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BACKGROUND: The registry is the main source of information about patients with acromegaly for assessing the quality of medical care, effectiveness of treatment, determining the compliance of real clinical practice with existing standards and patient management protocols. AIMS: To evaluate epidemiological, demographic and clinical characteristics of acromegaly in Russian Federation and effectiveness of treatment modalities. MATERIALS AND METHODS: The object of the study was the database of the united Russian registry of patients with pituitary tumors with specific analysis of patients with acromegaly only. We analyzed the data of 4114 patients with acromegaly stored on the online system in February 2019. RESULTS: Based on the data 32% of patients had complete clinical and laboratory remission of acromegaly; the percentage of patients with no remission was 68%, among them 22.5% had significant improvements in clinical symptoms and a decrease in growth hormone (GH) and insulin-like growth factor-1 (IGF-1) without IGF-1 normalization. The average age of patients at the onset of the disease was 42.7 years and at diagnosis 45.8 years. The ratio of men to women was 1:2.6. In patients with acromegaly hypopituitarism was registered in 14.7% of cases and among them hypothyroidism (66%) and hypogonadism (52%) were registered more often. Among other complications the leading were diabetes mellitus (15.7%) and acromegalic arthropathy (15%). The proportion of patients receiving neurosurgical treatment increased from 35.7% to 49.6% in 20122019; the portion of patients undergoing radiation therapy decreased significantly from 17.7% in 2012 to 0.8% in 2019. Remission was achieved in 40.47% after neurosurgery and 28.95% after medical treatment as a first line therapy p0.01. The number of patients receiving medical treatment at the time of the study was 1209. Among them 51% of patients treated with long-acting lanreotide and 24% receiving long-acting octreotide achieved remission (p0.0001) CONCLUSIONS: The remission rate of acromegaly remains suboptimal despite increased surgical activity, which corresponds to global trends. Long-acting lanreotide was significantly superior versus long-acting octreotide in the rate of acromegaly remission, which does not correspond with clinical trials.

Time course of psychological status of diabetics during automonitoring training is analyzed. Seventeen patients with insulin-dependent diabetes mellitus aged 15-43 years with disease standing of 1-17 years were followed up, who were never trained automonitoring before. Two control groups were not trained, which helped assess the results from different viewpoints. The levels of depression, anxiety, energy, positive sensations, total well-being, satisfaction with treatment, subjective perception of hypoglycemic reactions, and subjective perception of hyperglycaemia were assessed using special questionnaires. Compensation of diabetes was improved both in the main and control groups. Psychological status of diabetics improved after training: levels of depression and anxiety decreased, levels of energy, psychological well-being, and general psychological status increased (p

Pseudohypoparathyroidism (PGPT) - Albright's hereditary osteodystrophy is a sex-related disease rarely seen in medical practice. Inherited by the dominant type. It is caused by insensitivity of the kidneys and bones to parathyroid hormone (PG), which is secreted in normal or slightly elevated amounts [6, 10]. GH may not have a specific effect on cells due to pathology of GH receptors, impaired expression of information RNA synthesis by an unchanged hormone-receptor complex, the presence of pathological components of adenylate cyclase, pathological AMP-dependent protein kinase, or a defect in the synthesis of kinase substrates in the presence of circulating GH antagonists [5, 10 ].

The present study deals with the currently employed method for continuous monitoring blood glucose level, indications for its use, information and therapeutic potential, and major technical aspects. The authors emphasizes that routine application of the continuous monitoring technique fails to improve the blood glucose level. Its potential benefits for the patients presenting with diabetes mellitus are discussed with reference to certain clinical situations. Special attention is given to the methods of mathematical analysis of the results obtained by means of continuous monitoring blood glucose level.

The purpose of the study was to comprehensively analyze glycemic control in type 2 diabetes (T2D) patients who were first given glucose-reducing therapy. Glidiab MB and Diabeton MB caused a comparable reduction in glycemic control parameters: the level of HbA1c, fasting glycemia, and mean glycemic levels as shown by the results of its continuous glucose monitoring system (CGMS) study. The lower glycemic level was not accompanied by weight gain and it improved lipid spectrum parameters. The readings of monthly self-control of glycemia were transformed to its deviation from the goal range (ADRR) that and the hyper- and hypoglycemia indices calculated from the continuous glycemic control were used to evaluate glycemic lability not reflected by HbA1c. In this connection ADRR may be used to evaluate the efficiency of sugar-reducing therapy and in the examined groups it proved to be low, which generally reflects the stable course of the disease in new cases of T2D. The mean glycemic value calculated from CGMS data virtually coincides with the mean glycemia estimated from glycemic self-control readings both on the day of continuous glucose monitoring and in the month to come before and after CGMS study. In this connection the latter is justified only when the continuous glycemic curve undergoes a complex analysis. The complex analysis of the continuous glycemic curve includes symmetrization of the continuous glycemia scale; calculation of hyper- and hypoglycemic indices, hourly diurnal hyperglycemic index and hourly glycemic variations (Poincare method). The use of this procedure could compare the glucose-reducing effect of the two drugs within the framework of a short-term study.

The study included 18 patients (10 females and 8 males) with a not less than 2 year-history of type 1 diabetes (T1D), who had received insulin therapy since its diagnosis was established. The patients ' mean age was 32.9± 13.0 years; the mean duration of TID was 15.1+11.5 years; the mean daily dose of insulin was 40.1+16.0 units; the mean level of glycosylated hemoglobin (HbAJ was 9.4±2.1% (the normal value 4.4-4.9%). The glycemic curve symmetrization method proposed for statistical analysis of glycemic self-control is also quite suitable for the statistical monitoring of a continuous daily glycemic curve. The high and low glycemic indices calculated from the symmetrized glycemic data correlate well with the level of HbAk and with the duration of hypoglycemia and hyperglycemia and hence they may be used as additional criteria for a risk of diabetes complications. The criteria, calculated from the symmetrized data of glycemia for the risk of hyper- and hypoglycemia, adequately reflect the behavior of a continuous glycemic curve and may be used as integral indices of the efficiency of glucose-reducing therapy in clinical practice.В исследование включено 18 больных сахарным диабетом 1-го типа (СД1) (10 женщин, 8мужчин) с продолжительностью диабета не менее 2 лет, которые получали инсулинотерапию с начала установления диагноза. Средний возраст 32,9 ± 13,0 года; средняя продолжительность диабета 15,1 ± 11,5 года; средняя доза инсулина в сутки 40,1 ± 16,0 Ед; средний уровень гликированного гемоглобина (НЬА1с) 9,4 ± 2,1% (норма 4,4—6,9%). Метод симметризации кривой гликемии, предложенный для статистического анализа данных самоконтроля гликемии, вполне пригоден и для статистического анализа непрерывной суточной гликемической кривой. Индексы высокой и низкой гликемии, рассчитываемые из симметризованных данных гликемии, хорошо коррелируют с уровнем НЬА1с, а также с продолжительностью гипогликемии и высокой гипергликемией и следовательно могут использоваться как дополнительные критерии риска развития осложнений СД. Вычисляемые из симметризованных данных гликемии критерии риска развития гипер- и гипогликемии адекватно отражают поведение непрерывной кривой гликемии и могут использоваться в клинической практике как интегральные показатели эффективности сахароснижающей терапии.

Women of reproductive age with acromegaly can be interested in pregnancy, even when the pituitary tumor keeps rather big sizes, or control over secretion of GH and IGF-1 has not been reached. In this regard doctors often meet questions of acromegaly influence on the course of pregnancy. Now a little more than 100 cases of pregnancy at acromegalic female patients were described. In article the short review of the cases published in literature is carried out, and a new own clinical case of pregnancy at the patient with acromegaly is represented. The young woman (24 y.o.) received treatment with octreotide prolonged release in a dose 20/40 mg after non-radical adenomectomy for somatoprolactinoma, on this background she became pregnant, and continued medical treatment during all pregnancy. There were no complications during pregnancy and/or pathology of fetal formation. In women with acromegaly treatment with somatostatin analogs is not the indication for pregnancy interruption. It is possible to stop this treatment for the period of pregnancy as such break in treatment is safe for mother and fetus in most cases according to the literature. However if the estimated risk of further growth of a pituitary tumor is high, treatment can be continued during pregnancy.

A total of 60 patients given substitution treatment with levothyroxin for diffuse toxic goiter were examined within 3-7 years after iodine radiotherapy. The patients showing different TSH levels were allocated to three groups: (group 1: low normal TSH level: 0.4-2.25 mcIU/ml; group 2: high normal TSH level: 2.6-4.0 mcIU/ml; group 3, decompensated hypothyroidism: above 4.0 mcIU/ml but lower than 10 mcIU/ml). The quality of life was assessed with the use of the abridged version of the SF-36 questionnaire and the psychoemotional status based on the Beck depression inventory and the Spilberg-Khanin test. The patients presenting with compensated hypothyroidism showed better characteristics of the quality of life compared with the patients of other groups. Moreover, they were less frequently subjected to anxiety and depressive disorders. It is concluded that replacement therapy with levothyroxin designed to maintain the TSH level within the low normal values ensures a higher quality of life and lower incidence of depressive disorders than in the patients having TSH levels closer to the upper normal limit.

This paper summarizes the original clinical experience of the authors concerning differential diagnostics of ACTH-dependent hypercortisolism. A total of 8 patients were available for the estimation of the potential of such diagnostics with the use of the high-dose dexamethasone suppression test, pituitary MRI, and selective blood sampling from the inferior petrosal sinuses for the determination of the ACTH concentration gradient between central and peripheral compartments. It turned out that neither the high-dose dexamethasone suppression test nor pituitary MRI provided unambiguous information about the source of ACTH hypersecretion whereas the use of selective blood sampling allowed to confirm the primary diagnosis of Cushing's disease in 4 patients and revise it in 2 others. In all the patients having the diagnosis established based on the results of selective blood sampling, it was confirmed after transsphenoidal adenomectomy. At the same time, the diagnosis of ACTH-ectopic syndrome was confirmed by an immunohistochemical method only in 1 of the 2 patients. Thus, the results of the present study indicate that selective blood sampling from the inferior petrosal sinuses is a valuable diagnostic tool which should be recommended for a wider application in endocrinological practice. However, this method failed to reveal lateralization of the tumours in all the examined patients.

The present questionnaire study including female residents of the Moscow region (MR) above the age of 55 years with the confirmed diagnosis of post-menopausal osteoporosis (OP) was designed to obtain an insight into the procedure employed to diagnose post-menopausal OP, categories of specialists involved in diagnostics of this condition, and the methods they use for the purpose. The results of the study indicate that 57.4% of the patients with OP in the first place applied for advice in connection with this disease to an endocrinologist, 19.7% to an orthopedist-traumatologist, 13.% to a rheumatologist, and 4.9% to a neurologist. The endocrinologists referred such patients for bone densitometry and made the diagnosis of post-menopausal osteoporosis in 79% and 70% of the cases respectively. Only a small fraction of orthopedists-traumatologists and rheumatologists practicing in the Moscow region are engaged in diagnostics of post-menopausal osteoporosis as a part of their major activities. At the same time, therapists, gynecologists, and general practitioners do not practically encounter the patients complaining of post-menopausal OP. 38%, 30% and 28% of the respondents reported to have applied to two, three, and one physicians respectively to have the diagnosis of this condition confirmed. However, in the majority of the cases the period from the first visit to a specialist till the establishment of the definitive diagnosis was as long as 1 year (39%). The diagnosis of OP in a small number of the patients was made with the use of a single method, e.g. X-ray densitometry (12%), ultrasonometry (4%), and X-radiography of the skeletal bones (2%). The remaining patients were examined by more than one method; most of them had the primary diagnosis verified by means of X-ray densitometry (77%), blood biochemical analysis (77%), X-radiography of the spinal column (67%), and either by the detection of the serum bone turnover markers or ultrasonometry (16%). The majority of densitometric procedures were performed based at the Moscow Therapeutic and Prophylactic Department and M.F. Vladimirsky Moscow Regional Research Clinical Institute (73% and 17% respectively) for the lack of densitometers in the local medical facilities of the Moscow region.

The first case of type 1 diabetes mellitus with concomitant rare genetically determined Hajdu-Cheney syndrome has been documented among the Russian population. The patient was a 26 year-old subject at the early stage of diabetes.

The results of a population-based study involving 2 638 adult subjects residing in two districts of the Moscow region are considered in terms of the currently available screening models for detection of disturbances in carbohydrate metabolism; a new screening modality is proposed. The merits and demerits of different screening models were evaluated based on the comparison of validity of different diagnostic tests deduced from the estimation of sensitivity, specificity, and prognostic value of positive and negative results; the ROC-curve was constructed. It was shown that screening based on diagnostics of disturbances in carbohydrate metabolism from the fasting blood glucose level (FBGL) alone according to 2006 WHO diabetes criteria fails to reveal type 2 diabetes mellitus (DM2) in every fifth patient. Screening with partial exclusion of the oral glucose tolerance test (OGTT), i.e. confining it to subjects with impaired fasting glycemia (IFG) according to WHO criteria, allows up to 92.5% of DM2 cases to be diagnosed. However, this approach grossly underestimates the incidence of impaired glucose tolerance (IGT). The application of the 2003 ADA diagnostic criteria leads to a significant increase in the fraction of IFG subjects (up to 40%) while 18.2% of the patients with DM2 remain unidentified. Because the probability of diagnosis of DM2 (from 2-h point time of OGTT) and IGT increases in subjects with OGTT over 5.0 mmol/l, it appears desirable to use OGTT in the screening of cases with FBGL in excess of 5.0 mmol/l. This model may simplify the screening procedure (by avoiding OGTT) in 23.3% of those to be examined.

Mucoromycosis is an aggressive fungal infection, the so-called phytomycosis is a general term for the spectrum of diseases caused by Mucorales class fungi [2]. Mucoromycosis is rare in Northern Europe (occasionally imported from the countries of the Mediterranean or America), which often leads to fatal diagnostic errors. In the last decade, cases of mucoromycosis have been reported in the Moscow region; our experience in treating this disease may prove useful to endocrinologists.

The authors proposed a new analytical approach to a search for the RD parameter in euglycemic insulinemic clamp which imparts a rate to glucose infusion. Two diabetic patients were investigated (RD parameter in the first case was determined by intuition, and in the second case on the basis of mathematical iterative formulas). The analytical approach permitted a two-fold reduction of the time of clamp investigation improving its quality.

Introduction. Previous studies demonstrated a relationship between T1- and T2-weighted signal intensity and tumor growth patterns and potential as well as hormonal activity in somatotropinomas. Further investigation of these findings could serve to define predictive diagnostic and treatment factors based on MRI characteristics. The aim of this retrospective study was to analyze the MRI characteristics of growth hormone-producing pituitary adenomas in newly diagnosed patients with acromegaly and to compare them with the corresponding morphological and biochemical characteristics. Methods. Seventy five patients with newly acromegaly were included in the study. Pre-treatment T1- and T2-weighted MR-images of all patients were analyzed, taking into account the intensity of the signals produced by the tumors, as well as their dimensions and growth direction. Growth hormone and IGF-1 levels were also recorded. Results. Out of 75 patients, 74.7% were macroadenomas. T1-weighted adenoma signal was hypointense in 45.3% of patients, hyperintense in 18.7% of patients and isointense in all other cases. T2-weighted adenoma signal was hypointense in 32.3% and hyperintense in 40.5% of patients. No statistically significant differences were found between GH and IGF1 levels as well as signal intensity in relation to patient age. Inferior tumor extension was present in 60.0% of patients overall and 33.3% more prevalent in patients with hyperintense T2 signal and 24.5% and 11.7% more prevalent in patients with hypointense and hyperintense T1 signal respectively. Superior extension was observed in 46.7% of patients and did not differ significantly from inferior extension in patients with hypointense T2 signal. The highest levels of IGF1 were associated with superior extension, while the highest levels of GH were associated with inferior extension. Mean adenoma volume was 8.45 times higher and GH levels were 3.8 times higher in patients with hyperintense T2-weighted signal and 2.3 and 1.3 times higher respectively in patients with hyperintense T1-weighted signal. Conclusion. Hyperintense T1- and T2-weighted MRI signal was associated with larger tumor dimensions, increased GH levels and more frequent inferior extension, all of which indicate higher proliferative potential of the adenomas.

Aim: to evaluate clinical manifestations of hypercortisolism in patients with adrenal Cushing’s (ACush).Material and Methods. 32 patients (30 (93.7%) female, 2 (6.3%) male, 41.5 [32.2; 54.0] y.o. with ACush.Results. Adenoma was found in right adrenal in 37.5% of patients, in left – 40.6%, bilateral adenomas in 21.9%. Maximum size of adenoma was 3.3 [3.0;4.2] cm. Level of UFC was 654.1 [383.0;1153.0] nmol/l/h, ACTH – 1.1 [1.1;2.3] pmol/l, serum cortisol after 1-mg overnight dexamethasone suppression test– 644.0 [431.5;710.5] nmol/l. Features that best discriminate Cushing’s syndrome were found not in all patients - proximal muscle weakness - in 81.3%, facial fullness -75.0%, easy bruising - 56.2% and striae - 43.7%. The most frequent (≥80%) complains were weight gain (87.5%), fatigue (84.3%), headache (50-80%). In

Background and aims. Due to changes in criteria of diagnosis of GDM in Russia from 2013, it is relevant to study clinical course of GDM and pregnancy outcomes depending on terms and methods of diagnosis of GDM.Material and methods. 192 pregnant women aged 29,4±5,5ys, with a body weight 68,8±14,8 kg, BMI 25,3±5,3. 1st group: 86 pregnant women with high fasting glucose level before 20th week of pregnancy, 2nd group: 43 pregnant women with hyperglycemia in OGTT after 20th week of pregnancy, 3rd group: 63 pregnant women without GDM - control group.Results. Pregnant women with GDM were older than non-GDM women (29,5±5,4ys., 30,8±5,3ys., 28,4±5,7ys, р=0,05) and had higher body weight (72,3±16,9 kg, 68,0±12,4 kg, 64,4±11,5 kg, р=0,016). There weren't difference in age, BMI between groups 1st and 2nd. The proportion of compliant women was the same in groups 1st and 2nd (38,4% and 34,9%, p=0,85). Pregnant women who needed insulin were older and had higher BMI (32,4 ± 5,3 ys. vs. 28,9 ± 5,4 ys, р=0,04; 29,7 ± 7,1vs.25,6 ± 5,7, р=0,03 respectively). The number of women treated by insulin was higher in 2nd group (46,6%vs.15,5%, p=0,03). Women, who treated by insulin, were younger and had higher BMI in 1st group compared with 2nd group (29, 0±4,7ys vs 35,0±4,3ys, р=0,03; 34,4±5,7 vs 26,1±5,9 respectively, р=0,02). There was a significant difference in delivery term and summary severe adverse outcomes (macrosomia, preterm delivery, stillbirth) between non-compliant women with GDM and 3rd group (38,6±2,7ws 1st group, 38,0±1,9ws 2nd group, 39,5±1,09ws 3rd group, р=0,008; 34,3% 1st group, 66,7% 2nd group, 19,4% 3rd group, р=0,027). The frequency of macrosomia and summary adverse pragnancy outcomes (hypoglicemia, neonatal jaundice, clavicle fracture, asphyxia) was higher in non-compliant women with GDM compared with compliant women ((29,5% vs. 12,2%, р=0,03; 70,5% vs. 46,3%, р=0,02 respectively).Conclusions: Pregnant women with GDM diagnosed on base of high fasting glucose level, need insulin less frequently. Pregnancy outcomes in women with GDM depend on compliance rather than on terms or methods of diagnosis.

Aim: to evaluate the primary complaints of patients with pituitary macroadenomas and “first-referred” specialists for them.Material and Methods. 351 with pituitary macroadenomas (at least one size >10 mm) were examined: 144 non-functional adenomas (NFA), 65 macroprolactinomas, 142 somatotropinomas. A pituitary adenoma was considered as giant if at least one of the sizes was >40 mm. MRI with an impact study of the pituitary was performed on high field instrument Intera Achieva (PHILIPS company) 3.0 TL, with intravenous extracellular gadolinium contrast agents. Statistical analysis of the results was carried out using the IBM statistical program SPSS Statistics 20 for Windows 7.0 with variation statistics methods for nonparametric data. The data are expressed as Mе [25%, 75%].Results. The patients’ age ranged from 20 to 80 years and were: NFA 60 [51; 66] y.o., prolactinomas 44 [35; 59] y.o. and somatotropinomas 57 [47; 66] y.o. (р

Background . Hypogonadotropic hypogonadism (HH) is a disorder characterized by delayed or absent pubertal development due to pathology of the hypothalamic-pituitary-gonadal axis. HH may be both congenital (Kallmann’s syndrome) and sporadic. Congenital or isolated HH is divided into with anosmia/hyposmia (KS) and with normal olfaction (nIHH). Nowadays several tens of genes involved in the functioning of the reproductive axis are known. However DNA lesions can be found just in 5-15% of such cases of HH. Aim . So we decided to measure mRNA expression of several genes which can be found in leukocytes of peripheral blood - namely GNRHR and GNRH1 (are necessary for adequate biological effect of GnRH); PROK2 and CHD7 (are responsible for the migration of GnRH neurons), WDR11 and DUSP6 (are involved in normal sexual development). Methods . A quantitative determination of mRNA expression of these genes were comlpeted in the fresh peripheral blood sample by PCR in real time. Results . Examined patients: 9 women with hypogonadotropic hypogonadism (age from 18 to 28 y.o.); duration of the disease from 2 to 15 years; 3 of them – amenorrhea I and 6 – amenorrhea II. Reasons of amenorrhea II were: stress, excessive exercises, rapid body weight loss, past use of oral contraceptives. The control group: 19 healthy women; age from 19 to 37 y.o.; with regular ovalutory menstrual cycle, some of them have children. mRNA expression of examined genes differed from normal patterns in each case of hypogonadotropic hypogonadism. Changes in GNRHR, GNRH1 and DUSP6 mRNA expression were found in most of cases. However variations of mRNA expression were multidirectional in each case and there was no similarity among expression profiles of patients according to amenorrhea type or anamnestic factors. Conclusions . According to our preliminary results, in women with hypogonadotropic hypogonadism the functional activity damage of “reproductive-responsible” genes could be found in each case. Probably mRNA expression measuring could be a perspective method for proving hypothalamo-pituitary level of reproductive disorders and may help to determine which genes should be tested for DNA impairment.

To estimate the prevalence of diabetes mellitus (DM) among the patients with acromegaly residing in the Moscow region (MR). A total of 93 patients aged from 48.0 to 64.5 (mean 57.5) years presenting with acromegaly from 7.5 to 20.25 (mean 13.0) years in duration were available for the examination. Twenty seven of these patients developed diabetes mellitus prior to acromegaly. Oral glucose tolerance test (OGTT) for diagnostics of DM was performed in 66 patients. The overall prevalence of diabetes mellitus among the patients with acromegaly was estimated at 51.6% which is higher than that in the general population of the Moscow region and worldwide (2.3% and 8.3% respectively). The prevalence of DM among women was higher than in men (55.1% and 33.5% respectively; p0.05). The prevalence of DM2 among the patients with acromegaly is significantly higher than in the world's general population; it depends on the patients' age and sex and as well as on the duration of acromegaly.

Regular (for 5 years) addition of salt iodinated with potassium iodinate to diets of children living in a region with moderate iodine deficiency normalized iodine content in the organism, decreased the incidence of goiter from 22.6 to 7.3% (according to ultrasonic data), and prevented an increase in the incidence of goiter during the prepubertal period. Evaluation of the size of goiter in screening examinations by palpation using О. V. Nikolaev’s classification leads to hyperdiagnosis (67%>), while palpation in combination with WHO classification results in hypodiagnosis of goiter (47%). Palpation of the thyroid with WHO classification is recommended as the main screening method; such a combination of methods results in a lower incidence of erroneous diagnoses (22%) than with Nikolaev's classification (56%). The level of serum TTH did not depend on iodine prophylaxis and was normal.

The main problem in analysis of the register of diabetes mellitus is evaluation of the reliability of data and the probability of extrapolating the results to a population of patients in the studied region. Our task was to assess the efficacy of diagnostic methods used in a region. Study of the prevalence of diabetic retinopathy and neuropathy by referent tests revealed poor sensitivity of methods for diagnosis of these complications in patients with insulin-dependent diabetes mellitus (IDDM) in the Mytischi region; hence, the prevalence of diabetic retinopathy and neuropathy might be higher than recorded in IDDM register. Analysis confirmed the usefulness of active detection of early stages of complicated IDDM by screening (examination of the fundus oculi, detection of microalbuminuria and vibration sensitivity) for reflecting the true incidence of complications and timely therapy. Detection of numerous patients with IDDM at the phase of diabetes decompensation necessitates revision of preventive and therapeutic measures. High incidence of hypoglycemic reactions among IDDM patients necessitates their more active prevention, specifically, training IDDM patients to practice automonitoring methods.

Clinical efficacy of two drugs, natural metabolites glycine and limontar, alone and in combination with substitute hormone therapy (SHT), is studied in patients with menopausal disorders. The clinical efficacy was assessed from the time course of neurovegetative, psychoemotional, and urogenital menopausal symptoms and from changes in mineral compactness of bone tissue and biochemical parameters of calcium-phosphorus metabolism and osseous metabolism. The results confirmed the efficacy of SHT in all types of climacteric disorders (neurovegetative, psychoemotional, urogenital, and in postmenopausal osteopenia). Combination of SHT with glycine and limontar did not affect the time course of the neurovegetative syndrome in general, but facilitated the arrest of arterial pressure differences and giddiness by estrogens. Moreover, glycine and limontar effectively relieve headaches. Combination of glycine with limontar is effective in asthenoneurotic syndrome in general and in individual psychoemotional symptoms: irritability, labile spirits, sleep disorders. In general asthenia and urogenital disorders glycine and limontar accelerated the clinical effect of SHT and in case of low spirits and decreased libido extend the spectrum of positive effects of SHT. The combination of glycine with limontar had no positive effect on the mineral compactness of bones. Combination of both drugs with SHT attenuated the process of bone formation, increased calcium excretion with the urine, and increased the hypocalcemic effect, and hence, they should not be prescribed in postmenopausal osteopenia or osteoporosis.

Diabetes mellitus register in the Moscow region is created within the framework of the National Register of Russia in 1994. Two districts of the Moscow region served as the model for the register: the Mytischi district and the town of Roshal. The register of insulin-dependent diabetes mellitus (IDDM) includes 1542 patients. The prevalence of IDDM in the Mytischi district is 622.8, in Roshal 1828/100,000. IDDM of obesity is responsible for 33.1%) cases in Roshal and 44.6%) in the Mytischi district. A high percentage of IDDM patients have excessive body weight. The prevalence of late complications of diabetes is much higher in Roshal, where the percentage of patients with retinopathy is very high (89%). High incidence of retinopathy among patients with newly detected diabetes may be regarded as an evidence of late diagnosis of the disease. Collection of reliable information requires special training of endocrinologists, therapists, and other specialists involved in work with diabetes mellitus registers; they should be trained to fill in the information charts and use strictly determined classification of diabetes mellitus and its complications.

A population of adult residents of the Stupino district in the Moscow region is examined. Urinary iodine excretion was measured, the thyroid examined by the ultrasonic method and by palpation, and serum TTH measured. Moderate decrease of iodine excretion with the urine (median iodine level in the urine was 91.7%) \ig/liter) indicates a slight iodine deficiency. Palpation revealed enlargement of the thyroid, which was confirmed by ultrasonic examination only in 25%) cases. The highest percentage of disagreements was observed only in first-degree enlargement, the least in third-degree enlargement according to О. V. Nikolaev ’s classification. As for the types of ultrasonic structure of the gland determined by the ratio of its linear parameters (flat, triangular, and cone-like), the highest percentage of disagreements was observed in cases with the flat structure, which is the most incident (77.3%)). Subclinical hypothyrosis was detected in 3%o subjects with iodine deficiency. Only 26%) residents of the examined region regularly consume iodinated salt with food.

One of the main complications leading to high disability and mortality in patients with diabetes mellitus is atherosclerotic vascular disease (diabetic macroangiopathy). At the same time, the frequency of atherosclerosis among patients with diabetes mellitus is significantly affected by the so-called risk factors for atherosclerosis. In particular, the incidence of atherosclerosis among the general population and among diabetics increases with increased levels of cholesterol (cholesterol) in the blood, blood pressure, smoking and obesity. However, in patients with diabetes mellitus, mortality, for example, from coronary heart disease increases by 3 times against any of the known risk factors. But even without risk factors, the frequency of atherosclerotic vascular damage in patients with diabetes is much higher than in non-diabetic patients, i.e. diabetes in itself is a risk factor for atherosclerosis.

Type II diabetes mellitus, or non-insulin-dependent diabetes mellitus (NIDDM) is a common endocrine disease, it affects up to 5-10% of the population aged 60-70 years, the frequency of NIDDM increases rapidly in individuals over 40, although it can occur at an earlier age. Mortality among patients with NIDDM is approximately 2 times higher than among people without diabetes. In particular, in patients with NIDDM under the age of 50 years, life expectancy is reduced by 5-10 years. Moreover, the life expectancy of women is less than that of men, but this difference disappears with age. The main cause of death with NIDDM is cardiovascular and cerebrovascular diseases. However, the prognosis of the disease depends not only on the degree of normalization of metabolism, but also on the effectiveness of the treatment of such often concomitant NIDDM conditions as hypertension, obesity, hyperlipidemia, as well as the elimination of bad habits, in particular smoking.

Nutrition is one of the constantly acting environmental factors that have a powerful effect on a number of biological constants of the body. Due to the absence of etiotropic therapy for diabetes mellitus (DM), the only real preventive measure for the occurrence and development of vascular complications at the present stage is the maximum compensation of various metabolic disorders characteristic of this disease. Diet therapy not only helps lower blood pressure (BP), but can also reduce the risk of coronary heart disease due to its lipid-lowering effect.

Original computer programs for assessment of energetic value of nutrition and daily energy expenditures of man based on physical activity protocols have been developed. The programs were tried in 16 patients with insulin-dependent diabetes, and essential individual differences from tentative table estimations of energy expenditures were detected. Correlations between treatment efficacy and individual energy expenditures of patients were observed; a moderate deficit of nutrition calories was found more detrimental for metabolic control than their moderate excess. The regularities detected even in such a nonrepresentative sample permit us evaluate high the potentialities and significance of the suggested method for assessment of energy expenditures.

Twenty-one obese patients with non-insulin dependent diabetes mellitus, 16 female and 5 male ones, were led similar isocaloric rations, differing only by the share of substitution of the traditional protein products (0 %, 60 %, 30 %, 45 %) in the Danpro-S, Danpro-Fibre soybean protein concentrate. The parameters tested were daily glycemia, C-peptides, blood hydrocortisone, and urinary excretion of nitrous metabolites. Indirect calorimetry was used to assess the protein, fat, and carbohydrate oxidation rates at rest. Addition of proteins of a plant origin to the diets of such patients was associated with significant changes of the energy metabolism at rest at the expense of increased oxidation of carbohydrates and reduced protein catabolism, that may be regarded as a favorable effect. In this patient population a 30 % soybean diet brings about an almost maximal positive effect in patients with the first degree of obesity, whereas in those with the second degree of obesity such effect is attained by the 45 % soybean diet.

The paper presents data on the cellular and humoral immunity in different periods of insulindependent diabetes mellitus (with the disease standing of 0.50.4 years, group A; 31.8 years, group B; and 154 years, group C). Group A patients presented with the immunity system activation: increased counts of T cells, В lymphocytes, T helpers and T inductors, increased share of active T cells (that is, DR positive ones), elevated content of IgM, IgG, IgA (21451 mg%, 1200124 mg%, 25034 mg%, respectively) as against the reference group (15674, 914387, 18949 mg%, respectively) (p0.01). In group В patients, who suffered a longer disease, the immunity parameters were within the normal range, and in group C patients, in whom the disease standing was the longest, these shifts were contrarywise as against those in group A, that is, T and В cell counts were lowered, as were the counts of T-helpers-inductors, lg levels, and the phagocytosis index was 655 vs. 8510 % in the controls (p0.05), the phagocytosis level being 42 vs. 102 in the controls (p0.05). The authors analyze the association of the HLA system characteristics with the immunity shifts. Patients with the HLA A9, B8, B15, B18, DR3, DR4 presented with significant shifts in the immunity status as against those with the HLA Al, A10, B5, B12, B16, B27, DR5, DR7. These data confirm a high informative value of the HLA markers for predicting the degree of alterations in the immunological homeostasis.

Plasma and erythrocyte concentrations of lipid acyl hydroperoxides, malonic dialdehyde (MDA), and a-tocopherol were measured in 45patients with diffuse toxic goiter (DTG) before and after thyrostatic therapy and in 26 of these patients 3—6 months after subtotal resection of the thyroid in a state of euthyrosis. The initial link in lipid peroxidation (LPO) was activated in erythrocytes and plasma in hyperthyrosis, while toxic LPO product MDA accumulated only in the plasma. The level of one ofpotent antioxidants a-tocopherol was decreased at all stages of examination in erythrocytes, while in the plasma it was decreased only before therapy. Estimation of the Horvitt index and LPO-antioxidant defense conjugation index (a-tocopherol requirement, content, or insufficiency) in the plasma and erythrocytes showed decreased content of vitamin E in tissues of patients with DTG, which recommends antioxidant therapy to DTG patients.