[Predictors of postoperative remission of acromegaly. (Experience of the Burdenko Neurosurgical Center)]. / Prediktory posleoperatsionnoi remissii akromegalii. (Opyt FGAU «NMITs neirokhirurgii im. akad. N.N. Burdenko¼).

BACKGROUND: Treatment of acromegaly is still an unresolved problem. Overall postoperative remission rate ranges from 34 to 85%. These values are better for microadenomas (75-90%) and worse for macroadenomas (45-70%). Identification of predictors of acromegaly remission after surgical treatment is an urgent objective to improve the quality of medical care for these patients. OBJECTIVE: To analyze postoperative freedom from acromegaly and predictors of remission. MATERIAL AND METHODS: A retrospective single-center study included 227 patients with acromegaly who underwent resection of pituitary adenoma between August 2018 and August 2021. RESULTS: Remission (normalization of serum IGF-1) was achieved in 65 (55%) patients. Growth hormone and IGF-1 index decreased after surgery in all patients. Mean preoperative serum growth hormone was 12.45 [6.88, 29.85] ng/ml, early postoperative concentration - 1.54 [0.80, 3.38] ng/ml, in delayed period - 1.15 [0.57, 3.80] ng/ml. Mean IGF-1 index was 2.18 [1.69, 2.71], 1.47 [0.99, 1.90] and 0.99 [0.74, 1.43], respectively. CONCLUSION: Significant predictors of acromegaly remission after neurosurgical treatment were age, preoperative level of growth hormone, tumor size and location, growth hormone and IGF-1 index in early postoperative period and residual tumor after surgery. Multivariate analysis revealed a significant association of acromegaly remission with small tumor size, low postoperative level of growth hormone and no residual tumor within 3-6 month after surgery.

[Selective screening of patients with associated somatic diseases as a method of early detection of acromegaly].

Backgraund: Acromegaly is a multi-organ disabling disease, the effectiveness of treatment of which directly depends on timely diagnosis. Latent course and delayed diagnosis increase the exposure of pathological hypersecretion of growth hormone and insulin-like growth factor-1, contributing to the development of irreversible systemic and metabolic changes in the body that negatively affect survival. AIMS: The aim of the study was to clinically test a comprehensive diagnostic approach using selective screening to detect cases of acromegaly in patients with combined somatic diseases. MATERIALS AND METHODS: The diagnostic search algorithm included a 2-stage questionnaire, expert assessment of the clinical status, laboratory and instrumental examination. The inpatient examination included the use of additional laboratory and instrumental methods and expert evaluation of the results obtained by filling out a doctor's questionnaire. When the score was higher than 18 points, a more specific examination was performed: double determination of the insulin-like growth factor-1 level, oral glucose tolerance test with determination of the nadir of growth hormone value, and MRI of the brain with contrast enhancement. The diagnosis of acromegaly was made on the basis of personal data, expert assessment of the clinical status, results of laboratory and instrumental examinations. RESULTS: A survey of 1249 patients with combined systemic and metabolic disorders conducted using the point system allowed us to suspect acromegaly in 367 patients (29.4%), who were offered further examination. The majority of patients were previously seen by specialists for diabetes mellitus (79.3%) or thyroid pathology (10%). In the result of inpatient -examination of 329 patients, 35 (10.6%) patients showed an increase in the blood level of IGF-I. In 19 patients, a persistent increase in the level of IGF-I was combined with the absence of GH suppression of less than 0.4 ng/ml against the background of glucose load. During MRI in 9 patients, pituitary adenoma was detected (in 2 - microadenoma and 7 - -macroadenoma). CONCLUSIONS: As a result of the study, among the group of 1249 patients (mean age 58±13 years) with the presence of concomitant diseases, 9 newly identified patients with acromegaly were found who were prescribed adequate treatment. The introduction of selective screening technology into the practice of an endocrinologist will improve the effectiveness of diagnostic search for patients with acromegaly, more accurately assess the prevalence of the disease in Russia and the need for specialized medical care.

[Association of insulinase gene polymorphisms with type 2 diabetes mellitus in patients from the Moscow population].

Association of 13 single nucleotide polymorphisms (SNPs) of insulinase (IDE) gene with type 2 diabetes mellitus (T2D) in the Moscow population has been examined. Three polymorphic markers (rs7078413, rs7899603, and rs551266) associated with the risk of T2D development have been revealed. Allele and genotype frequency distribution for these three markers differed significantly only in the sample of females between T2D patients and control individuals, while only in case of rs7078413 SNP genotype frequencies varied significantly in the total population.

[The clinical features of acromegaly and its treatment policy according to age at the onset of disease].

The hormonal activity and the duration of an active phase of the disease are important factors that are involved in the pathogenesis of organ and system complications decreasing lifespan in patients with acromegaly. A hundred and forty patients with active acromegaly were examined to determine the age-related features of the course of the disease. According to the age by the moment of the examination, all the patients were divided into 3 groups: 1) 14 patients aged 20-39 years; 2) 72 patients aged 40-59 years; and 3) 54 patients aged 60 years or more. The mean age at the onset of disease was 27.5±1.9, 37.5±1.0, and 51.2±1.2 years in Groups 1, 2, and3, respectively (p - 0.000); the duration of a latent period being 3.8±0.7, 6.2±0 6, and 9.3±0 8years (p.

[The effect of betulonic acid and its alanine amide derivatives on rat liver parenchyma repair during postcytostatic period].

The effects of betulonic acid, its p-alanine amide derivative, and p-alanine amide derivative of betulonic acid methyl ether on the histologic structure of rat liver have been studied on the model of experimental polychemotherapy in rats. These agents significantly decrease the dystrophic and cytolytic damage of hepatocytes and increase the repair processes in liver parenchyma.

Enhanced erythrocyte Na+/H+ exchange predicts diabetic nephropathy in patients with IDDM.

Diabetic nephropathy develops in a subset of patients with an apparently hereditary predisposition. Microalbuminuria and elevated arterial pressure have been proposed as predictors of nephropathy but both appear when renal damage is impending. Enhanced sodium-hydrogen exchange in the cell membranes of diabetic patients is an early marker of diabetic nephropathy but its predictive value has not been assessed. In this study, sodium-hydrogen exchange was measured in erythrocytes as an initial velocity of amiloride-inhibited H+ efflux (pH 6.35-6.45) into a Na+ - containing medium (pH 7.95-8.05) in 156 non-microalbuminuric insulin-treated diabetic patients (98 women, 58 men, age 33+/-8 years, diabetes duration prior to enrollment 15+/-4 years) during 8 years of follow-up. Enhanced erythrocyte sodium-hydrogen exchange predicted diabetic nephropathy alone and in association with a familial tendency to hypertension/nephropathy with 86 and 96% sensitivity, and 80% specificity. Thus, sodium-hydrogen exchange appears to detect a subset of diabetic patients prone to develop renal damage, in whom a more intensive treatment modality might be considered.

Amiloride-sensitive Na+/H+ exchange in erythrocytes of patients with NIDDM: a prospective study.

Intensive treatment of non-insulin-dependent diabetes mellitus (NIDDM) decreases the rate of microvascular complications, but is associated with increased incidence of cardiovascular morbidity. Enhanced permeability of plasma membranes for sodium (e.g. sodium-hydrogen exchange, NHE) may predict the subset of diabetic patients for whom intensive modalities of treatment are indicated despite their potential risk. However, the accuracy of NHE as a marker of microangiopathy has not been assessed. In this study NHE as initial velocity of amiloride-inhibited H+ efflux from erythrocytes (pHi 6.35-6.45) into an Na(+)-containing medium (pHo 7.95-8.05), was estimated during 8 years of follow-up in 138 non-microalbuminuric diabetic patients (74 women, 64 men, age 52 +/- 4 years) treated with antihyperglycaemic drugs for 14 +/- 2 years. Appearance of microalbuminuria, overt proteinuria, azotaemia and retinopathy was assessed annually. Enhanced erythrocyte NHE predicted diabetic nephropathy alone and in association with a family history of hypertension and/or nephropathy with a sensitivity of 86 and 93%, respectively. No association was found between NHE and retinopathy in NIDDM. It is concluded that assessment of erythrocyte NHE can identify a subset of patients likely to develop renal damage, for whom an aggressive treatment approach might be considered.

[Diffusion of glucose through the erythrocyte membrane]. / Issledovanie diffuzii gliukozy cherez membranu éritrotsitov.

The change of volume of human erythrocytes due to diffusion of glucose through their membranes was investigated. The dependence of membrane glucose penetration on functional state of the cells was discovered.

[New approaches to the diagnosis of carbohydrate metabolic disorders]. / Novye podkhody k diagnostike narushenii uglevodnogo obmena.

A bioenergetic conception of insulin-independent diabetes mellitus (IIDM) is put forward. Molecular mechanisms of carbohydrate and fat metabolism are discussed which result in a vicious regulatory cycle to provoke a transition to stable pathology. Previously unknown role of human saliva in oral cavity in this regulatory cycle is revealed. New diagnostic tests are developed on the basis of the conception on IIDM pathogenesis. The results of clinical trials are presented which have been obtained during population screening.

[Determination of the value of Na+/H+-metabolism in erythrocytes of patients with arterial hypertension of endocrine origin]. / Opredelenie velichiny Na+/H+-obmena v éritrotsitakh u bol'nykh s arterial'noi gipertenziei éndokrinnogo geneza.

The paper is concerned with the results of determination of a value of Na+/H(+)-metabolism in 66 patients with arterial hypertension of different genesis, including 21 patients with stage 11 essential hypertension, 8 patients with renal hypertension, 25 patients with Itsenko-Cushing syndrome or disease, 7 patients with pheochromocytoma, and 5 patients with primary hyperaldosteronism. The control group consisted of 11 healthy persons without predisposition to essential hypertension. It was shown that a value of Na+/H(+)-metabolism in patients with essential hypertension exceeded a 3.8-fold the control values. In patients with hyperglucocorticism, pheochromocytoma, arterial hypertension of renal genesis, the rate of Na+/H(+)-metabolism was significantly decreased as compared to that of a group of patients with essential hypertension. It could be used in differential diagnosis of the hypertensive syndrome. The problem of the diagnostic value of this indicator in primary hyperaldosteronism needs further investigation.

[Combined idiopathic fibrosing alveolitis and lung cancer]. / O sochetanii idiopaticheskogo fibroziruiushchego al'veolita i raka legkikh.

Data are reported of a rare disease of idiopathic fibrosing alveolitis in association with an adenoma of the thyroid gland in a 68 years old woman. The authors emphasize difficulties in the clinical roentgenological and morphological diagnosis in this kind of combined pathology.

[Results of the clinical and electroencephalographic studies in patients with acromegaly of different etiologies]. / Rezul'taty klinicheskogo i elektroentsefalograficheskogo issledovaniia u bol'nykh akromegaliei razlichnogo geneza.

A complex examination of 56 patients with an active stage of acromegaly was performed according to the scheme, involving clinical and electroencephalographic studies as well as the investigation of somatotropic secretion by means of functional tests with thyroliberin and parlodel. Two main forms of acromegaly, i.e. "hypophyseal" (hypothalamus-independent) and hypothalamic (central) were revealed, differing in the disease course, clinical pattern, results of the electroencephalographic examination and response to thyroliberin and parlodel functional tests.