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Aim: To study the clinical, biochemical characteristics, treatment results and follow-up of patients with ectopic ACTH syndrome EAS (ACTH adrenocorticotropic hormone )., Materials and Methods: A retrospective, observational, single-center study of 130 patients with EAS. Demographic information of patients, medical history, results of laboratory and instrumental investigations at the pre- and postoperative stages and follow-up of EAS were analyzed., Results: The mean age at the diagnosis ranged from 12 to 74 years (Me 40 years [28; 54]). The duration of the disease from the onset of symptoms to the verification of the diagnosis varied from 2 to 168 months (Me 17.5 months [7; 46]). Eighty-one (62,3%) patients had bronchopulmonary NET, 9 thymic carcinoid, 7 pancreatic NET, 5 pheochromocytoma, 1 cecum NET, 1 appendix carcinoid tumor, 1 medullary thyroid cancer and 25 (19.2%) had an occult source of ACTH. The median follow-up period of patients was 27 months [9.75; 61.0] with a maximum follow-up of 372 months. Currently, primary tumor was removed in 82 (63.1%) patients, bilateral adrenalectomy was performed in 23 (18%) patients, in 16 of them there was an occult source of ACTH-producing NET and in 7 patients in order to control hypercortisolism after non-successful surgical treatment. Regional and distant metastases were revealed in 25 (19.2%) patients. At the time of the last observation 59 (72%) patients were exhibited a full recovery, 12 (14.6%) had relapse of the disease and 26 (20%) died from multiple organ failure (n=18), pulmonary embolism (n=4), surgical complications (n=2), disseminated intravascular coagulation syndrome (n=1) or COVID-19 (n=1)., Conclusion: In our cohort of patients bronchopulmonary NET are the most frequent cause of EAS (62.3%). Surgical treatment leads to remission of hypercortisolism in 72% cases; the proportion of relapse (14.6%) and fatal outcome (20%) remains frequent in EAS.

Aim: To study effects of one-year therapy with bivalos on mineral bone density (MBD) of the spine in patients with postmenopausal osteoporosis (PMO), effects of bivalos (strontium ranelate) on MBD of the neck of the femur and femur, the levels of bone metabolism markers, quality of life, tolerance of long-term therapy., Material and Methods: The study was made of 60 females aged 54-75 years with PMO. MBD was measured with x-ray absorptiometry in the vertebra and proximal femur. Bone markers in blood serum were detected by enzyme immunoassay., Results: After a year of taking bivalos MBD in lumbar vertebra increased by 4.68 +/- 4.94%, in the neck of the femur--by 2.0 +/- 4.29%, in the proximal femur--by 3.10 +/- 3.34%. A significant 19.5% rise in bone alkaline phosphatase and a 16.5% fall in the level of CT were noted showing a stimulating effect of bivalos on bone formation and an inhibiting effect--on bone tissue resorption. Bivalos treatment raised quality of life of the patients: better motility, regress of depression, improved self-appraisal, decreased number of patients with pain in the spine, attenuated pain. The drug was well tolerated, unwanted effects arose in 15% patients, discontinuation of the drug because of toxicity occurred in 5%. Serious side effects were not observed., Conclusion: Strontium ranelate is effective in PMO and is well tolerated.

То study the efficiency of neurosurgical treatment of the Itsenko-Cushing disease (1CD), the authors analyzed the early and late results of adenomectomy in 99 patients (90 females and 9 males) with ICD. The diagnosis of ICD was verified on the basis of hormonal studies, functional tests, and the results of topic diagnosis. All the patients had an active stage of the disease and a pituitary tumor, as evidenced by magnetic resonance Imaging (MRI). Out of the 99 patients, 75% had a microadenoma of the pituitary and 25% had its macroadenoma. No correlation was found between the sizes of a tumor, the duration of the disease, and the severity of hy-percorticism. The Indication for surgery was a well-defined localized pituitary tumor as verified by MRI. The patients tolerated a neurosurgery well and complications as incoming diabetes insipidus were observed only in 12%, which is in agreement with the data available in the literature. Algorithms were developed for postoperative management of these patients. The findings have indicated that the development of the hormonal and clinical signs of hypocorticism serves as a good predictive marker of a radically performed operation. Six months after surgery, 82% of the patients were at remission. At an average 8.6-year follow-up, remission continued to be in 69(85.2%) of 81 patients. After surgery, patients with ICD should be, however, followed up since 14% developed a recurrence in the late postoperative period.

То evaluate the effectiveness and safety of drug treatment for acromegaly, the authors conducted an open-labeled prospective study of the impact of treatment with long-acting octreotide Sandostatm LAR) on the content of growth hormone (GH) and IRF-1 and on the size of a pituitary tumor. The study covered 40 patients (28 females and 12 males) aged 21 to 65 years (median 45 years) who had active acromegaly; 4 (10%) patients were diagnosed as having pituitary microadenoma; 36 (90%) had pituitary macroadenoma. Twenty-four patients received no therapy; 16 patients had tumors after their ineffective removal. All the patients took Sandostatin LAR, 20 mg intramuscularly, once every 28 days. The mean duration of treatment was 8.25 months (range: 3 to 12 months). Clinical and hormonal parameters were estimated 3, 6, and 12 months of treatment. A treatment-induced decrease in GH and/or insulin-like growth factor 1 (ILGF-1) by at least 30% of their baseline values considered effective. The state of a tumor was evaluated by brain magnetic resonance imaging in 26 patients. Three month following Sandostatin LAR treatment, the median concentration of GH significantly decreased from 33.5 to 5.55 ng/ ml (p < 0.001) and later on it remained nearly at this level (5.1 ng/ml and 5.35 ng/ml after 6 and 12 months, respectively). The concentrations of ILGF -1 similarly changed: its median was 779 ng/ml at baseline, 390 (p < 0.001), 390, and 330 ng/ml after 3, 6, and 12 months, respectively. Following 12 months of treatment, there were reductions in GH levels in 52.2% of the patients (including a < 2.5-ng/ml reduction in 33.3% of the patients) in the concentration of ILGF-1 by more than 50% of the baseline values in 49.9% (including a complete ILGF-1 concentration normalization in 33.3%). Twelve months after treatment, there was a reduction in the size of a tumor in 38.4% of the patients (by an average of41.25±7.22% of the baseline volume) and its growth stabilization in 59.1%. The findings suggest that treatment with Sandostatin LAR in a dose of 20 mg Is an effective and safe treatment, leads to a significant reduction in the values of GH and IL GF-1 just 3 months after treatment, and controls hormonal secretion and tumor growth in most patients with acromegaly.

Fifty three consecutive patients with Cushing's disease were operated on in the Neurosurgical Institute from 1987 to 1995. In all cases the diagnosis was based on clinical and laboratory data, as well as radiographic images. Ten patients with false-negative CT scans had MRI confirming the presence of microadenomas less than 5 mm in size. The majority of patients (n = 51) were operated via transsphenoidal approach, transcranial route was utilized in 2 cases. Among the pathological findings, corticotropinomas were revealed in 49 cases, 4 patients were considered to have hyperplasia of the anterior pituitary without well demarcated adenoma. All patients were divided into 2 groups based on the history of previous treatment. Group 1 included 37 primary patients who had not been treated before admission. Group 2 included 16 patients treated surgically (e.g. neurosurgical operations, bilateral/unilateral adrenalectomy), or with irradiation therapy, including proton beam irradiation prior to admission. We came to conclusion that the following principles were essential in the management of Cushing's disease. 1. Properly interpreted clinical signs and symptoms along with biochemical data and radiographic imaging (including MRI) are extremely helpful in the preoperative evaluation of such patients. Our approach helped us reveal corticotropinomas with 98% accuracy. 2. Microsurgical removal was proved to be effective in up to 83% of patients, which was demonstrated by clinical and biochemical remission. 3. It should be emphasized that the results of treatment were significantly better in the first group versus the second one. In group 1, remission was reached in 91.1% of patients as compared to 62.5% in Group 2. 4. In primary patients, the trauma associated with surgical procedure is less and tumors demonstrate a less aggressive biological behavior.

The paper is concerned with experimental and clinical problems. Posttranslation modification of ferritin with glucose has been shown to cause change of its immunochemical properties. Changes in iron metabolism and in the level of glycosylated hemoglobin A1c were noted in patients with different forms of diabetes mellitus.

This work was aimed at the study of reserve capacities of the insular apparatus of the pancreas during the glucose tolerance test, and the test with tolbutamide and leucine in patients with Itsenko-Cushing's disease. The mentioned patients showed an increase in the immunoreactive insulin (IRI) level on the fasting stomach and a fall of the regulatory capacities of the insular apparatus of the pancreas; this was expressed in a later and high increase in the IRI level during the tests.

A study was made of the hypothalamo-hypophysio-adrenal gland interrelations during the insulin test in patients with Itsenko-Cushing disease, dyspituitrism of the puberto-juvenile period and diencephalic syndrome. The majority of the patients with Itsenko-Cushing disease displayed a reduction of insulin sensitivity, this being expressed in a delayed fall of the glucose level during the insulin test and the absence of any increase in the blood 17-OCS. An increased reaction of the hypothalamo-hypophysio-adrenal system to insulin hypoglycemia was observed in the patients with dyspituitrim of the puberto-juvenile period. A normal reaction to the insulin test was seen in all the patients with the diencephalic syndrome. The data obtained could be used in differential diagnosis between these diseases and Itsenko-Cushing disease.