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Possibilities of application of magnet-resonance tomography (MRT) for differential diagnosis of the adrenal glands tumors were studied up. MRT was conducted to 39 patients with adrenal glands tumors, including 22 - with malignant adrenal gland tumor, 17 - with benign tumor of adrenal gland. MRT constitutes the most effective method of topic diagnosis of the adrenal glands tumor, owes multipurpose possibilities, do not deliver radiation load, permits to visualize the vessels without the contrast media usage. The tumor diameter more than 10,1 cm, irregular form, illegible edges, uneven contours, presence of lymphadenopathy, regional or remote metastases constitutes diagnostic criterions of the adrenal glands malignant tumors. The intensity of MRT signal could not be used for differential diagnosis of malignant and benign tumors of adrenal glands.

Possibilities of ultrasound investigation (USI) application for differential diagnosis of the suprarenal glands tumors (SGT) were studied. USI was conducted in 169 patients with SGT, including 95 with malignant tumors of suprarenal glands (MTSG) and 64--with benign SGT. USI constitutes the main method of screening, permitting to reveal SGT in 90.5% of patients. Diagnostic criterions of MTSG were: diameter of tumor exceeding 10.1 cm, incorrect form, irregular edges, presence of invasion, lymphadenopathy, regional and remote metastases. In 45.3% of observations it was possible to establish the MTSG diagnosis, using USI.

Possibilities of computer tomography (CT) application for differential diagnosis of tumors of the adrenal cortex (TAC) were studied. CT was conducted in 157 patients with TAC, including 75--with malignant (MTAC), 82--with benign (BTAC), permitting to revealed MTAC in 76% patients. In 17.1% patients with BTAC false-positive results were noted, reducing, thus, the method diagnostic value. While the trustworthy signs of malignancy are absent, it is necessary to conduct morphological verification of the adrenal tumors nature using puncture biopsy and/or intraoperative express-cytological investigation.

Possibilities of application of the fine-needle aspiration puncture biopsy (FNAPB) in diagnosis of suprarenal glands tumors were studied. Of 43 patients, to whom FNAPB was performed, in 27 the suprarenal gland tumor was diagnosed, in 11--renal tumor, in 5--the puncture biopsy material occurred noninformative. Of 27 patients with tumor of suprarenal gland in 15 it was malignant, in 11--benign adenoma and cyst of suprarenal gland were revealed. FNAPB of the suprarenal gland tumor is a safe, informative and in some situations curative method. FNAPB is recommended for diagnosis of primarily revealed tumors of suprarenal glands more than 2 cm in diameter. The procedure should be performed by specially trained physician, who determines technical conditions of its conduction by himself and possesses the method o fultrasonography. Data of cytological investigationspermits to differentiate benign and malignant tumor, to determine the tumor type, what constitutes diagnostic background for the tactic choice of surgical intervention and the disease prognosis.

The extent of diagnostic possibilities of medical technique, permitting to reveal the majority of suprarenal tumors, and the most modem information technologies as well demands creation of the suprarenal tumors applicable classification, well-adopted for physician in practice and also for scientist dealing with analysis of the investigation results in these pathology. Taking into account hormonal activity of majority of tumors, influencing the patients management tactic, the authors propose the insight on suprarenal tumor diagnosis of their own.

Carcinoma of parathyroid glands is characterized by relatively slow course, frequent recurrence after performance of operation. Authors were observed 8 patients, operated in 1967-2001, what had constituted 6% of all quantity of the primary hyperparathyroidism observations. Early diagnosis and performance of adequate surgical intervention promote the efficacy of treatment raising and the prognosis improvement. Most favourable prognosis was noted after performance of primary radical operation. In most observations the performance of reoperation guarantee long-lasting remission, but rarely constitutes the radical measure.

For the 1967-2000 period 134 patients with primary hyperparathyroidism (PHPTH) were treated in the clinic. Clinico-morphological characteristics of PHPTH were analyzed. In majority of the patients the mixed form of PHPTH was revealed. In 90% of patients solitary adenoma of parathyroid gland had constituted the morphological substrate of the disease. In 117 (87%) of patients positive result of treatment was noted. In 18 (15%) of patients postoperative permanent hypoparathyroidism occurred. Seven (4.5%) patients died. For the improvement of early diagnosis and effective treatment it is necessary to secure wide screening of the calcium content, peculiarly in patients, constituting the risk group.

Essential approaches to the regional metastasizing rubric in TNM system were analyzed. Basing on summary of the results of 466 operations, performed for the thyroid gland cancer including intervention on cervical lymph nodes, the subgroup N alteration in international classification TNM was proposed, permitting to reflect individual clinical situation full to the brim and to achieve significant practical gain in further management of patient. The grading proposed corresponds to general principle, according to which every subsequent rubric must determine more severe affection without combining several types of affection in individual patient.

Results of reoperation for the thyroid gland cancer (THGC) were analyzed in 189 patients for 1981-2001 yrs period. Majority of patients were primarily operated in other hospitals of Ukraine. Thorough characteristic of the cancer forms, terms of reoperation performance, results of histological investigation of the tumor are adduced. Large frequency (41.2%) of the operation performance for THGC recurrences in term up to one years after performance of primary intervention trusts the necessity of operative intervention performance on thyroid gland (THG) in specialized centre by experienced surgeons. Absence of malignant growth in the THG stump while performance of definitive thyroidectomy in 60% of observations is not the cause to reject of doing it because the conduction of radioiodine therapy is possible after complete excision of the THG tissue. Examination and ultrasonographic investigation of the THG region and of cervical lymphatic nodes after performance of operation for THGC is recommended to conduct no less than once in 6 months.

The results of treatment of 330 children (< 14 years) and adolescents (15-18 years) with thyroid cancer who were operated on at the Institute of Endocrinology after the Chernobyl accident in 1986 were analyzed. The number of young patients increased after 1986 (1981-1985, 9 cases; 1986-1990, 37 cases; 1991-1995, 177 cases; 1996-1998, 116 cases). Most of these children and adolescents were younger than 8 years at the time of the accident (84.2%). More than half of the children (58.1%) lived in areas receiving the highest radiation exposure. These thyroid cancers developed after a short latent period, were more aggressive at presentation, and expressed regional (57.3%) or distant (14.5%) metastasis. Solid papillary cancers were present in 93.1%. Coexisting thyroid conditions were common (thyroid hyperplasia, 25.1%; nodular goiter, 18.8%; chronic thyroiditis, 10.2%). Most patients were treated by total thyroidectomy with intraoperative visualization of recurrent laryngeal nerves and parathyroid glands. When lymph node metastases were identified, a modified neck dissection was performed. Such operations were done in 277 (84.1%) patients. Postoperatively, the patients were treated with radioiodine and thyroid-stimulating hormone suppressive therapy. Postoperative complications included recurrent nerve palsy in 12.3% and permanent hypoparathyroidism in 6%. Operations for local recurrence of cancer were performed in 2.8% cases and for regional metastasis in 4%. The general mortality was 1. 8%. We anticipate that there will be more patients with thyroid cancer during the next few years. Therefore this high risk population for thyroid cancer must be carefully monitored and evaluated during the next several decades.

The comparative analysis of immune state of the various age patients with benign and malignant thyroid gland (TG) tumors is presented. In the TG cancer the immunogenesis insufficiency is more pronounced. The data obtained trusts the perspectiveness of the immunocorrecting therapy application in patients with the TG cancer.

The state of calcium metabolism in 249 patients after performance of thyroidectomy was studied up. It was established that precisional technique of the surgical intervention performance directed on the parathyroid glands vascularization preservation, is the main prophylactic method for the parathyroid insufficiency occurrence. Indications for the parathyroid tissue autotransplantation application during the performance of thyroidectomy are substantiated.

In 1981-1998 years 552 children and juveniles were operated on for benign tumors of thyroid gland (TG). The enhancement of the revelation frequency of solitary and polynodous goiter and lowering of follicular adenoma and cystadenoma was noted. The tactics of children and juvenile patients with benign TG tumors was proposed, which included an early morphological verification of diagnosis, the puncture biopsy performance as well as intraoperative express-histological investigation. While solitary node in TG existence and preoperatively established its benign essence, extrafascial hemithyroidectomy, using original method, is the operative of choice.

Background: The increase in the number of childhood thyroid carcinoma cases in Ukraine after the Chernobyl nuclear accident in 1986 prompted the development of a registry of thyroid carcinoma cases at the Institute of Endocrinology and Metabolism in Kiev. In the current study, the authors report the statistical data and clinicomorphologic features of the cases included in this registry., Methods: To study the incidence, and age and gender distribution of thyroid carcinoma in Ukraine, the authors compiled complete clinical information from cases diagnosed and treated at the Institute of Endocrinology and Metabolism and statistical reports submitted to the registry from 27 regions of Ukraine. Morphologic features of the resected tumors were examined and were included in the database., Results: During the 5 years preceding the Chernobyl nuclear accident, a total of 59 cases of thyroid carcinoma were identified in the birth to 18 years age group (25 in children age < or = 14 years and 34 in adolescents ages 15-18 years). Between 1986 and 1997, the total number of thyroid carcinomas in Ukrainian children and adolescents was 577 (358 children and 219 adolescents). Morphologically, the thyroid tumors overwhelmingly were papillary carcinomas, and the majority of these also showed a follicular and/or solid growth pattern. Lymph node metastases and other extrathyroidal spread were common, thus necessitating total thyroidectomy and lymph node dissections in many patients., Conclusions: Between 1990 and 1997, a significant increase in the incidence of thyroid carcinoma was noted in children and adolescents in Ukraine; the group most affected was comprised of the individuals who were age < or = 5 years in 1986 (the year of the Chernobyl nuclear accident). The largest number of cases occurred in patients living in areas of thyroid radiation doses of > or =0.50 grays. The morphologic features of those thyroid tumors suggest that they are aggressive tumors with a high frequency of lymph node metastases, venous invasion, and extrathyroidal spread.

Retrospective analysis of results of organpreserving operations for the thyroid gland cancer (TGC) in 55 children and juveniles for 1981-1997 yrs period was done. The informativity of preoperative cytological (96.4%) and intraoperative express--histological (95.6%) investigations was determined. In cases of the cytological and express--histological diagnosis complexities the possibility of organpreserving intervention of hemithyroidectomy with the isthmus extirpation was noted. Primary thyroidectomy is operation of choice in the established diagnosis of TGC.

Classification of operations on thyroid gland depending on the tissue volume preserved and basing on the analysis of surgical treatment of more than 2000 patients was presented. Substantiation and characteristics of its headings permits to take into account the intervention volume, what is peculiarly important during the automatized processing of large masses of information.

The organ culture transplantation of the adrenals cortical substance of a newborn piglets was applied while 94 patients treatment to whom total adrenalectomy for Itsenko--Cushing disease was done. Significant lowering of the substitutional hormonal therapy (steroid preparations) dosage was permitted due to the noted improvement of hypocorticism clinical course and an organism hormonal security indexes. The clinical effect duration is 6-9 months. The methods physiologically substantiated, technically simple, economically advantageous, do not cause the side effects.

Laparoscopic adrenalectomy (LA) using transperitoneal lateral access was conducted in 56 patients from June 1994 to September 1996 yr. Unilateral adrenal gland tumor up to 8 cm in diameter was diagnosed in all the patients. All the patients are alive. LA is the method of choice in the patients with syndromes of Conn, Cushing, pheochromocytoma up to 8 cm in diameter. The LA conduction is not indicated if malignant or large (more than 8 cm in diameter) tumor was revealed.

Results are submitted of studying the function of the kidneys in 34 patients with Itsenko [correction of Icenko]-Cushing disease and syndrome, who were evaluated by dynamic renoscintigraphy besides routine clinical procedures. Dynamic renoscintigraphy was found to be an important diagnostic acid enabling one to disclose function disorders of the kidneys in the preclinical stage under normal routine investigations. In this setting, there have been revealed disturbances both in secretory-filtrational and excretory and aggregate functions of the kidneys practically in all the patients irrespective of the type of hypercorticoidism. Surgical treatment of hypercorticoidism does not lead to normalization of the function of the kidneys. And what is more, function disorders of the kidney on the side of the surgical intervention appear to be even more serious.

A comparative analysis is presented of surgical treatment of 603 patients with malignant tumors of the thyroid gland before and after the Chernobyl NPP accident. Pediatric patients showed higher aggressiveness of the struma maligna course in the post-accident period, which fact suggests the need for broadening indications for thyroidectomy with radical intervention on regional lymph collectors.

Blood contents of pressor peptide hormones vasopressin and angiotonin II were studied in patients with neuro-endocrine syndrome before and after single intake and prolonged treatment with anti-serotonin drug peritol and cholinergic agent parlodel which affect biogenic amine metabolism and, consequently, influence blood pressure. Single doses of the drugs were established to cause different blood dynamics of vasopressin and angiotonin II which classified as marked and paradoxic reactions on peritol and parlodel used separately and associatively. Fall of blood vasopressin content induced by single dose of parlodel was accompanied by blood pressure decrease. Tree-week treatment with peritol and parlodel exerted hypotensive effect and significantly reduced vasopressin blood content.

Thyroid cancers in children from the affected areas of Ukraine were investigated by means of light (33 cases) and electron (20 cases) microscopy. Statistical data from 25 regions of Ukraine have been analyzed concerning thyroid cancer in patients aged up to 18 years for the period 1981-1990. There is an increase in the number of thyroid cancers in the children of Ukraine from 0.04-0.06 cases in the "pre-chernobyl" period to 0.23 cases per 10(5) children's population in 1990. In the children operated in the Clinic of the Institute of Endocrinology in 1990-1991, severe forms of thyroid lesions with metastases to the lymph nodes were noted. Histopathological studies show prevalence of different variants of papillary cancer with presence of follicular, solid, poorly differentiated areas. Ultrastructural analysis revealed polymorphism of tumour cells, various degrees of their differentiation and functional specialization that point to a mixed multicomponent nature of carcinomas.

A comparative analysis of the results of surgical treatment of 603 patients with malignant neoplasms of the thyroid gland before and after the accident at the Chernobyl atomic power station are presented. A very aggressive course of thyroid cancer in pediatric patients after the accident and the ensuing necessity to extend the indications for the performance of thyroidectomy with radical intervention on the regional lymph collectors are noted.

The effect of aminalon, baclofen and valproic acid on the levels of ACTH and cortisol was investigated in 58 patients with Itsenko-Cushing disease. The effect of GABAergic drugs showed correlation with the basal level of blood GABA: with aminalon and valproic acid the effect was observed only in patients with a low level of GABA, with baclofen--in patients with a high level of GABA there was found a decrease in the level of ACTH, associated with a high level of cortisol.

Results are reported of a study of the content of gonadotropins, prolactin and sex steroids in different regions of the vascular bed in women with Itsenko-Cushing disease. It was found that the content of gonadotropins were similar at all levels of the vascular bed indicating their secretion reduction in the pituitary. At the same time there was an increase of prolactin, testosterone, progesterone and cortisol in the blood of the ovarian, adrenal, peripheral and lower cavernous sinus veins. It is suggested that increased secretion of testosterone, progesterone and cortisol inhibits the production of gonadotropins and prolactin-inhibiting factor in the pituitary and leads to an increased prolactin level.

The content of GABA was measured in blood plasma of 111 patients suffering from Itsenko-Cushing disease. In untreated females, the blood GABA content was noticeably lowered; during treatment it increased, reaching normal, on the average, in patients with a history of total adrenalectomy. The changes in the blood GABA content in male patients were marked to a less degree. In the persons with a history of total adrenalectomy the GABA content turned out higher than normal. The blood GABA content in patients was dependent on the age and disease standing. In males experiencing disease exacerbation, it was appreciably reduced. As compared to females, the degree of a negative correlation between the blood content of GABA and ACTH (or cortisol) in males was more pronounced. The correlation between the excretion of 17-HCS with urine and GABA blood content in men and women was reverse. Women manifested a positive correlation between the excretion of 17-HCS with urine and blood GABA content, whereas men between arterial pressure and blood GABA. The problem of potential disorders of the GABAergic brain system in patients afflicted with Itsenko-Cushing disease is under discussion.

The paper is devoted to surgical treatment of patients with Itsenko-Cushing disease. Altogether 16 patients after adrenalectomy with subsequent autotransplantation of the gland on a vascular pedicle were investigated. The purpose was to study a morphological picture of the gland in ischemia and the determination of time required for blood flow recovery in the gland. Light and electron microscopy, radiological and clinical methods were employed. Emerging of the removed gland before autotransplantation into a nutrient medium for 30 min. (before blood flow recovery in a graft) was shown to damage neither secretory cells nor the components of the microcirculatory bed. The extracorporal condition of the gland for 1 h was accompanied by an increase in autolytic processes, especially in the medullary substance and deep layers of reticulated cortical zone, but most of the adrenocorticocytes preserved their viability and structural features of steroid activity, which became an indication for effective autotransplantation of the adrenal gland on a vascular pedicle in the treatment of Itsenko-Cushing disease.

An analysis of gestational and obstetric histories of 40 women with Cushing's disease has shown that pregnancy is contraindicated during an active phase or partial clinical remission of the disease. Pregnancy is permissible at a prolonged time following the onset of a stable clinical and hormonal remission, bilateral total adrenalectomy and compensation of chronic adrenal insufficiency. No specific therapy is required in the former situation. The adrenalectomized patients need an intensification of replacement therapy and switch to parenteral glucocorticoids ante-, intra- and postpartum. Twenty infants of mothers with Cushing's disease were examined and found to have a normal clinical and endocrine status.

To diagnose the Icenko-Cushing syndrome and disease, samples of the venous blood were taken from the inferior vena cava, the renal and adrenal veins of 51 patients to determine hydrocortisone and ACTH. Thirty-nine patients showed a tendency to an increase in the basal level of hydrocortisone in the blood from the inferior vena cava and the renal veins and a significant elevation of its concentration by approximately an equal value in the blood from both adrenal veins. The ACTH content in their blood was elevated, all these indicating the presence of primary disorders in the hypothalamus-hypophysis system and the secondary involvement of the adrenal cortex in the pathological process, i.e. the Icenko-Cushing disease. Different changes of the hydrocortisone content in some places of the venous blood sampling were observed in 12 patients. A significant difference in the hydrocortisone concentration from the left and right adrenal veins and a decrease in the ACTH level in the blood were observed. Such a combination of the signs points to the presence of an autonomous hormone producing adrenal tumor (the Icenko-Cushing syndrome). The results of measurement of the hydrocortisone concentration in the blood within a group of patients with suspicion of corticosteroma recurrence were taken into account to select an appropriate therapeutic method.

The indices of central hemodynamics and renin-angiotensine-aldosterone system, as well as their relationship, were studied in patients with aggravated Icenko-Cushing's disease. A stable high arterial pressure, a raised total peripheral resistance, a decreased cardiac index, an increased blood corticotrophin, cortisol and aldosterone levels and an enhanced plasmatic renin activity were revealed. It is suggested that activation of the renin-angiotensin-aldosterone system stimulates the development of arterial hypertension in patients with Icenko-Cushing's disease, taking into account a significant role of this system in alteration of the central hemodynamics indices.

Mineralocorticoid function of the adrenal cortex and the activity of the renin-angiotensin system were studied in patients with Itsenko-Cushing's disease before (36 cases) and after (27 cases) the treatment with chloditan--an adrenocortical inhibitor. Minertalocorticoid function of the adrenal cortex was assessed by the blood immunoreactive aldosterone content, urinary 18-aldosterone-glucuronide excretion, and the rate of aldosterone secretion. Condition of the renin-angiotensin system was assesed by the blood renin activity. Aldosterone and renin concentration was studied by the radioimmunological method. There proved to be a reverse relationship between the blood aldosterone concentraiton and the severity of Itsenko-Cushing's disease. Elevation of the mineralocorticoid function of the adrenal cortex in Itsenko-Cushing's disease was due to activation of the renin angiotensin system. During clinical remission of the disease following a course of chloditan treatment the patient displayed an increased blood aldosterone level and a rise of its secretion. The minralocorticoid function of the adrenal cortex was intensified at the state of clinical remission because of an increased blood corticotropin concentration.

The results of the clinical study are presented, concerning the use of a comparatively new method for the topical diagnosis of the chromaffine tissue tumors. The technique is based on the determination of the catecholamine content in several blood plasma samples, collected from different regions of the vena cava inferior and its flows. Twenty patients with suspected hormonal-active tumor of the chromaffine tissue were examined. Pheochromocytoma of the left adrenal was found in 5 patients and of the right one in 1 subject; bilateral adrenal tumors were revealed in 2 patients and extraadrenal chromaffinomas in 2 persons on the ground of the increased local blood catecholamine content in the circulatory channel regions studied.