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24 hr monitoring of arterial pressure (AP) in 46 patients with acromegaly in active phase revealed systolic-diastolic arterial hypertension. Analysis of diurnal profile showed the absence of the normal nocturnal fall in AP (non-dipper profile) and the significant rise in the number of patients with elevated nocturnal AP (night-peakers).

Background: Myokines are produced and released by muscle cells in response to muscular contractions. Endogenous Cushing syndrome (CS) and acromegaly cause significant changes in muscle tissue leading to atrophy or hypertrophy. However, there is no data whether these endocrine abnormalities influence myokine secretion., Aims: To evaluate serum levels of myostatin, interleukin-6 (IL6) and irisin in patients with CS and acromegaly., Materials and Methods: Fasting serum samples were taken and stored in aliquot at ≤-20°C from consecutive subjects with clinically evident and biochemically confirmed active CS, acromegaly and healthy volunteers matched by age, sex and body mass index (BMI). Commercially available kits were used to assay serum myokine levels. Grip strength was measured by a dynamometer. Insulin-like growth factor-1 (IGF1) was measured by immunochemiluminescence assay (Liaison), twenty-four hours urine free cortisol (24hUFC) ― by immunochemiluminescence assay (Vitros ECi), salivary free cortisol ― by electrochemiluminescence assay (Cobas). One-way ANOVA was utilized to assess the difference between groups., Results: We enrolled 88 subjects: 30 patients suffered from CS (group 1), 28 ― acromegaly (2) and 30 matched healthy controls (3) with no difference among the groups in sex, age and BMI (p=0.492, 0.062 and 0.174 respectively). Mean 24hUFC in subjects with CS and mean IGF1 in subjects with acromegaly were significantly higher as compared to other groups (p<0.001). Right-hand grip strength was lower in patients with CS as compared to both patients with acromegaly and healthy subjects (p=0.04). However, among these young adults we did not find statistically significant differences in measured myokines levels: irisin ― p=0.15; IL6 ― p=0.34; myostatin ― p=0.50. There was a significant correlation between myostatin and irisin in the whole group of people and in every separately analyzed subset of patients (p<0.001), but no correlation was found between any measured myokines and 24hUFC or IGF1., Conclusions: Hypercortisolism or supraphysiological IGF1 levels do not significantly influence serum levels of myostatin, IL6 and irisin in young adults.

Altogether 25 patients with acromegaly, 19 patients with prolactinomas, and 6 patients with nonfunctioning hypophyseal tumors (NHT) were investigated. Dopaminergic regulation of PRL, STH, TSH, LH and FSH was investigated with sulpiride (an antagonist of peripheral action) in all the patients. In acromegaly, irrespective of the presence of hyperprolactinemia, one can observe dysfunction of the central dopaminergic system (DAE) and DAE-regulation of adenohypophyseal hormones. Signs of disordered hormonal DAE-regulation are disorder of the normal ejection of PRL and pathological ejection of TSH in response to administration of DA antagonists. The results of investigations revealed both an enhanced tone of the DAE-system and insufficiency of DAE-control of hormonal secretion in patients with different hypophyseal tumors and other neuroendocrine diseases.

Some acromegalic male patients (50%) have weakened sexual function accompanied by a decrease in the levels of LH, FSH and testosterone. Hyperprolactinemia of various degrees was observed in 11 of 13 patients (84%). The summary index SFM (the male sexual formula) and a PRL level showed negative correlation. There was no significant difference in LH response to LH-RH administration between patients with normal and disturbed sexual function. Radiation therapy, in particular proton-beam therapy, produced no negative influence on male sexual function in a long-term period after therapy.

The functional state of parathyroid glands and calcitonin-produced thyroid C-cells was studied in 25 patients with acromegaly. 14 subjects were in the active stage of the disease and 11 persons developed clinical remission. The study on parathyroid hormone (PTH) and calcitonin (CT) basal levels was performed by radioimmunoassay, using the standard test-sets of DRG K degrees (USA). It was shown that acromegaly is characterized by the secondary hyperparathyrosis occurrence, accompanied by a typical disorder of functional interactions between parathyroid hormone and calcitonin. During the stabilized stage of the disease PTH and CT basal levels decrease, not reaching, however, normal values. Besides, the active form of hypercalcitoninemia manifestation, depending on the disease duration, was found out.

The results are presented of the treatment of 31 females with different hypothalamic-hypophyseal abnormalities: persisting lactorrhea-amenorrhea syndrome, acromegaly, hypothalamic syndrome, lactorrhea syndrome without amenorrhea. The effect of parlodel acute load on STH and the blood serum prolactin content was studied. It was concluded, that parlodel acute load produces a marked decrease in the prolactin level 2 hours after the drug injection both in the patients with an originally elevated prolactin level, and in the subjects, having the prolactin level within normal. Significant changes in the STH level were not observed 2 hours after parlodel load.

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.

The results of treatment of pituitary adenomas manifested by the acromegaly syndrome with catamnestic follow-up of up to 10 years are discussed. The dynamics of changes in acromegaly and various endocrine functions with the use of distance gamma therapy and proton beam irradiation were studied in the comparative aspect, on the basis of which the indications for these methods of radiotherapy in acromegaly were specified.

Dependence of lactorrhea on the basic blood level of somatotropic hormone (STH), prolactin (PL), folliculostimulating hormone (FSH), and luteinizing hormone (LH) was studied in 62 patients with an active phase of acromegaly, untreated, and in 41 with inactive phase of the disease following radiation therapy. Thyrotropic hormone (TTH), PL, and STH secretion (basic and after intravenous injection of 200 micrograms of thyroliberin) was determined in 20 patients with active and in 6--with inactive acromegaly following radiation therapy. In patients with active acromegaly the percentage of lactorrhea in women constituted 60 and in men--9.5, and with inactive acromegaly (after radiation therapy) it was 13.3 and 0, respectively. Basic PL level was significantly elevated in both groups of patients. The principle role in the pathologenesis of lactorrhea in acromegaly proved to be played by increased PL secretion. Under the effect of thyroliberin PL secretion was significantly elevated in comparison with control in 15 patients with active acromegaly and in all cases at the stage of remission. Basic TTH level and this level after thyroliberlin stimulation was within the normal range. In 4 patients with lactorrhea the absence of TTH secretion was combined with unresponsiveness of PL secretion, this suggesting the presence of tumour growth. STH secretion was independent of lactorrhea both under basic conditions and after thyroliberin stimulation.

Determination of the indices of central hemodynamics by means of radiocardiography shows them to be essentially changed in patients with acromegaly in the active stage. A clear correlative relationship has been established between the shifts in hemodynamics and the heart volume determined by X-ray. The diagnosis of preclinical stage of circulatory insufficiency is based on revealing a statistically significant increase in the stroke index and a decrease in the circulation volume and total peripheral resistance. In the early stage of acromegaly there is a statistically significant increase in the minute and stroke indices, in the index of minute work, and in the coefficient of circulation effectiveness. With an increase in the duration of the disease, these indices decrease considerably, which denotes hemodynamics deterioration.

A study was made of 38 persons, including 25--with acromegaly, 5--with chromophobic adenomas of the hypophysis, 3--with diencephalic tumours and 5 healthy individuals. STH, TTH and ACTH were determined in the blood plasma with the aid of radioimmunological methods under basic conditions and L-DOPA loading (10 mg per 1 kg of weight) with insulin (0.10 U/kg). There was an increase in the plasma content of STH, TTH and ACTH with a maximum 60 min after the administration of L-DOPA. In the patients with acromegaly STH increased considerably, and in cases with chromophobic adenomas and diencephalic tumours--less. ACTH level was also elevated. STH and ACTH level rose after insulin hypoglycemia. Possible mechanisms of a stimulating action of L-DOPA and insulin are discussed.

Metoclopramide (DA-antagonist, M) tests were performed in 21 patients with acromegaly and in controls; the levels of adrenohypophyseal hormones were determined before and after drug administration. Irrespective of the basal level of prolactin (P) all the patients demonstrated a decrease in stimulated P secretion which was more noticeable in patients with hyperprolactinemia. The hyperergic response of TSH to M administration was observed in some of the patients with acromegaly. Such a response indicated an elevated tone of the dopaminergic (DA) system. The results obtained were suggestive of dysfunction of DA regulation of P secretion in all the patients with acromegaly.

Insulin content was studied by radioimmunological and histochemical methods in the erythrocytes and the blood serum of patients with acromegaly and the postpartum panhypopituitrism (Sheehan's syndrome) in comparison with that in healthy persons on fasting stomach and after glucose-tolerance test (GTT). It appeared that the erythrocytes of healthy persons contained 50 times more insulin on fasting stomach than the blood serum. In persons with acromegaly complicated by diabetes mellitus insulin content in the blood serum was almost double that in healthy individuals. But this "hyperinsulinism" was only seeming, since the hormone reserves in the organism (erythrocyte insulin content) were sharply diminished. Sheehan's syndrome was characterized by hypoinsulinemia (both in the serum and in the erythrocytes). After the GTT the insulin content rose in the serum, and decreased in the erythrocytes. This indicated that erythrocytes participated in the homeostasis regulation of glycemia.

In 37 patients with endosellar pituitary adenoma attended by the acromegaloid syndrome, a plasma STH level determined by a radioimmunoassay against a background of an insulin test was compared with EEG findings before and at varying time (up to 7 yrs.) after proton beam therapy using the synchrocyclotron of the Leningrad Institute of Nuclear Physics. EEG was shown to be an informative method of diagnosis of continuous pituitary adenoma growth and complications of proton beam therapy in the form of temporal paroxysms.