinary androgen excretion were revealed in comparison with SAA. An increase in urinary THS excretion more than 485 pg/day indicates the presence of a malignant potential in a number of patients with CS and BMAH.

Currently, on the territory of the Russian Federation, the use of the FreeStyle Libre Flash-glucose monitoring system is possible only in combination with a scanner, which must be brought to the sensor at a distance of less than 4 cm to read the data. In 2021, the Abbott is launching software on the Russian market designed to receive data from a sensor, store them, analyze the received data and transfer them to medical specialists or other persons at the request of the patient. The article presents the advantages of new software products and the opportunities they provide.

Background. Pheochromocytoma, or adrenal paraganglioma, is a neuroendocrine tumor from the adrenal medulla cells. In the vast majority of cases, pheochromocytoma is a hormonally active tumor with hypersecretion of catecholamines: adrenaline, norepinephrine, dopamine. However, due to the neuroendocrine origin of the tumor, extremely rare cases of ectopic hypersecretion of other peptide hormones, such as adrenocorticotropic hormone, somatostatin, neuropeptide Y., methenkephalin, and vasoactive interstitial peptide, have also been described. In the available literature in Russian and English, we found only 4 cases describing the secretion of calcitonin by pheochromocytoma; the earliest of them was published in 1977. Description of the clinical case. In a 38-year-old patient with a mixed course of arterial hypertension, with sympathoadrenal crises with autonomic symptoms occuring against a background of constantly elevated blood pressure, a large tumor of the right adrenal gland with diameter up to 78 mm was revealed during examination. Detailed radiation characteristics of the tumor according to the data of ultrasound, computed tomography (CT), magnetic resonance imaging, positron emission tomography/CT with 18-fluorodeoxyglucose are presented. According to the results of laboratory tests, catecholamine overproduction by the tumor was detected. In addition, a repeated increase in the blood calcitonin level was revealed, which, in the absence of a genetic study of the RET-protooncogene, did not allow to exclude multiple endocrine neoplasia type 2 (MEN2). After surgical treatment, the blood calcitonin level decreased to undetectable value, which suggested calcitonin overproduction by pheochromocytoma. This hypothesis was confirmed by the results of histological and immunohistochemical studies. Conclusion. Ectopic production of calcitonin by pheochromocytoma is not typical and is extremely rare, however, its development is possible, which should be taken into account in case of its increased level in patients with pheochromocytoma. Preoperative genetic study of patients with pheochromocytoma in such cases greatly facilitates the diagnostic search, significantly reducing the risk of developing medullary thyroid carcinoma in patients without hereditary MEN2.

Background. The vast majority of pituitary adenomas (PA) are sporadic, and only a small proportion (5%) arise in the framework of hereditary syndromes. More than half of all cases of familial pituitary adenomas are associated with multiple endocrine neoplasia type 1 (MEN-1) and Carney’s complex (CNC). Familial isolated pituitary adenoma (FIPA) is a term used to identify PA in two or more members of the same family in the absence of other endocrine syndromes associated with tumors. The proportion of PA in the framework of FIPA accounts for approximately 2% of the total incidence of pituitary tumors. Description of the clinical case. The article presents a clinical case of the diagnosis of prolactinoma in members of the same family: mother and daughter. Conclusion. PA within the framework of hereditary syndromes account for small proportion of all PA. The evaluation of their clinical and genetic characteristics opens up new possibilities for understanding the pathophysiological processes of their formation. The search for new genes and mutations that can cause the development of hereditary forms of PA is an important and promising area of scientific research.

Background. Doctors of different specialties can face hypoglycemic syndrome due to the nonspecific symptoms of this condition. In order to avoid diagnostic errors and prevent complications of hypoglycemia, as well as the appointment of unreasonable examinations for patients with unproven organic hyperinsulinism, it is necessary to follow a clear diagnostic algorithm. Description of a series of clinical cases. This article presents a description of the clinical cases of two patients with suspected hypoglycemic syndrome observed in the Clinic of Rostov State Medical University in 2020-2021. Both patients had identical complaints and medical history. However, endogenous hyperinsulinism was confirmed in the first patient; and in the second one, hypoglycemic syndrome was excluded. Therefore, the tactics of management and treatment of these patients differed. Conclusion. In most cases, hypoglycemia is the result of an overdose of insulin or sulfonylureas in diabetic patients. Patients without diabetes require differential diagnosis with a wide range of diseases, including rare and life-threatening ones.