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The hormonal activity and the duration of an active phase of the disease are important factors that are involved in the pathogenesis of organ and system complications decreasing lifespan in patients with acromegaly. A hundred and forty patients with active acromegaly were examined to determine the age-related features of the course of the disease. According to the age by the moment of the examination, all the patients were divided into 3 groups: 1) 14 patients aged 20-39 years; 2) 72 patients aged 40-59 years; and 3) 54 patients aged 60 years or more. The mean age at the onset of disease was 27.5±1.9, 37.5±1.0, and 51.2±1.2 years in Groups 1, 2, and3, respectively (p - 0.000); the duration of a latent period being 3.8±0.7, 6.2±0 6, and 9.3±0 8years (p.Степень секреторной активности и продолжительность активной фазы представляются важными факторами, принимающими активное участие в патогенезе органных и системных осложнений акромегалии, непосредственно влияющих на выживаемость больных. С целью выявления возрастных особенностей течения заболевания обследовано 140 больных активной акромегалией. В зависимости от возраста к моменту обследования все пациенты были разделены на 3 группы: 20-39 лет (14 больных), 40-59 лет (72 пациента) и 60 лет и более (54 пациента). При сопоставительном анализе межгрупповых параметров отмечено: средний возраст пациентов при дебюте заболевания составлял соответственно 27,5 ± 1,9, 37,5 ± 1,0 и 51,2 ± 1,2 года (р = 0), продолжительность латентного периода составляла 3,8 ± 0,7, 6,2 ± 0,6 и 9,3 ± 0,8 года (р0,002). Уровень гормона роста в крови как показатель секреторной активности составлял соответственно 58,6 ± 15,3, 41,2 ± 5,9 и 20,5 ± 3,5 нг/мл (р1-3 = 0,007). У пациентов с дебютом заболевания старше 50 лет основным фактором патогенеза, негативно влияющим на их выживаемость, является продолжительность активной фазы, способствующая развитию кардиоваскулярных, респираторных, обменных нарушений и злокачественных неоплазий, выраженность которых существенно ограничивает возможность хирургического вмешательства. Более показанным является использование аналогов соматостатина в относительно меньших дозах. Назначение агонистов дофамина (без учета чувствительности) и лучевого лечения (в старшей возрастной группе) представляется нецелесообразным.

This paper reports the results of research designed to study the possible predictors and the frequency of development of neoplasms in the thyroid gland and the gastrointestinal tract in the patients presenting with acromegaly. Special attention is given to the role of IGF-1 and IRI in the formation of tumours in the aforementioned organs and systems and the dependence of the frequency of their development on the patients’ age and (25)OH)D level. The detailed description of the features of the revealed thyroid and gastrointestinal neoplasms is presented.

Acromegaly is frequently associated with the development of colon and thyroid cancer. Stomach cancer concomitant with this pathology is a rare form of tumorigenic complications of acromegaly. The present paper reports a 33 year-old woman with verified diagnosis of acromegaly characterized by enhanced serum IGF-1 and GH levels and the presence of pituitary microadenoma confirmed by the MRT study (2006). The patient was many times advised to undergo neurosurgical treatment that she flatly refused. The patient was regularly treated with sandostatin and dopamine agonists. In 2008, the patient began to complain of uncomfortable feeling in the epigastric region and was examined in the ultrasound study of the abdominal cavity and small pelvis organs. She was found to develop ascites and bilateral ovarian tumour. By way of preparing for the surgical treatment of ovarian cancer, the patient underwent gastroscopy that revealed infiltrative ulcers in the stomach. The histological study of gastric biopsies gave evidence of gastric signet ring cell carcinoma while the bilateral ovarian tumour turned out to be Krukenberg's metastases.

The authors present the data on the prevalence of malignant tumours of the thyroid glands, gastrointestinal tract, mammary glands, prostate, and testicles in the patients presenting with acromegalia. The possible mechanisms of the development of neoplasms in the patients with acromegalia and immunological characteristics of the tumours in the patients with acromegalia are discussed.

Acromegaly is a serious disease with different complications leads to reduced life expectancy and increase mortality. Only early diagnosis and modern methods of management of disease lead to remission. According to consensus on criteria for cure of acromegaly (2010) the measurement of GH and age-matched total IGF-I concentrations are the most important biochemical variables for the diagnosis of acromegaly and for monitoring progression or treatment response. The optimal disease control is now defined as IGF-I level in the age – adjusted normal range, random GH levels less than 1,0 µg/liter and nadir GH level during OGTT less than 0,4 µg/liter. MRI with use a contract substance is the best method of adenoma visualization. The trassphenoidal surgery with new technologies (endoscope, intraoperative blood sampling, neuronavigation, intraoperative MRI), radiosurgery, modern medical treatment (multiligand long-acting somatostatin analogs, GH receptor antagonist) are effective modalities for treatment of acromegaly, which elaborated last decades.

В представляемой работе обобщен первый опыт применения Бивалоса в терапии ПМО в России. Целью настоящего исследования являлось изучение влияния терапии Бивалосом в течение года на МПК позвоночника, МПК шейки бедра и бедренной кости в целом, уровень маркеров костного метаболизма, а также на качество жизни и переносимость длительной терапии у пациенток с ПМО. В исследование включено 60 женщин от 55 до 75 лет с ПМО, проходивших лечение в 3 медицинских центрах г. Москвы (ЭНЦ, ИР РАМН, ЦИТО - по 20 пациенток в каждом центре). Через год применения Бивалоса отмечено достоверное увеличение МПК в поясничных позвонках на 4,68±4,94%, в шейке бедра на 2,0±4,29% и по общему показателю МПК проксимального отдела бедренной кости на 3,10±3,34%. Оценка динамики маркеров костного метаболизма выявила статистически значимый прирост КЩФ на 19,5% и снижение СТх на 16,4%, что подтверждает разнонаправленный эффект Бивалоса на костеобразование и резорбцию костной ткани. Терапия Бивалосом повышает качество жизни пациентов: расширяет двигательную активность, снижает уровень депрессии, повышает самооценку, уменьшается количество пациентов с болью в спине, снижаются уровень боли и частота ее возникновения. Бивалос хорошо переносится пациентами, частота НЯ, связанных с приемом препарата, не превышает 15%, а отмена препарата из-за НЯ составила 5%. Не наблюдалось серьезных побочных явлений. Наши результаты сходны с данными многоцентровых двойных слепых плацебо-контролируемых исследований с большой статистической мощностью.

The aims of the reported multinational open study were to estimate the influence of subcutaneous injections of 20 mkg daily Teriparatide on bone mineral density (BMD) at the lumbar spine and proximal femur, the markers of bone metabolism, the quality of life as well as the safety of treatment. Duration of the treatment period was one year. Fifty postmenopausal women with osteoporosis (L1-L4 T-score mean -3,2±0,6 SD) were enrolled in the study. 70,8% of patients had fragility fractures. Forty four patients (78%) remained until the end of the study. BMD was detected by dual energy X-ray absorptiometry (DXA) («Prodigy», Lunar and «Hologic» 4500 W) at the lumbar spine (L1-L4) and proximal femur with converting to the standardized BMD. Bone alkaline phosphatase (BAP) and osteocalcin (OC) were measured as markers of bone formation and C-terminal cross-linking telopeptide (CTX) were measured in serum as a marker of bone resorption. The significant increase in BMD was found at the lumbar spine (L1-L412,5±6,6%), whereas BMD at the proximal femur did not change significantly. The levels of markers of bone metabolism were increased after 3 months of the treatment and to the end of the study were 192,2%; 385%; 526,3% higher versus the baseline levels for BAP, OC., CTX consequently. There was also found a significant improvement in the quality of life of the patients which was estimated by EQ-5D inquirer at the baseline visit and at the end of the study. The adverse effects, which were related to the teriparatide injections, were observed in 44% of the patients. Due to the adverse effects Tereiparatide was cancelled for 6 (12%) patients. In other cases the adverse effects were slight and the cancellation of treatment was not required. Conclusions: The daily injections of Teriparatide (20 mkg) during 1 year provide the significant increase in BMD at the lumbar spine for postmenopausal women with osteoporosis as well as the early increase in the bone turnover rate. Treatment with Teriparatide improves the quality of life for women with postmenopausal osteoporosis. The daily injections of Teriparatide during 1 year are well tolerated and safe.

The article is devoted to the descripition of the rare case with Icenko-Cushing syndrome caused by multiple bilateral benign and malignant adrenocortical tumors.

The paper is concerned with the results of determination of a value of Na+/H(+)-metabolism in 66 patients with arterial hypertension of different genesis, including 21 patients with stage 11 essential hypertension, 8 patients with renal hypertension, 25 patients with Itsenko-Cushing syndrome or disease, 7 patients with pheochromocytoma, and 5 patients with primary hyperaldosteronism. The control group consisted of 11 healthy persons without predisposition to essential hypertension. It was shown that a value of Na+/H(+)-metabolism in patients with essential hypertension exceeded a 3.8-fold the control values. In patients with hyperglucocorticism, pheochromocytoma, arterial hypertension of renal genesis, the rate of Na+/H(+)-metabolism was significantly decreased as compared to that of a group of patients with essential hypertension. It could be used in differential diagnosis of the hypertensive syndrome. The problem of the diagnostic value of this indicator in primary hyperaldosteronism needs further investigation.

A total of 15 families were investigated: probands with insulin-dependent diabetes mellitus and their relatives of the 1st degree of progeny (43 persons) in order to study the distribution of HLA antigens and their interrelationship with the gravity of a course of diabetes mellitus and the type of GTT. Antigens DR3 and/or DR4 were revealed in 93% of probands, especially in heterozygous patients (57.1%). A low level of C-peptide (0.21 +/- 0.03 ng/ml) was noted in most of the probands excluding 3 patients with nephropathy. Distinct relationship of antigens DR3 and DR4 with a clinical course of disease and its severity was undetectable. Antigens DR3 or/and DR4 were detected in 96% of the relatives with the prevalence of antigen DR4 (in 54.2%). During GTT normal tolerance was observed in 82.1% (23 persons), disorders were noted in 4, insulin-dependent diabetes mellitus--in one. Most of the relatives (82.6%) with normal glucose tolerance had antigens DR3 and/or DR4. Irrespective of the type of DR antigens the probands' relatives were characterized by moderate hyperinsulinism (by the results of IRI and C-peptide of blood serum).

The content of pancreatic hormones and their relationship with the degree of carbohydrate metabolism disorder as well as the somatotropin level were studied in 26 patients with acromegaly. It was found that the degree of carbohydrate metabolism disorder is not dependent on the increase extent in the growth hormone concentration. Hyperinsulinemia was practically revealed in all the patients regardless of the glycemic curve type. There was no correlation between glycemia and insulin indices as well. It was determined that hyperglucagonemia provokes no carbohydrate metabolism injury.