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We’ve studied a carbohydrate metabolism in morbidly obese (MO) patients and the patients after bariatric surgery. The patients of the 1st group had BMI40 (n=22) and no history of diabetes mellitus. Patients after biliopancreatic diversion (BPD) performed for MO were included in the 2nd group (n=23). The 3rd group was a control group of normal weight healthy subjects (n=22). Blood glucose levels, insulin, GLP-1, GIP and glucagon during the OGTT (with 75 g of glucose) at 0, 30, 60 and 120 minutes were measured in all patients. In MO group fasting glucose levels were the highest. Impaired glucose metabolism was revealed in 68.2% of patients (n=10). Impaired fasting glucose (IFG) was diagnosed in 4 cases (18.2%), impaired glucose tolerance (IGT) in 11 patients (50%). In the BPD postprandial blood glucose levels (120 min) were lower if compared to the other groups. In 4 individuals (17.4%) we found postprandial hypoglycemia (2.8 mmol/l). Patients of the MO group had the highest fasting insulin levels and HOMA-IR (p0.001). The maximum of insulin concentration was seen on minute 30 of the OGTT in the 2nd and 3rd groups, and it was significantly higher in the post-bariatric patients (p=0.026). In MO group the maximum of the plasma insulin levels were on the 60th minute and were still elevated after 120 minutes. Fasting and stimulated (on the 30th minute) levels of GLP-1 were significantly higher after BPD (р=0.037 and p=0.022 at 0 and 30 min, respectively). Morbidly obese patients had higher fasting and stimulated GIP. Fasting glucagon concentrations were similar in the surgical and control groups, while the people with MO had higher initial levels of glucagon (p=0.013) and it was not suppressed during the OGTT (p=0.076). Glucose intolerance and insulin resistance incidence was higher in MO patients. Hyperglucagonemia, increased GIP and decreased GLP-1 levels are observed in MO patients. Stimulated plasma insulin and GLP-1 concentrations were significantly increased in patients who underwent BPD, and may cause postprandial hypoglycemia.

Aims: this study evaluates the most common associations of symptoms and complications in patients with Cushing’s syndrome (CS) in order to choose a potential population to be screened for CS and estimates the diagnostic accuracy of first line screening tests (cortisol, ACTH) to differentiate ACTH-ectopic CS from Cushing’s disease. Materials and Methods: The clinical data of 259 patients with proven CS during 2001–2011 was analyzed. The clinical presentations of 197 patients (159 Cushing’s disease, 28 ACTH-ectopic CS and 10 cases of benign cortisol-secreting adrenal adenoma) were compared according to the cause of hypercortisolism. ROC-analysis was performed to estimate the diagnostic accuracy of the first line tests (cortisol, ACTH) to suggest ACTH-ectopic CS. A threshold for the test with the highest area under the curves was chosen based on the maximum sum of the sensitivity and specificity. Results: The most frequent complaints were related to fatigue, muscle weakness, weight gain and changes in appearance (facial plethora and fullness, striae). Among the complications of CS the most frequent were being overweight or obese (71%), hypertension (63%), dislipoproteinemia (41%), low traumatic fractures (43%) and steroid-induced diabetes (31%). In women, 16% were older than 50, in those who were younger amenorrhea was registered in 43%. The patients with ACTH-ectopic CS had higher rate of low traumatic fractures (p=0.04), increased serum late-night cortisol, 24 hours urinary free cortisol, morning and evening ACTH and lower levels of potassium (p0.01 for all parameters). Plasma late-night ACTH measurements showed the highest AUC (0,811 (95% CI 0,712–0,909)) to differentiate ACTH-ectopic CS from Cushing’s disease. A cut off value of 108.9 pg/ml for late-night ACTH yielded a sensitivity of 60,7% and a specificity of 79%. Conclusions: patients with a coexistence of obesity, muscle weakness, fatigue, some components of metabolic syndrome and especially low traumatic fractures should be screened for CS. High plasma late night ACTH values in patients with proven CS value suggest ACTH-ectopic syndrome.

Genetic aspects of familial isolated pituitary adenomas (FIPA) are expanding rapidly in the last few years. Around 20% of these FIPA families have been identified to have mutations within the aryl hydrocarbon receptor interacting protein (AIP) gene. The number of identified AIP-positive FIPA families is increasing all over the world.

Diabetes mellitus is associated with increased risk of several types of cancer, and also with increased cancer mortality. Chronic hyperinsulinemia plays the main pathogenetic role in this association, which is mediated by a number of molecular mechanisms, described in this issue. Drugs that increase insulin sensitivity and reduce hyperinsulinemia (metformin in the first place) display anticancer effect. Aside from the anticancer effect, mediated by reduction of insulin resistance, metformin may directly suppress cancer cells growth and proliferation via stimulation of AMP kinase (AMPK). Antiproliferative action of metformin in breast and ovarian cancer is confirmed in a number of experimental and clinical trials. Its found out that therapeutic effect of metformin in treatment of breast cancer depends on the presence/absence of some molecular features of the tumor (for example, increased expression of HER2 and/or activation of p70S6K1). In order to specify mechanisms of action and effects of metformin in oncological practice several trials are being conducted or planned, most of all, in all subtypes of breast cancer. Confirmation of the anticancer effectiveness of metformin will promote an expansion of its use in clinical practice and in clinical oncology, particularly.

Chronic heart failure (CHF) is a complication of most cardiovascular diseases. Despite of the last achievements in pharmacotherapy, life expectancy in patients with CHF remains to be the lowest, and the risk of sudden death is the highest. The last 20 years stressed the importance of growth hormone role in the development of cardiovascular disease, and its potential in treatment of terminal CHF. This article reviews the most well-known research conducted in this area.

The aim of this study was to investigate the characteristics of visfatin - PBEF1 - gene expression in subcutaneous and visceral adipose tissue and serum levels of visfatin in children with relation to age and anthropometric parameters. The study included 52 patients (27 boys (52%), 25 girls (48%) aged from 2,5 to 18 years (13,8 [7,4-15,1] years)), who underwent an elective surgical intervention. PBEF1 mRNA level was measured by real-time PCR and serum level of visfatin was quantified by immunoenzyme assay. According to our study visfatin serum concentration in children with normal body weight was 9,2 [7,4-11,6] ng/ml, whereas in the overweight group - 9,5 [7,5-11,1] ng/ml (p=0,5). No statistically significant gender difference in serum visfatin levels was observed. No correlation between visfatin levels and age, pubertal stages and anthropometric indices in children was found. Statistically significant differences in the level of gene expression between subcutaneous and visceral adipose tissue were found (р=0,002) in the total group of children surveyed and children with normal weight, while there were no depot-specific differences in overweight children. The study did not reveal any dependence of PBEF1 expression on age and sex of children. Expression of PBEF1 in adipose tissue decreases with puberty (PBEF1VATγ=-0,24, р=0,02; PBEF1SATγ=-0,25, р=0,02). PBEF1 expression in adipose tissue was not correlated with the serum visfatin (R=-0,06, р=0,6).

Исследование выполнено при поддержке фармацевтической компании «Ф. Хоффман-Ля Рош Лтд».