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Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal.

Over the past years and decades, in the world in general and particularly in Russia, bariatric surgery is becoming more widespread for the treatment of severe forms of obesity. There is an increase in the number of operations performed along with the effectiveness and minimising risks of the operations held due to the improvement of surgical techniques. In this lecture, there are clearly stated indications and contraindications for the surgical treatment of obesity. Here are presented various types of bariatric surgeries and their pathophysiological mechanisms which affect on body weight, carbohydrate and lipid metabolism. There is also presented their effectiveness in comorbid obesity pathology, primarily among patients with type 2 diabetes. Here was held an analysis of possible negative effects after surgical treatment for obesity, including secondary hyperparathyroidism, post-bariatric hypoglycemia, etc., as well as predictors of postoperative prognosis in relation on metabolic control among patients with obesity and type 2 diabetes.

Non-alcoholic fatty liver disease (NAFLD) is the common chronic disease, associated with obesity, especially abdominal obesity, and a metabolic syndrome, that considerably raises cardiometabolic risk and is reflected in morbidity, prognosis of the disease and life expectancy of patients. NAFLD at the stage of steatosis does not increase the risk of mortality in the general population, however, the potentially dangerous stage, non-alcoholic steatohepatitis, in many cases remains unrecognized in a timely manner and, in the absence of adequate treatment, can progress and lead to the development of cirrhosis, liver failure, and hepatocellular carcinoma. The issues of NAFLD treatment are relevant due to the high prevalence of obesity, diabetes mellitus type 2, cardiovascular diseases and their complications. NAFLD therapy should be aimed primarily at the etiopathogenetic factors that contribute to its development and progression, as well as the correction of associated metabolic disorders. The growing prevalence of obesity, NAFLD and associated risk factors, diagnostic difficulties and the lack of an algorithm for managing such patients confirm the urgency of this problem. In this article describes the basic mechanisms of pathogenesis NAFLD, its role in obesity, prognosis of the disease, diagnostics and treatment.

Guidelines on treatment of patients with arterial hypertension comorbid with metabolic disorders and diabetes mellitus type 2

The mechanisms of mutual influence of fat tissue and the hypothalamo-pituitary-adrenal (HPA) axis include the regulation of the metabolism of adipocytes by adrenal cortex hormones, on the one part, and the effect of adipocytes and adipocytokines on secretion, metabolism and action of steroid hormones in target cells - on the other part. Glucocorticoids contribute to the differentiation of preadipocytes into mature adipocytes; brown fat tissue transforms into white under the effect of GC. Mineralocorticoids are also involved in the process of adipocyte differentiation, regulate adipokine expression, and induce oxidative stress in fat tissue. There is evidence that suggest that circulating dehydroepiandrosterone sulfate (DHEAS), obesity, insulin sensitivity are associated with the presence of cardiovascular diseases. Orexigenic neuropeptides and inflammatory mediators, which trigger the synthesis of corticotropin-releasing hormone (CRH) in the hypothalamic paraventricular nuclei, are considered as possible mechanisms of (HPA) axis activation in obesity. Expression of 1ip-hydroxysteroid dehydrogenase type 1 (11P-HSD1) in fat tissue and the formation of cortisol from cortisone at the tissue level can be considered as one of the factors involved in development of insulin resistance. The autocrine and paracrine regulatory effect of these hormones on adipocyte function is the consequence of aldosterone production and aromatization of androgens by fat tissue.

The lecture is addressed to doctors of various specialties and devoted to the role of vitamin D in the prevention of bone and metabolic disorders. Modern data on the physiological effects of vitamin D confirm its multifactorial effect on the skeletal and muscular systems, both direct and indirect. The mutual influence of obesity and vitamin D deficiency is determined by several mechanisms, while the decrease in the bioavailability of vitamin D in obesity causes the development of secondary hyperparathyroidism. The existing algorithms for prevention and treatment of vitamin D deficiency involve not only the initial level of 25(OH)D, but also the patient's age, body mass index, and the presence of concomitant diseases. Modern clinical guidelines of the Russian Association of Endocrinologists on prevention and treatment of vitamin D deficiency are an effective instrument in patients’ management. For prevention and treatment of vitamin D deficiency in obese patients higher doses of colecalciferol are required. In adult patients it is recommended to start correction of vitamin D deficiency (lower than 20 ng/ml) and insufficiency (20–29 ng/ml) with a saturating colecalciferol dose with further switch to the use of maintenance doses. Saturation can be conducted with the use of various therapy regimens.

In the last decades all over the world surgical methods are used more widely for severe obesity treatment. A tendency is evident both in increase of the amount of operations and in increase of the number of countries where bariatric surgery becomes more widely spread. Indications and contraindications for bariatric surgery are presented in the guidelines including specific ones – in patients with type 2 diabetes mellitus (DM2). Different types of bariatric surgical interventions and mechanisms of influence on body mass, carbohydrate and lipid metabolism as well as main results in obese patients including ones with DM2 are described. The requirements for bariatric surgical interventions and parameters of their effectiveness estimation including DM2 remission are presented. The causes of postbariatric hypoglycemia and predictors of post-operation prognosis in relation to metabolic control in obese patients with DM2 are analyzed.

BACKGROUND The Republic of Tyva is a region with a proven severe natural iodine deficiency and a high prevalence of IDD (iodine deficiency disorders). However, in the region in certain periods of time, measures were taken to eliminate iodine deficiency in the diet of the population. The article presents the results of the October 2020. by specialists of the Endocrinology Research Centre, a control and epidemiological study aimed at assessing the current state of iodine supply in the population of the Republic of Tyva. The study was carried out on behalf of the Ministry of Health of Russia within the framework of the state task «Scientific assessment of the need to take additional regulatory legal and other measures to eliminate iodine deficiency in pilot regions with severe iodine deficiency». AIM Assessment of iodine supply of the population of the Republic of Tuva. MATERIALS AND METHODS The research was carried out in three settlements of the republic - years. Kyzyl, Shagonar, Saryg-Sep settlement. A total of 227 pre-pubertal schoolchildren (8-10 years old) were examined with anamnesis collection, examination by an endocrinologist, palpation of the thyroid gland, collection of single urine samples into disposable eppendorfs, followed by freezing to minus 20-25 degrees to further determine the concentration of iodine in urine with using the cerium-arsenitic method in the laboratory (clinical diagnostic laboratory of the Federal State Budgetary Institution «National Medical Research Center of Endocrinology» of the Ministry of Health of Russia). In addition, all schoolchildren underwent an ultrasound examination of the thyroid gland (using a portable ultrasound machine LOGIQe (China) with a multifrequency linear transducer 10-15 MHz, in the supine position). The height and weight of children was determined according to the standard method at the time of the examination. A collection of samples of edible salt, which is used in families of schoolchildren, was carried out and the presence of iodine in it was determined by an express method for the qualitative determination of potassium iodate.Parents of schoolchildren signed informed consent for the examination of children. Permission of the local ethical committee of the Endocrinology Research Centre - received, date: March 25, 2020, N 5. RESULTS 227 schoolchildren of 8-10 years old were examined. The median concentration of iodine in urine was determined, the presence of iodine in food salt was investigated, and an ultrasound examination of the thyroid gland was carried out in order to clarify the iodine supply, the coverage of the use of iodized salt in nutrition and the prevalence of goiter.The median concentration of iodine in urine was 153 μg/l, the frequency of goiter was 7.7%, and the proportion of households using iodized salt was 95.2%. CONCLUSION Results of assessment (median urinary iodine concentration) confirm that population of Tuva, Russian Federation, has optimum iodine nutrition. The prevalence of goiter in schoolchildren significantly decreased compared to earlier assessments. The proportion of households using iodized salt indicates the effectiveness of preventive measures in the -region.

The exponential rise in the use of immune checkpoint inhibitors (Ipilimumab, Nivolumab, Pembrolizumab, Atezolizumab, Durvalumab, and Avelumab) as the new standard for cancer treatment increase the incidence the immune-related adverse events due to immune activation. Endocrine immune-related adverse events are the third most commonly reported. Thyroid gland is most susceptible to autoimmune dysfunctions from immune checkpoint inhibitors and associated with the use of anti-PD-1 monoclonal antibodies. Hypophysitis develops more often during therapy with anti-CTLA-4 monoclonal antibodies. But such immune-related adverse events as diabetes mellitus, hypoparathyroidism are rare (about 1% of cases).We present a clinical case of the patient with skin melanoma who was prescribed therapy with immune checkpoints inhibitors (Pembrolizumab). Immune-related adverse events developed with damage to the endocrine organs after 3 Pembrolizumab injections. Of greatest interest is the development of two endocrine immune-related adverse events at once: destructive thyroiditis (with a short phase of thyrotoxicosis and subsequent persistent hypothyroidism) and diabetes mellitus. We tried to reflect the chronology of diseases and their features as fully as possible for endocrinologists, oncologists, therapists, family doctors and other medical doctors of related specialties.

Objective: The aim of the study was to assess the effectiveness and safety of long-term sibutramine therapy in routine clinical practice. Methods: In total, 98,774 patients (82.3% women, 17.7% men) from 142 cities of the Russian Federation were enrolled in the PRIMAVERA program. The mean age of the patients was 39.39 ± 10.38 years, the mean body weight was 99.1 ± 14.28 kg, and the mean BMI was 35.7 ± 4.41 kg/m2. The duration of the sibutramine therapy was determined by physicians: 59.3% of patients took the drug for 6 months, the treatment course of 37.7% of patients was 12 months, and 3% of patients had treatment for 3 months. Results: The BMI reduction correlated with the treatment duration: 3.4 ± 1.53 kg/m2 after 3 months of therapy, 5.4 ± 2.22 kg/m2 after 6 months, and 7.2 ± 3.07 kg/m2 after 12 months. The body weight reduction after 3, 6 and 12 months of treatment was 9.5%, 15.1%, and 19.7%, respectively. The body weight loss associated with sibutramine treatment was accompanied by a slight decrease in blood pressure and did not lead to any significant increases of the heart rate. Conclusions: The results of the PRIMAVERA study confirmed the lack of increased risk of using sibutramine in routine clinical practice in patients without underlying cardiovascular disease and low rate of adverse events.

The purpose of the present study was to investigate a relationship between the distribution of genotypes of the polymorphic markers TSHR (rs3783949, A/C substitution), NIS (rs7250346, C/G substitution), DUOXI (rs2467825, A/G substitution), DUOX2 (rs71713669, G/T substitution), and TRO (rs!7091737, G/T substitution) genes and the result of treatment for diffuse euthyroid goiter (DEG) using two regimens: monotherapy with iodine preparations and combined therapy with iodine and levothyroxine. To identify a more effective and safe treatment for DEG, the authors compared thyroid volume, the levels of pituitary thyroid-stimulating hormone and thyroid peroxidase antibodies in two groups: 1) monotherapy with KI (200 pg/day) (n = 40) and 1) combined therapy with KI (100 pg) + L-T4(lpg/kg/day) (n = 41). According to the result of treatment, each group was divided into 2 subgroups: "fair result" and "poor result" (the thyroid volume failed to achieve the normal range or continued to increase). Correlation analysis was made to assess a relationship between the polymorphism of the genes and the result of therapy for DEG. There was a significant correlation between the distribution of genotypes of the polymorphic marker the TSHR gene and the result of treatment for DES in the monotherapy group: there were prevalent AA + AC and CC genotypes with fair and poor results, respectively. There was no significant correlation between the distribution of the genotypes of the study polymorphic markers and the result of treatment using the combined therapy. Thus, the result of treatment for DES via monotherapy with iodine preparations may depend on genetic factors.Целью настоящего исследования явилось изучение зависимости между распределением генотипов полиморфных маркеров генов TSHR (rs3783949, замена — А/С), NIS (rs 7250346, замена — C/G), DUOXI (rs2467825 замена — A/G), DUOX2 (rs7171366, замена G/Т), ТРО (rs 17091737, замена — G/Т) и результатом лечения диффузного эутиреоидного зоба (ДЭЗ) с использованием двух режимов: монотерапии препаратами йода и комбинированной терапии препаратами йода и левотироксина. Для выявления более эффективного и безопасного метода лечения ДЭЗ сравнивались между собой объем щитовидной железы (ЩЖ), уровни тиреотропного гормона гипофиза и антител к тиреопероксидазе в двух группах: ''Монотерапия'' (п = 40) — KI(200мкг/сут) и "комбинированная терапия"(п = 41) — К1 (100мкг) +Ь-Т4(1 мкг/кг/сут). Каждая группа в зависимости от результата лечения была разделена на 2 подгруппы: "удовлетворительный результат" и "неудовлетворительный результат" (объем ЩЖне достигал пределов нормы или продолжал увеличиваться). Для оценки зависимости между полиморфизмом изучаемых генов и результатом терапии ДЭЗ был проведен корреляционный анализ. Имелась достоверная корреляция (г = -0,39; р = 0,03) между распределением генотипов полиморфного маркера гена TSHR и результатом лечения ДЭЗ в группе "Монотерапия": при удовлетворительном результате преобладали генотипы АА + АС, а при неудовлетворительном — генотип СС. Достоверной корреляции между распределением генотипов изучаемых полиморфных маркеров и результатом лечения при помощи комбинированной терапии выявлено не было. Таким образом, результат лечения ДЭЗ с использованием монотерапии препаратами йода может зависеть от генетических факторов.

Nodular thyroid formations are detected in approximately 4-7% of individuals living in regions with normal iodine supply. In regions of iodine deficiency, the prevalence of nodular goiter is significantly higher, especially in women older than 40 years, in which it can exceed 30%.Узловые образования щитовидной железы выявляются примерно у 4–7% лиц, проживающих в регионах с нормальной йодной обеспеченностью. В регионах йодного дефицита распространенность узлового зоба значительно выше, особенно у женщин старше 40 лет, у которых она может превышать 30%.

To estimate the parameters of glucose metabolism and to assess the secretion of incretins in patients after biliopancreatic diversion (BPD) for morbid obesity (MO) in the early and late postoperative periods.The prospective part of the investigation included 22 patients with a body mass index of 35.8 to 68.4 kg/m2 and type 2 diabetes mellitus (T2DM). All the patients were examined before, 3 weeks and 3 months after BPD. The retrospective part covered 23 patients who were examined after BPD for MO; the postoperative period was 4.7 [2.3; 7.2] years. A control group consisted of 22 healthy, normal weight volunteers. A 75-g oral glucose tolerance test was carried out in all the groups to study the levels of glucose, immunoreactive insulin (IRI), glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and glucagon at 0, 30, 60, and 120 min.T2DM patients showed improvement in glucose metabolism just 3 weeks after BPD; following 3 months, they had normalized fasting blood glucose levels (5.6 [5.0; 6.0] mmol/l). During 3 months, glycated hemoglobin decreased from 7.5 [6.6; 8.5] to 5.7 [5.3; 5.9]%. In the early period following BPD, there was an increase in basal and postprandial GLP-1 levels associated with the peak IRI concentration. In the late period after BPD, the enhanced secretion of IRI and GLP-1 persisted, which was followed by a reduction in postprandial glucose levels in 4 of the 23 patients.T2DM remission does not depend on weight loss in the early period after BPD. In this period, the significant improvement of glucose metabolic parameters in patients with obesity and T2DM is associated with elevated GLP-1 levels. The altered incretin response is a stable effect of BPD and remains in its late period.Цель исследования. Оценить показатели углеводного обмена и продукцию инкретинов у пациентов, перенесших билиопанкреатическое шунтирование (БПШ) по поводу патологического (морбидного) ожирения (ПО), в раннем и отдаленном послеоперационном периоде. Материалы и методы. В проспективную часть исследования включили 22 пациентов с индексом массы тела от 35,8 до 68,4 кг/м² и сахарным диабетом 2-го типа (СД-2). Всех пациентов обследовали до операции, через 3 нед и 3 мес после БПШ. В ретроспективной части обследованы 23 пациента, перенесшие БПШ по поводу ПО, послеоперационный период составил 4,7 (2,3; 7,2) года. Контрольную группу составили 22 здоровых добровольца с нормальной массой тела. Во всех группах проведен пероральный тест на толерантность к глюкозе с 75 г глюкозы с исследованием уровней глюкозы, иммунореактивного инсулина (ИРИ), глюкагонодобного пептида 1-го типа (ГПП-1), глюкозозависимого инсулинотропно полипептида (ГИП) и глюкагона исходно и через 30, 60 и 120 мин. Результаты. У пациентов с СД-2 улучшение состояния углеводного обмена наблюдалось уже через 3 нед после БПШ, через 3 мес отмечена нормализация уровня глюкозы в крови натощак - 5,6 ммоль/л (5,0; 6,0). За 3 мес произошло снижение уровня гликированного гемоглобина с 7,5 (6,6; 8,5) до 5,7 (5,3; 5,9) %. В раннем периоде после БПШ выявлено повышение базального и стимулированного уровня ГПП-1, ассоциированного с пиковой концентрацией ИРИ. В отдаленном периоде после БПШ, сохранялась повышенная секреция ИРИ и ГПП-1, что сопровождалось снижением уровня глюкозы в крови после приема пищи у 4 из 23 пациентов. Заключение. Ремиссия СД-2 в раннем периоде после БПШ не зависит от снижения массы тела. Значительное улучшение показателей углеводного обмена у больных ожирением и СД-2 в раннем послеоперационном периоде после БПШ ассоциировано с повышением уровня ГПП-1. Изменение инкретинового ответа является стойким эффектом хирургического вмешательства и сохраняется в отдаленном периоде после БПШ.Резюме Цель исследования. Оценить показатели углеводного обмена и продукцию инкретинов у пациентов, перенесших билиопанкреатическое шунтирование (БПШ) по поводу патологического (морбидного) ожирения (ПО), в раннем и отдаленном послеоперационном периоде. Материалы и методы. В проспективную часть исследования включили 22 пациентов с индексом массы тела от 35,8 до 68,4 кг/м² и сахарным диабетом 2-го типа (СД-2). Всех пациентов обследовали до операции, через 3 нед и 3 мес после БПШ. В ретроспективной части обследованы 23 пациента, перенесшие БПШ по поводу ПО, послеоперационный период составил 4,7 (2,3; 7,2) года. Контрольную группу составили 22 здоровых добровольца с нормальной массой тела. Во всех группах проведен пероральный тест на толерантность к глюкозе с 75 г глюкозы с исследованием уровней глюкозы, иммунореактивного инсулина (ИРИ), глюкагонодобного пептида 1-го типа (ГПП-1), глюкозозависимого инсулинотропно полипептида (ГИП) и глюкагона исходно и через 30, 60 и 120 мин. Результаты. У пациентов с СД-2 улучшение состояния углеводного обмена наблюдалось уже через 3 нед после БПШ, через 3 мес отмечена нормализация уровня глюкозы в крови натощак — 5,6 ммоль/л (5,0; 6,0). За 3 мес произошло снижение уровня гликированного гемоглобина с 7,5 (6,6; 8,5) до 5,7 (5,3; 5,9) %. В раннем периоде после БПШ выявлено повышение базального и стимулированного уровня ГПП-1, ассоциированного с пиковой концентрацией ИРИ. В отдаленном периоде после БПШ, сохранялась повышенная секреция ИРИ и ГПП-1, что сопровождалось снижением уровня глюкозы в крови после приема пищи у 4 из 23 пациентов. Заключение. Ремиссия СД-2 в раннем периоде после БПШ не зависит от снижения массы тела. Значительное улучшение показателей углеводного обмена у больных ожирением и СД-2 в раннем послеоперационном периоде после БПШ ассоциировано с повышением уровня ГПП-1. Изменение инкретинового ответа является стойким эффектом хирургического вмешательства и сохраняется в отдаленном периоде после БПШ.

In today's world the problem of obesity is discussed in the context of non-communicable diseases, leading to significant encumbrances on society. This article provides information about the basics of the regulation of energy balance and eating behavior. Particular attention is paid to the role of neurotransmitters, including serotonin, a metabolic disorder that is one of the suspected causes of eating disorders. Demonstrated experience in the use of sibutramine in the world, and in the Russian practice, taking into account the impact on the development of comorbid conditions and their complications.

We report a case of 50-year-old woman with thyroid hormone resistance syndrome. For 20 years this patient have been treated for autoimmune thyrotoxicosis: she underwent thyroid surgery and then was on thyroid-blocking therapy. Repeated laboratory tests demonstrated elevated serum thyroid hormones concentrations and elevated TSH concentration. Inappropriate TSH secretion became the reason for conducting further investigations. In those cases, the diagnostic approach is complicated and cases may be referred as a syndrome of thyroid hormones resistance or as a pituitary mass. Results of magnetic resonance imaging as well as results of octreotide test did not confirm TSH-producing pituitary adenoma. Lack of consistent thyrotoxicosis symptoms and normal level of biochemical markers that reflect peripheral tissue response to excessive thyroid hormones action were regarded as an evidence for thyroid hormones resistance syndrome. In cases of thyroid hormone resistance syndrome, there is no reduction in thyroid hormones after octreotide administration and we could observe it in our patient. Thereby clinical data and laboratory tests supported the diagnosis of thyroid hormone resistance syndrome. To establish definitive diagnosis and to verify genetic cause of the disease we performed direct sequencing of the THRB gene exons 9-10.В статье приводится описание клинического случая резистентности к тиреоидным гормонам. В течение 20 лет пациентка получала лечение по поводу аутоиммунного тиреотоксикоза: было проведено хирургическое лечение – субтотальная резекция щитовидной железы, в дальнейшем назначена тиреостатическая терапия. Повышение концентрации тиреоидных гормонов сопровождалось повышенным содержанием ТТГ, что послужило основанием для проведения более углубленного обследования. В подобных случаях требуется проведение дифференциальной диагностики с ТТГ-продуцирующей аденомой гипофиза и синдромом резистентности к тиреоидным гормонам. МРТ гипоталамо-гипофизарной области, а также результаты пробы с октреотидом не подтвердили наличие ТТГ-продуцирующей аденомы гипофиза. В пользу синдрома резистентности к тиреоидным гормонам свидетельствовали отсутствие клинических признаков манифестного тиреотоксикоза и нормальные значения биохимических маркеров, позволяющих оценить действие тиреоидных гормонов в периферических тканях. В случае резистентности к тиреоидным гормонам на фоне пробы с октреотидом не происходит снижения концентрации тироксина и трийодтиронина, что мы могли наблюдать в данном случае. Таким образом, клинические и лабораторные данные позволили установить диагноз резистентности к тиреоидным гормонам. С целью подтверждения диагноза и верификации генетического дефекта было проведено исследование экзонов 9–10 гена THRB методом прямого секвенирования.

Modifications of glucose metabolism are observed after bariatric surgery and are attributed to the increased release of incretins – biologically active gut peptides. Hypoglycemia episodes after bypass operations are mostly of functional origin (dumping syndrome) and can be corrected by dietary recommendations. At the same time multiple cases of nesidioblastosis in patients, who underwent gastric bypass surgery are reported. This article is focused on a clinical case of postprandial hypoglycemia in patient after biliopancreatic diversion for morbid obesity

Objective: The objective was to estimate the prevalence of inadequate vitamin D status and secondary hyperparathyroidism (SHPT) in morbidly obese patients and in patients who underwent biliopancreatic diversion/duodenal switch surgery (BPD/DS) Design: 3 groups were included in the cross-sectional comparative study: group 1 - morbidly obese (MO) patients with BMI > 40 and without type 2 diabetes mellitus (n=22), group 2 � patients in the long-term period after BPD/DS (n=23); group 3 � healthy normal weight controls (n=22). Results: 25(OH)D levels were significantly different in the controls (21.8 ng/dl), in the MO (8.8 ng/dl) and in the BPD/DS patients (8.6 ng/dl). Parathyroid hormone (PTH) elevation was found in 4 (18%) MO patients, in 12 (52 %) patients after BPD/DS, and was not detected in the control group. The frequency of SHPT was significantly higher in the operated group (52 %) in comparison with the MO group (18 %) (р=0.029). Conclusions: Vitamin D deficiency and secondary hyperparathyroidism are significantly more prevalent in MO patients than in normal weight subjects. In the long-term period after BPD secondary hyperthyroidism is more frequent than in MO and is not always accompanied by vitamin D depletion. Special attention should be paid for adequate control of calcium metabolism and supplementation by calcium and vitamin D.

Biliopancreatic diversion (BPD) surgery is one of the most efficacious bariatric procedures employed to manage morbid obesity. However, apart from a stable reduction of the body weight and beneficial action on the clinical course of various diseases associated with obesity, this method creates the risk of inducing osteometabolic disorders following the surgical intervention. We present here a clinical case of osteomalacia that developed in the late post-BPD period in the absence of regular intake of medicines and adequate medical care.

The present work was designed to study parameters of calcium and vitamin D metabolism in the patients presenting with morbid obesity (MO) including those who had undergone biliopancreatic diversion bypass (BPD). The patients were allocated to three groups. Group 1 was comprised of the patients with BMI in excess of 40 kg/sq.m. (n=22), group 2 included the patients after BPD (n=23), and group 3 (control) consisted of the healthy volunteers having normal body weight in the absence of signs of obesity (n=22). The three groups were significantly different in terms of consumption of vitamin D (p

In this review we highlight the pathogenesis of vitamin D deficiency, the development of secondary hyperparathyroidism in obesity and after malabsorptive bariatric surgery. We also discuss vitamin D supplementation and calcium metabolism disorders correction in obesity as well as after previous malabsorptive bariatric surgery

The influence of various medicinal preparations on the function of the hypothalamo-pituitary-thyroid axis is discussed. Thyroidal status at different somatic diseases is considered alongside the efficiency of substitution therapy with thyroid hormones for the management of hypothyroidism.

One of the main goals in treatment of obesity is descending of overall cardiometabolic risk, which is mostly defined by atherogenic changes in blood lipid spectrum. Scientific data, presented in this review confirm that orlistat is effective for treatment of obesity, its introduction significantly increases proportion of patients who reach clinically valuable results. The mechanism of action of orlistat explains its influence on parameters of blood lipids, which doesn't directly depend on the decrease of body mass during treatment. Improvement of cardiometabolic parameters during orlistsat treatment allows to consider this therapy as one of the methods for correction of dyslipidemia

To compare clinical, laboratory, and morphological parameters in patients with abdominal obesity and non-alcoholic fatty liver disease (NAFLD) and to assess the relationship between the degree and stage of the disease and the cardiometabolic risk factors of type 2 diabetes mellitus and cardiovascular diseases.Eighty patients aged 30 to 50 years with abdominal obesity were examined. NAFLD was diagnosed after liver puncture biopsy. The parameters of carbohydrate and lipid metabolism and the activity of hepatic transaminases and the protective adipocytokine adiponectin were investigated.NAFLD was verified in 77 examinees. Metabolic disturbances were found in the majority of the examinees with abdominal obesity and NAFLD; they were concurrent and increased in their rate and degree with the progression of NAFLD, obesity, and insulin resistance. The patients with NAFLD had a significantly decreased adiponectin level that got worse as NAFLD progressed.The investigation has revealed that NAFLD is associated with cardiometabolic disorders (dyslipidemia, carbohydrate metabolic disturbances, and insulin resistance) increasing in their rate and degree with the progression of NAFLD and the lower adiponectin level reducing as NAFLD worsens.

Clinical implication of Met-hepatocytic growth factor receptor (Met/HGF-R) in thyroid adenocarcinoma tissue was studied on 163 operative thyroid samples (129papillary cancers, 21 follicular cancers, and 13 anaplastic cancers). 49 adenomas, 50 nodular goiters and 50 normal thyroids were compared. Expression of Met/HGF-R was estimated using semiquantitative immunohistochemical method including proportion (limits 0-5) and intensity (limits 0-5) of cell staining and calculation of Met/HGF-R total expression (limit 0-10). Met/HGF-R was not found in normal thyroid tissue, was absent or focally expressed in follicular and aplastic tumors, and was present in different amounts in papillary adenocarcinomas. It is suggested that low expression of Met/HGF-R is an indicator of unfavorable prognosis in papillary thyroid cancer.

Autoimmune polyendocrine syndromes (APS) are rare endocrinopathies characterized by the coexistence of at least two glandular autoimmune diseases. APS comprise a wide spectrum of autoimmune disorders and are divided into a very rare juvenile (APS type 1) and a more common adult type with (APS 2) or without adrenal failure (APS 3). The first clinical manifestations of APS 1 usually occur in childhood whereas APS 2 mostly occurs during the third and fourth decades of life. The third type has been described in adults that, contrary to types 1 and 2, does not involve the adrenal cortex. No clinical differences between types 2 and 3 have been described except the absence of adrenal failure. Type 4 APS is a rare syndrome characterized by the combination of autoimmune conditions not falling into the above categories. It consists of adrenal failure with one or more minor autoimmune disorders barring major components of type 1 and 2 APS. Usually, autoimmune polyendocrine syndrome of adults manifests itself as one of the major autoimmune diseases (such as adrenal failure, Grave's disease, or type 1 diabetes) and minor autoimmune disorders (vitiligo, alopecia) preceding the development of autoimmune deficiency of major endocrine glands. This article describes a patient with type 3 APS, who developed type 1 diabetes. Grave's disease and vitiligo. The development of the syndrome started from vitiligo in the chidhood. Moreover, the patient suffered primary sterility and presented with progressive diabetic nephropathy of autoimmune origin. It is concluded that patients with a single autoimmune component of polyendocrine syndrome should be screened to exclude other autoimmune endocrine disorders.

The results of 7-year utilization of a Russian analyzer for noninvasive x-ray fluorescent measurement of intrathyroid stable iodine for diagnosis and monitoring the treatment efficiency in patients with thyroid diseases are analyzed. A total of 400 adults (130 men and 270 women) aged 20-50years and 67children (12 boys and 55 girls) aged 5-16 years with various thyroid diseases were examined. Control group consisted of 60 women and 30 men without thyroid diseases (according to clinical and laboratory studies). Ultrasonography and scintigraphy of the thyroid, measurements of the blood pituitary thyrotropic hormone, thyroid hormones, antibodies to thyroglobulin and thyroid peroxidase, cytological and h istological studies, and a new method for thyroid iodine measurements were used. The results indicate the need in a new diagnostic method based on analysis of intrathyroid iodine. Such a method is needed for 1) prophylactic screening of population, including children, pregnant and nursing women in order to detect (with an accuracy of 7095%) subjects with suspected autoimmune thyroid diseases; 2) accurate evaluation of the degree of thyroid involvement in autoimmune thyroiditis and identification of the pathogenesis of hypothyrosis or thyrotoxicosis; 3) monitoring the efficiency of treatment with iodides, thyroxin, and their combinations and for thyroid function recovery after mercazolil therapy of diffuse thyroid goiter; and 4) differential diagnosis of benign and malignant thyroid diseases.