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Commonly used clinical and biochemical parameters, such as the content of glucose, insulin, somatotropic hormone, triglycerides, lactate, pyruvate, and free fatty acids (FFA) in blood of practically healthy subjects and in patients with insulin-independent diabetes mellitus (IIDM), were compared with the parameters obtained by mass-spectrometric analysis of 13CO2 in expired air after 13C-glucose loading. It was shown that, as opposed to healthy subjects, the content of blood glucose and free fatty acids in patients with IIDM increased, the level of glucose dropped in progression upon short-term fasting, and the concentration of lactate changed both upon fasting and after the administration of small test doses of glucose. The use of the 13C-glucose breathing test (13C-GBT), which presupposes the loading of safe small doses of glucose enriched in 13C-isotope permitted one to reveal a number of novel quantitative diagnostic criteria for the evaluation of glucose metabolism in patients with IIDM: a decrease in the rate of 13C withdrawal as a constituent of expired carbon dioxide after the administration of 13C-glucose; a reduction in the amount of exogenous glucose metabolized to carbon dioxide; and increased oxidation of endogenous substrates participating in carbon dioxide formation. Small glucose loads proposed by the authors in 13C-GBT are safe for patients with diabetes mellitus and have no effect on the level of blood glucose in healthy persons. The parameters determined by noninvasive 13C-GBT are more sensitive for diagnosis than commonly used biochemical characteristics of blood in patients with IIDM. The diagnostic criteria obtained allow the prediction of the maximum prohibited glucose loading for every patient.

The study was undertaken to examine the nature and degree of postprandial lipemia during routine food fat loading (FFL) in young obese patients and the possible ways of correcting excessive body mass (BM) and hormonally metabolic disturbances. Fifty obese patients aged 18 to 25 years were examined. Group 1 comprised 20 patients with the BM index (BMI) of 33.4 +/- 0.8 kg/m2; Group 2 included 30 patients with the BMI of 33.05 +/- 5.22 kg/m2. The conventional glucose tolerance test was performed in all the examinees, by determining the degree of glycemia, the levels of immunoreactive insulin, and the insulin-resistance index (IRI). With FFL, lipid profile trends were studied in Group 1 patients. Before and 6 months after xenical therapy, anthropometric, lipid and carbohydrate metabolic parameters were determined and BMI was calculated in Group 2 patients. Group 1 patients were found to have impaired tolerance to FFL as compared with the control group. Postalimentary lipemia was accompanied by atherogenic changes in hormonally metabolic parameters. During xenical therapy, Group 2 patients were found to have positive changes in all anthropometric parameters, including those characterizing abdominal obesity, as well as normalized basal hyperinsulinemia, diminished stimulated insulinemia, increased insulin sensitivity, improved blood lipid profile with decreased atherogenic changes. Thus, the study has revealed that young obese patients show impaired fat tolerance with normal glucose tolerance. For therapy of obesity in young individuals, xenical may be recommended as an agent that not only decreases BM, but also improves hormonally metabolic parameters.

Aim: To study nervous systems in chronic adrenal failure (CAF)., Material and Methods: 262 patients with CAF were studied clinically, biochemically and electrophysiologically before and after treatment., Results: The patients were found to have syndromes of vegetovascular dystonia by hypotonic type, syncopal paroxysms, myastenic, minor strokes, dyscirculatory-dysmetabolic encephalopathy, polyneuropathy. A direct correlation was established between the severity and duration of adrenal failure (AF), lowering of adrenal cortex hormones, coefficient Na/K and clinical manifestations of the neurological syndromes. Adequate hormone replacing and symptomatic therapy promoted a regress of neurological disorders in most of the patients especially in mild and moderate AF., Conclusion: Adequate therapy corrects neurological disturbances in patients with chronic NN.

The state of vibration sensitivity and of gustatory perception as well as the influence of interval hypoxic training on these indices were estimated in 21 patients with insulin-independent diabetes mellitus (IIDM) without neuropathic manifestations, in 21 analogous patients with neuropathic manifestations and in 16 individuals with neuropathies of nondiabetic genesis. The improvement of indices studied was observed in patients with neuropathies. Interval hypoxic training may be recommended for the treatment of distal neuropathies including the patients with IIDM in the state of compensation.

The examination of 40 patients with generalized lipodystrophy elucidated the dependence of the severity of cardiovascular disorders in these patients on the immunoreactive insulin/C-peptide index. In high values of the latter cardiovascular disorders occur more frequently. The role of insulin in pathogenesis of essential hypertension, chronic IHD is assessed.

Red cell membrane permeability was studied in 46 patients with pubertal juvenile dyspituitarism by measuring the rates of Na+/H,-Na+/Li(+)-metabolism, Na(+)-K(+)-contra-transport. The reference group consisted of 25 healthy adolescents and youths whose heredity was not aggravated for essential hypertension. No significant differences in the membrane permeability for monovalent cations in the reference subjects and the patients with the pubertal juvenile dyspituitarism were revealed. Thus analysis of the membrane characteristics may be helpful in the differential diagnosis of hypertension.

Altogether 24 adolescents with pubertal juvenile dyspituitarism (PJD) were investigated in the course of an oral GTT for 3 hours. The patients were divided into 3 groups: (1) with liver dysfunction and normal BP; (2) with normal liver and arterial hypertension; (3) with normal BP and normal liver function. The levels of glycemia, immunoreactive insulin, C-peptide and a molar C-peptide/insulin ratio were measured. All the examinees were characterized by basal and stimulated hyperinsulinemia against a background of a normal C-peptide value, the absence of a tendency to IRI reduction by the end of the GTT. A decrease in the C-peptide/IRI ratio was marked in the 1st group. One of the reasons of hyperinsulinemia in PJD in parallel with high insulin secretory pancreatic function can be a decrease in the metabolic clearance of liver insulin, especially noticeable in patients with hepatocyte dysfunction.

The paper deals with a comparison of basal levels of secretion of total testosterone (T) and estradiol-17 beta (E2), their free and albumin and sex-steroid-binding globulin fractions as well as LH, FSH, prolactin and STH in blood serum of 60 normal height and 60 tall healthy adolescents and those with primary osteogenic sarcoma of bones at different stages of puberty. The study established a significantly higher level of testosterone and free androgen index and a lowered concentration of sex-steroid-binding globulin in blood serum of both normal and tall adolescent patients with osteogenic sarcoma at different stages of puberty. No significant differences were found in said indexes of estrogens between sarcoma patients and a specific group chosen for comparison, as far as physical status is concerned. The role of sex steroid hormones and, particularly, that of androgens in the pathogenetical mechanisms of osteogenic sarcoma growth is discussed.

It has been shown that stimulated TSH and prolactin levels in intranasal administration of rifathyroin are comparable with the results of i.v. administration of the drug. Intranasal administration can be used for both therapeutic and diagnostic purposes.

Arginine aspartate (Pargine), a stimulator of endogenous STH, was given to 13 adolescents with retarded growth resulting from a relative deficiency of STH for 6 mos. Two patients discontinued treatment after 3 mos., two others are still on therapy. In 3 adolescents the rate of growth against a background of therapy was insufficient (1.3 cm over 6 mos.). Six patients demonstrated a positive effect: the rate of growth over 6 mos. was 4.13 +/- 0.39 cm, the basal level of STH increased by 6.3 +/- 2.46 ng/ml. The drug use did not accelerate skeletal differentiation in either of the patients. A conclusion is that the drug can be used to influence growth processes in patients with hyposomal conditions.

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 study was made of the morphometric, ultrastructural and functional features of the thyroid in patients with diffuse toxic goiter (DTG) (women aged 16 to 12) with positive and negative dynamics of body mass (groups 1 and 2, respectively). Proliferation of the thyroid epithelium, detected in DTG patients of the 1st group, can be regarded as a morphological criterion for making a decision of a necessity of surgical intervention.

The studies conducted in adolescents with physical underdevelopment allowed a conclusion on reduced anabolic processes particularly growth process at the expense of both STH and sex steroids: T and E2. Studies of sex steroid and gonadotrophic hormone concentrations in blood serum revealed dysfunction of the hypothalamo-hypophyseal-gonadal system in this group of patients. Evaluation of androgen receptor level in protein cytosol fraction from the pubic skin of undersized youths with delayed sexual development demonstrated its significant reduction against the control group that may be explained by incomplete ability for androgen receptor synthesis due to relatively low T-level and its biologically active free fraction and low sensitivity of target tissues to androgens as a result of dissociation between functional activity of STH and T.

Function of the hypothalamo-hypophyseal-thyroid system was investigated in 51 patients with euthyroid hyperplasia. Basal and TRH-stimulated levels of TSH and STH were investigated. Hyperergic ejection of STH and two pathological types of STH reaction (suggesting dysfunction of the hypothalamohypophyseal-thyroid system in euthyroid hyperplasia) were revealed. A group of patients with a low level of STH in response to TRH-stimulation demonstrated more pronounced changes of the hypothalamo-hypophyseal-thyroid system, characterized by a rise of a TSH level in response to stimulation up to 27.59 +/- 3.7 microU and a slightly reduced level of thyroid hormones. Changes in the level of STH indicated certain interest of growth hormone in the genesis of thyroid hyperplasia and could also serve an additional sign in the evaluation of a severity of disorders of the hypothalamo-hypophyseal-thyroid system.

Altogether 10 patients (aged 15 to 18) with Basedow's disease, accompanied by a growing body mass were investigated before operation and 5 patients 6 mos. after subtotal strumectomy. Ten patients with Basedow's diseases without body mass increment were taken as controls. A characteristic feature of carbohydrate metabolism in the study group as compared to the control group was hyperinsulinism with normal GTT which was preserved after doing away with thyrotoxicosis. The C-peptide/IRI ratio in patients with Basedow's disease, accompanied by a growing body mass, was decreased as compared to the control group, a tendency towards its increase after subtotal strumectomy was observed. Any differences in the levels of thyroid hormones, TSH and thyroid stimulating blood activity were undetectable.

The results of investigation and treatment of 8 patients with initial hypothyrosis, galactorrhea and disturbed menstrual function are presented. The initial hypothyrosis in patients with galactorrhea may have a latent form and/or be combined with intracellular hypophyseal tumor. Sometimes the first sign of the syndrome mentioned is abnormal lactation. The prolactin level is elevated in these patients and its depot increased. In latent hypothyrosis the thyrotropin content is within normal, its response to thyroliberin stimulation being enhanced and prolonged. Thyroid hormone therapy is effective in these patients. It was concluded that thyroid hormone substituting therapy is an adequate method for the treatment of initial hypothyrosis, galactorrhea and disordered menstrual function.

The application of protons (heavy charged particles) for irradiation of the pituitary body has some essential advantages over other types of teletherapy: insignificant destruction of surrounding tissues, a possibility of a single therapeutic session as well as the absence of post-radiation effects. Proton beam therapy was given to 98 patients with Icenko-Cushing disease aged 15 to 40. Mild cases were treated by proton beam irradiation only while severe cases were managed using proton beam therapy combined with unilateral adrenalectomy or oral administration of ortho-para-DDD. Catamnesis duration varied from 3 to 5 years. In most cases the exposure dose was 80-90 Gy (50-110 Gy). The procedure was well tolerated by all the patients. A dynamic multipolar converting method with 15-20 entrance poles in the left temporal area was employed (with the beam energy of 200 MeV). Stabilization of the course of disease and some clinical improvement were observed in most of the patients 3-4 months after proton beam therapy. In 6-36 months after irradiation 90% of the patients showed normal biochemical indices and the absence of any clinical signs of the disease. Three-five years after treatment, 94% of the patients were in steady remission. A 24-hour ACTH and cortisol normalization pattern was observed in all the patients in parallel with an increase in GH and gonadotropin secretion and a decrease in the prolactin level. Sex function renewal appeared to be the first clinical sign of remission. Young patients aged 15 to 20 with a short duration of disease reached remission faster than patients of the other age groups. Thus the results of proton beam therapy of 98 patients with Icenko-Cushing disease after a follow-up of 3-5 years showed a high efficacy of this type of treatment. The method can be used alone or in combination with unilateral adrenalectomy as well as with oral administration of ortho-para-DDD.

The authors presented the results of a study of immunoreactive parathormone and calcitonin in patients with autoimmune thyroiditis. An increase in the content of parathormone in the blood was found in 55.5% of the patients, that of calcitonin in 30.5% of the patients with autoimmune thyroiditis. Correlation between the levels of immunoreactive parathormone and calcitonin in the blood was revealed. A degree of an increase in the levels of parathormone and calcitonin corresponded to the expression of autoimmune reactions in the thyroid. It was proposed that the determination of parathormone and calcitonin be used as an additional criterion in the diagnosis of autoimmune processes in the thyroid and in the determination of their activity.

The results of use of rifathyroin (the Soviet preparation thyroliberin), a stimulant of prolactin secretion, and of L-DOPA and cholstylbegit, blockers of prolactin secretion, in patients with various forms of the persisting lactorrhea-amenorrhea syndrome are presented in this work. Reaction of rifathyroin proved to be disturbed in these patients, i.e. decreased in adenomas and hypothalamic disturbances and exceedingly increased in combination of primary hypothyroidism and lactorrhea. L-DOPA and chlostylbegit were capable of reducing prolactin level in patients with the persisting lactorrhea-amenorrhea syndrome, this being accompanied by restoration of biphasic menstrual cycle in some of the patients. The use of estrogens led to increase of the serum prolactin level. Problems of diagnostic value of the test with rifathyroin, and of the efficacy of various therapeutic methods applied in lactorrhea-amenorrhea are discussed.

Sodium permeability of erythrocyte membranes was examined, using the recording of maximum rates of sodium-lithium countertransport, in patients with essential hypertension of stages II and III by the WHO classification, renal arterial hypertension, Itsenko-Cushing disease, pheochromocytoma, Conn's syndrome and in subjects with normal arterial pressure who made up a control group. Hypertensive patients demonstrated a more than 60% increase in erythrocyte membrane permeability, as compared to normotensive controls. In patients with pheochromocytoma, the permeability values were almost 40% as low as the control ones. No changes in sodium erythrocyte membrane permeability could be demonstrated in patients with renal hypertension, Itsenko-Cushing disease and Conn's syndrome. It is believed that the erythrocyte membrane permeability parameters can be used for the identification of essential hypertension in the differential diagnosis of hypertensions.

The influence of thyrostatic therapy upon immunoglobulin A, M and G serum concentrations and lymphocytic blast-cell transformation in thyroglobulin and PHA presence in patients with diffuse toxic goiter was studied. The results of the immunological test used do not define quite accurately changes in clinical manifestations of the disease. In the majority of patients disorders of the humoral and/or cell immunity persist during the thyrotoxicosis compensatory stage. A tendency towards normalization or normalization of the parameters studied of T- and B-immune systems is seen under the action of thyrostatic therapy.