[Similarity and differences of the pathogenesis of Itsenko-Cushing syndrome variants]. / Obshchnost' i razlichie patogeneza form sindroma Itsenko-Kushinga.

Proceeding from a study of the results of the investigation of 152 patients with Icenko-Cushing's syndrome the authors have arrived at the conclusion that hyperplasia, clear cell adenoma of monomorphous structure, dark cell and mixed adenomas of polymorphous structure, cancer of the adrenal cortex are different stages of a common pathological process. Such formation of morphological changes in the adrenal gland is one of the ways of development of Icenko-Cushing's syndrome. To confirm the proposed concept of the pathogenesis of this disease the authors provide some evidence of hyperplasia or the normal structure of nontumorous adrenocortical tissue in adenoma and cancer, of the absence of difference in a rise of the mean ACTH level in the blood in hyperplasia and different adrenocortical tumors. An increase in ACTH production in most of the patients should be regarded as one of the primary factors of the above morphological changes. The absence of suppression of 17-oxycorticosteroid excretion with urine in a test with 8 mg of dexamethasone in most of the patients with dark cell and mixed adenoma of polymorphous structure and adrenocortical cancer suggests a possibility of the development of certain autonomy of these neoplasms.

[Clinical characteristics of Itsenko-Cushing syndrome with various morphological changes in the adrenal cortex]. / Klinicheskie osobennosti sindroma Itsenko-Kushinga s razlichnymi morfologicheskimi izmeneniiami kory nadpochechnikov.

The frequency and nature of the main signs of Icenko-Cushing's syndrome were studied in 132 patients divided into 4 groups with relation to morphological changes in the adrenals. It was established that the peculiarities of morphological structure of the adrenals were not reflected in a clinical picture of disease. A more frequent development of some clinical manifestations of Icenko-Cushing's syndrome was noted in the group of patients with a significantly higher mean level of cortisol in the blood plasma. The test with 8 mg of dexamethasone for suppression of 17-OCS excreted with urine was not strictly specific for any stage of morphological changes in the adrenal cortex.

[Surgical treatment of the Itsenko-Cushing syndrome accompanying an adrenal cortex neoplasm]. / Operativnoe lechenie bol'nykh s sindromom Itsenko-Kushinga pri obnaruzhenii opukholi kory nadpochechnika.

The data of remote observations of 39 operated patients with adrenal cortex tumors were analyzed as well as the functional state of the hypothalamo-hypophysial system and morphological investigations of the adrenals removed. In the light of the results obtained the questions of surgical methods and choice of the operation volume are discussed which can liberate the patients of the Itsenko-Cushing syndrome.

[Role of insulin and its antagonists in the pathogenesis of diabetes mellitus and its complications]. / Rol' antagonistov i insulina v patogeneze sakharnogo diabeta i ego oslozhnenii.

The content of insulin antagonists (growth hormone, cortisol, catecholamine, DOPA, free fatty acids) was studied in 40 women suffering from diabetes mellitus, including 12 insulin-sensitive and 15 insulin-resistant, and 13 women with freshly diagnosed untreated diabetes. The greatest content of all the insulin antagonists was revealed in the insulin-sensitive patients during the decompensation period. It is assumed that in this period, diabetogenic actions of insulin antagonists create the most favourable conditions for the formation of insulin antagonists create the most favourable conditions for the formation of insulin resistance; this resistance is then maintained by the increased antibody titre due to the elevation of therapeutic insulin doses and lengthy persistence of the high growth hormone level in the insulin-resistant patients. Besides, the high growth hormone content promotes angioretinopathy development. A conclusion is drawn that the content of growth hormone, cortisol, catecholamines, DOPA, or free fatty acids does not serve as the primary factor in the pathogenesis of diabetes mellitus, since at any of the phases of the disease the level of each of them failed to differ from control.

[Problem of autonomy of adrenal cortex adenomas of different histological structures in Cushing's syndrome]. / Problema avtonomnosti adenom kory nadpochechnikov razlichnogo gistologicheskogo stroeniia u bolnykh s sindromom Itsenko-Kushinga.

The authors analyzed the results of examination of 69 patients operated on for Itsenko-Cushing's syndrome (ICS); in 32 cases tumours of the adrenal cortex were revealed during the operation. Two histological forms of adenoma of the adrenal cortex were distinguished, i.e. adenomas of mono- and polymorphous structure. Increased background urinary excretion of 17-oxycorticosteroids (17-OCS) in patients with ICS suffering from tumours of polymorphous structure persisted at the former level or increased in the tests with 8 mg of dexamethazone (DMZ). The character of tests with 8 mg of DMZ in patients with ICS having adenomas of monomorphous structure was analogous to such in patients with ICS, but without any adrenal gland tumours--urinary 17-OCS excretion was either decreased or suppressed by 50 or more per cent of the initial level. A suggestion is put forward on functional dependence of the adrenal cortex of monomorphous structure on the hypothalamo-hypophysial control.