[Osteocalcin--a marker of bone metabolism and calcium regulating hormones in steroid osteoporosis]. / Osteokal'tsin--marker kostnogo metabolizma i kal'tsiireguliruiushchie gormony pri steroidnom osteoporoze.

Altogether 15 patients with Itsenko-Cushing disease with moderate osteoporosis and 10 healthy persons were investigated. Calcium metabolism, calcium regulating hormones and osteocalcin were studied. Endogenous hypercorticoidism was characterized by a higher secretion of parathyroid hormone against a background of hypercalcemia. Positive correlation of these indices was revealed. In patients with Itsenko-Cushing disease the blood level of vitamin D was decreased as compared to that in the controls. A significant decrease in the blood level of osteocalcin was observed in patients with endogenous hypercorticoidism, there being close negative correlation between the level of osteocalcin and cortisol, and between osteocalcin and 17-hydroxycorticosteroid excretion with urine. A conclusion has been made that the excess of glucocorticosteroids suppresses osteoblast function, slows, down osteogenesis, disturbs the secretion of calcium regulating hormones and calcium metabolism enhancing resorption; this combined action of glucocorticoids causes rapid development of osteoporosis in endogenous hypercorticoidism.

[The clinical picture, hormonal disorders and humoral immunity in patients with autoimmune thyroiditis]. / Klinika, gormonal'nye narusheniia i gumoral'nyi immunitet u bol'nykh autoimmunnym tireoiditom.

Altogether 93 patients with autoimmune thyroiditis were investigated. A great variability of the functional clinical symptomatology (from thyrotoxicosis up to manifest hypothyroidism) was revealed. Subclinical hypothyroidism was detected in a majority of patients. In some patients the clinical symptoms of thyrotoxicosis were combined with euthyroidism or subclinical hypothyroidism basing on the findings of the hormonal investigation which should be taken into account while choosing therapeutic tactics. Patients with autoimmune thyroiditis demonstrated a preserved circadian rhythm of cortisol secretion. Adrenocorticotropin-zinc-phosphate testing has shown good functional adrenocortical reserves; cortisol secretion did not depend on thyroid function nor did it differ from the indicator in the control group.

[An immunoenzyme method for determining autoantibodies to the microsomal antigens of human thyrocytes]. / Immunofermentnyi metod opredeleniia autoantitel k mikrosomal'nym antigenam tireotsitov cheloveka.

In order to investigate the role of autoantibodies in the pathogenesis of autoimmune thyroid diseases and for clinicoimmunological control of treatment, an enzyme-linked immunosorbent assay (ELISA) for the determination of autoantibodies against human thyroid microsomal antigens (TMA) was developed. ELISA was evaluated using sera from 156 patients with different thyroid pathology and diabetes mellitus and from 54 healthy donors. In parallel experiments the same sera were analyzed by an indirect immunofluorescence method for the presence of autoantibodies against TMA. Comparing all these data, both techniques appeared to have the same specificity, however ELISA was more sensitive than the indirect immunofluorescence method. Another advantage of ELISA is a possibility of long-term storage of microplates with immobilized antigen material without loss of antigenic activity. ELISA can be used for the determination of autoantibodies against TMA in human sera as a routine technique in clinical practice and experiments.

[The relationship of endocrine ophthalmopathy to the thyroid status and to the indices of an autoimmune lesion of the thyroid]. / Sviaz' éndokrinnoi oftal'mopatii s tireoidnym statusom i pokazateliami autoimmunnogo porazheniia shchitovidnoi zhelezy.

The paper is devoted to a study of the pathogenetic relationship of endocrine ophthalmopathy with thyroid diseases. Altogether 76 patients with endocrine ophthalmopathy combined with various thyroid lesions (diffuse toxic goiter, Hashimoto's disease, primary hypothyrosis) and without thyroid diseases were investigated. The serum level of thyroid hormones, the content of Ig A, M, G, thyroglobulin and the presence of antithyroid antibodies were analyzed. HLA typing by A, B, C, D2 loci was done for a group of patients. The results did not show correlation of the origin and gravity of ophthalmopathy either with thyroid function or with the factors determining thyroid affection. Some differences in the genetic markers of endocrine ophthalmopathy and autoimmune thyroid diseases were also established.

[Antithyroid antibody dynamics in patients with Hashimoto's goiter receiving conservative treatment and after surgical interventions]. / Dinamika antitireoidnykh antitel u bol'nykh zobom Khashimoto na fone konservativnogo lecheniia i posle operativnykh vmeshatel'stv.

The content of antithyroid antibodies (AtAb) in the blood of patients with Hashimoto's goiter was studied over time, namely during the treatment with thyroid drugs and after surgical interventions of different scope. The patients' groups with diverse changes in the AtAb titers during the conservative treatment were revealed. The analogous types of the time-course of changes in antibodies to thyroglobulins (AbTg) were discovered after a surgical intervention irrespective of the operation scope whereas the persistence of antibodies to microsomal antigen (AbMa) after the operation depended on the mass of the remaining thyroid tissue. A correlation was found between the high titers of AbTg (rather than AbMa) and the elevated content of thyrotropic hormone in untreated patients with Hashimoto's goiter and after large-scope surgical interventions.

[Thyroid antibodies in autoimmune diseases of the thyroid and their dependence on the presence of autoantigens]. / Tireoidnye antitela pri autoimmunnykh zabolevaniiakh shchitovidnoi zhelezy i ikh zavisimost' ot prisutstviia autoantigenov.

Autoimmune thyroid diseases (especially diffuse toxic goiter) are characterized by a higher frequency of the detection and concentration of serum thyroglobulin. The frequency of the detection of antibodies to thyroglobulin in Hashimoto's thyroiditis was higher and their concentration lower than in diffuse toxic goiter. The frequency of the detection of antibodies to microsomal thyroid antigen in autoimmune thyroid diseases was lower than that of antibodies to thyroglobulin and did not depend on a type of disease. In diffuse toxic goiter the level of antibodies to thyroglobulin showed positive correlation with the level of antibodies to microsomal antigen and negative correlation with serum thyroglobulin concentration. In Hashimoto's thyroiditis the level of antibodies to thyroglobulin correlated with the level of serum thyrotropin. One-six years after thyroid extirpation serum thyroglobulin was practically absent in patients with Hashimoto's thyroiditis, and the frequency of the detection of thyroid autoantibodies (especially antimicrosomal ones) was sharply decreased.

[Comparative evaluation of the effectiveness of vitamin D3 preparations (1-alpha-hydroxy- and 1-alpha,25-dihydroxycholecalciferol in various forms of osteoporosis and osteomalacia]. / Sravnitel'naia otsenka éffektivnosti preparatov vitamina D3 (1-alpha- i 1-alpha,25-dihydroxycholecalciferol) pri razlichnykh vidakh osteoporoza i osteomaliatsii.

Clinical investigations have shown that 1 alpha-hydroxycholecalciferol (oxydevit, alphacalcidiol) and 1 alpha, 25-dihydroxycholecalciferol (rocaltrol) are act vitamin D3 agents producing a positive clinical effect in different types of osteoporosis and osteomalacia. Clinical improvement of the patients' status (alleviation of the pain syndrome, an increase in motor activity) was noted in 1-2 mos., an x-ray picture of regeneration of the bone structure of both axial and peripheral skeleton--in 6-12 mos. after the initiation of therapy. Therapy was attended by an increase in the serum content of total and ionized calcium, the return of alkaline phosphatase activity to normal, and a decrease in the level of parathormone. During prolonged therapy these agents administered at daily doses of 0.25-2 micrograms caused no pathological side-effects and hypercalcemia. In osteoporotic conditions all these drugs were equal in their clinical effectiveness. Rocaltrol has some advantages in the presence of associated liver pathology.

[Involutional osteopathies: the clinical x-ray, biochemical and hormonal aspects of the diagnosis]. / Involiutsionnye osteopatii: kliniko-rentgenologicheskie, biokhimicheskie i gormonal'nye aspekty diagnostiki.

A study of patients with involution osteopathy has shown that the development of this disease is associated with osseous tissue dystrophic changes (osteoporosis) and, to a lesser extent, with osteomalacia. Involution osteopathy is not accompanied by severe changes in indices of phosphoric-calcium metabolism; it is characterized by a tendency to an increase in the levels of total and ionized calcium and a decrease in the level of serum phosphorus. A lowered level of calcitonin with a tendency to a decrease in the level of the somatotropic hormone and the unchanged content of parathormone was revealed in involution osteopathy. The blood level of sex steroids (both estradiol and testosterone) in women was decreased, a degree of a rise of gonadotropins in them was lower than that in healthy postmenopausal women. In men with involution osteopathy the mean level of serum testosterone was within low normal limits, the LH content remained normal, and a FSH level was raised. The level of prolactin in patients of both sexes was unchanged.

[Hormone content of the blood in juvenile osteoporosis]. / Izuchenie soderzhaniia gormonov v krovi pri iuvenil'nom osteoporoze.

Juvenile osteoporosis should be regarded as a polyetiological disease developing against the background of constitutional osteopathy in which endocrine disorders play a certain role. A tendency to a decrease in the levels of calcitonin and parathyroid hormone was found in juvenile osteoporosis; mild signs of hypogonadism (secondary) and a relative decrease in hypophyseal somatotropic activity promoted its detection. Two groups of patients were defined: I--with raised AP activity and a normal or lowered level of serum inorganic phosphorus without hormonal disorders; II--with lowered or normal AP activity and a normal level of phosphorus, mild hormonal disorders. Prolonged multimodality therapy with calcitonin, anabolic steroids, active forms of Vitamin D3, calcium agents, physiotherapy and exercise therapy was found effective in juvenile osteoporosis.

[Immunoreactive parathyroid hormone and calcitonin in patients with autoimmune thyroiditis]. / Immunoreaktivnye paratogormon i kal'tsitonin u bol'nykh autoimmunnym tireoiditom.

The authors presented the results of a study of immunoreactive parathormone and calcitonin in patients with autoimmune thyroiditis. An increase in the content of parathormone in the blood was found in 55.5% of the patients, that of calcitonin in 30.5% of the patients with autoimmune thyroiditis. Correlation between the levels of immunoreactive parathormone and calcitonin in the blood was revealed. A degree of an increase in the levels of parathormone and calcitonin corresponded to the expression of autoimmune reactions in the thyroid. It was proposed that the determination of parathormone and calcitonin be used as an additional criterion in the diagnosis of autoimmune processes in the thyroid and in the determination of their activity.

[Surgical treatment of autoimmune thyroiditis]. / Khirurgicheskoe lechenie autoimmunnogo tireoidita.

The authors used combined modality therapy including clinical, laboratory, x-ray, radiological, immunological and histological methods to diagnose autoimmune thyroiditis. Enlargement of the thyroid up to the 3-4 th degree, signs of compression or shift of the trachea and esophagus, the presence of nodes, progressive goiter growth and suspected malignant transformation served as indications for surgical intervention. Subfascial extirpation of the thyroid can be an operation of choice in surgical treatment of Hoshimoto's thyroiditis. A question of the time of surgical intervention cannot be considered completely solved.

[Lymphoid infiltration of the thyroid gland and antithyroid antibodies in patients with diffuse toxic goiter]. / Limfoidnaia infil'tratsiia shchitovidnoi zhelezy i antitireoidnye antitela u bol'nykh diffuznym toksicheskim zobom.

The titer of antibodies to thyroglobulin (TgAb) was determined in 59 patients with diffuse toxic goiter before and in 21 patients 1.3 and 6 mos. after subtotal resection of the thyroid using the hemagglutination test (HAT), radioimmunoassay (RIA) and indirect immunofluorescence (IF). Microsomal antibodies were determined by the latter method only. Using the HAT TgAb were detected in 85% of the patients, using RIA and IF in 40 and 44%, respectively. A high titer of thyroid antibodies was detected on an average in 11-15% of the patients. Positive correlation was found in comparing the titer of thyroid antibodies with a degree of the expression of the thyroid lymphoid infiltration (TLI). It was most significant when it was between the titer of microsomal antibodies and TLI expression. The presence and severity of endocrine ophthalmopathy did not correlate with the TgAb titer. A tendency to the disappearance of TgAb or the reduction of their titer was noted in the first 6 mos. following operation.

[Differential diagnosis of ovarian dysgenesis and hypogonadotropic hypogonadism in women]. / Differentsial'naia diagnostika sindroma disgenezii iaichnikov i gipogonadotropnogo gipogonadizma u zhenshchin.

Similarity of anamnestic findings and the majority of clinico-experimental manifestations of the ovary dysgenesis (OD) and hypogonadotropic hypogonadism (HH) syndromes in women makes difficult the differential diagnosing of these states. The most significant differential diagnostic sign of OD and HH is the blood serum gonadotrophin content; OD is characterized by a high follicle-stimulating hormone (FSH) content with irregular release, less elevated and more stable luteinizing hormone (LH) level, while HH reveals sharply reduced monotonous FSH and LH levels. On an average, the blood serum testosterone content is significantly higher in OD than in HH.

[Functional state of the pituitary gland-ovarian system in gonadal agenesis and dysgenesis]. / Funktsional'noe sostoianie sistemy gipofiz-gonady pri agenezii i disgenezii gonad.

Functional condition of the hypophysis-gonad system with the determination of the LH and FSH level in the course of one month, of estrogens and testosterones in the blood, of estrogens in the urine, sex chromatine, kariotype, roentgenomorphology and histology of the gonads, as well as the changes in gonadotropines against the background of estrogen treatment were studied in 30 patients (in 18 with Shereshevsky-Turner's syndrome, and in 12 with pure gonad agenesis). There were differences in the state of gonadotropic activity in patients of these groups, rather similar by condition and time of the gonad affection. In Shereshevsky-Turner's syndrome gonadotropic activity was characterized by a sharp elevation of the LH and FSH level with frequent chaotic desynchronized fluctuations; in pure gonad agenesis the FSH level was elevated and subject to chaotic fluctuations; as to LH level--it was stable and within the normal limits. Shereshevsky-Turner's syndrome with pure agenesis displayed a retention of the feedback in the hypophysis-gonad system, this being indicated by reduction of the LH level against the background of estrogen therapy. The FSH content was a more informative index for the diagnosis of the gonad agenesis than the LH content. There was revealed no correlation between the kariotypes and the gonadotropin level in the patients. Estrogen therapy in the gonad agenesis and dysgenesis is required not only for feminization of the patients, but also for suppression of increased hypothalamic activity characteristic of these cases.