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[Modern concepts of genetic and immunohistochemical features of prolactin-secreting pituitary adenomas]. [催乳素分泌垂体腺瘤的遗传和免疫组织化学特征的现代概念]。
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.14341/probl13222
A S Shutova, L K Dzeranova, S Yu Vorotnikova, M A Kutin, E A Pigarova

Prolactinomas are the most common secreting adenomas of the pituitary. In 20% of cases resistance to dopamine-agonists treatment is observed. Medical therapy resistance causes progression of pathological symptoms of hyperprolactinemia and negative topographic and anatomical changes of prolactinoma. The causes of ineffectiveness of dopamine agonists therapy are not fully understood as well as approaches to managing patients require clarification. Current concepts of resistance are based on the data obtained as a result of surgery or after a period of long-term ineffective therapy. Thus, it is very important to find methods of assessing the sensitivity of prolactin-secreting adenomas to drug therapy before surgical treatment. Genetic and immunohistochemical studies find special place among these methods, making it possible to predict adenoma's response to drug therapy at early diagnostic stage. Obtained results will allow us to form personalized algorithm for managing patients.

泌乳素瘤是垂体最常见的分泌性腺瘤。在20%的病例中观察到对多巴胺激动剂治疗的耐药性。药物治疗抵抗导致高催乳素血症病理症状的进展和催乳素瘤的阴性地形和解剖改变。多巴胺激动剂治疗无效的原因尚不完全清楚,管理患者的方法也需要澄清。目前的耐药性概念是基于手术或长期无效治疗后获得的数据。因此,术前评估泌乳素腺瘤对药物治疗的敏感性是非常重要的。遗传和免疫组织化学研究在这些方法中占有特殊地位,使得在早期诊断阶段预测腺瘤对药物治疗的反应成为可能。获得的结果将使我们能够形成个性化的算法来管理患者。
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引用次数: 0
[The role of calcium sensitive and vitamin D receptors in the pathogenesis of sporadic multiple parathyroid gland disease]. [钙敏感受体和维生素D受体在散发性多发性甲状旁腺疾病发病机制中的作用]。
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.14341/probl13207
E A Ilyicheva, I A Shurygina, N N Dremina, G A Bersenev, E G Grigoryev

Background: Sporadic multiple parathyroid gland disease is ¼ cases of primary hyperparathyroidism (PHPT). However, a single tactic for diagnosing and operating volume in patients with this variant of PHPT has not yet been developed. One of the possible directions in the search for pathogenetically substantiated methods of diagnosis and treatment is the study of the molecular genetic features of the disease and associated clinical and laboratory factors.

Aim: To study the features of the expression of calcium sensitive (CaSR) and vitamin D (VDR) receptors on the surface of parathyroid cells in primary hyperparathyroidism with solitary and multiple lesions of the parathyroid glands, as well as its changes under the influence of a decrease in the filtration function of the kidneys.

Materials and methods: In a single center observational prospective study with retrospective data collection, there were patients who during 2019-2021. operated on for PHPT, secondary hyperparathyroidism (SHPT) and all cases of tertiary hyperparathyroidism (THPT) operated during 2014-2021. The expression of CaSR, VDR and its relationship with the main laboratory parameters, the clinical variant of hyperparathyroidism, and the morphological substrate were studied.

Results: The study included 69 patients: 19 with multiple and 25 with solitary PTG near PHPT, 15 with SHPT, 10 with THPT. A statistically significant decrease in the frequency of detection of normal expression of CaSR and VDR receptors occurs in any morphological variant of hyperparathyroidism and is observed in 93-60% of drugs. A decrease in the normal expression of CaSR in hyperplasia is detected statistically significantly less frequently than in adenoma (p≤0.01). The median expression intensity in adenoma was 2.5 (2:3), in hyperplasia 3.5 (3-4) (p≤0.01). The difference in the molecular mechanisms of the development of hyperparathyroidism with a predominance of a morphological substrate in the form of adenoma (PHPT with solitary adenoma) or hyperplasia (SHPT and PHPT with multiple PTG lesions) is realized in the frequency of maintaining normal CaSR expression in the PTG tissue. These mechanisms are implemented at the local level, their variability does not change under the influence of RRT. A common molecular genetic mechanism for the development of hyperparathyroidism with a predominance of a morphological substrate in the form of adenoma or hyperplasia has been found to reduce the frequency of maintaining normal VDR expression in PTG (up to 7-13%), p<0.01. This mechanism is implemented at the local level, its variability changes under the influence of RRT, reaching statistically significant differences in patients with THPT.

Conclusion: The study demonstrates the features of changes in the expression of CaSR and VDR in PHPT with multiple lesions of the parathyroid glands. The relationship betwee

背景:散发性多发性甲状旁腺疾病是原发性甲状旁腺功能亢进症(PHPT)的¼例。然而,尚未开发出一种单一的策略来诊断这种PHPT变体患者的手术量。寻找病因证实的诊断和治疗方法的可能方向之一是研究该疾病的分子遗传特征以及相关的临床和实验室因素。目的:研究原发性甲状旁腺功能亢进伴甲状旁腺孤立性和多发性病变患者甲状旁腺细胞表面钙敏感(CaSR)和维生素D(VDR)受体的表达特点,以及在肾脏过滤功能下降影响下的变化。材料和方法:在一项具有回顾性数据收集的单中心观察性前瞻性研究中,有2019-2021年期间的患者。2014年至2021年期间手术治疗PHPT、继发性甲状旁腺功能亢进症(SHPT)和所有三级甲状旁腺功能亢进病(THPT)。研究了CaSR、VDR的表达及其与主要实验室参数、甲状旁腺功能亢进症的临床变异和形态学基质的关系。结果:该研究包括69例患者:19例为多发性PTG,25例为PHPT附近的孤立PTG,15例为SHPT,10例为THPT。CaSR和VDR受体正常表达的检测频率在统计学上显著降低,这发生在甲状旁腺功能亢进的任何形态变体中,并且在93-60%的药物中观察到。CaSR在增生中的正常表达降低的频率在统计学上显著低于腺瘤(p≤0.01)。腺瘤中的中位表达强度为2.5(2:3),在增生3.5(3-4)(p≤0.01)中。甲状旁腺功能亢进的分子机制的差异主要表现在PTG组织中维持CaSR正常表达的频率上,其中形态基质以腺瘤(PHPT伴孤立性腺瘤)或增生(SHPT和PHPT伴多发性PTG病变)为主。这些机制是在地方一级实施的,其可变性不会在RRT的影响下发生变化。已经发现,以腺瘤或增生形式的形态基质为主的甲状旁腺功能亢进症发展的常见分子遗传机制降低了PTG中维持正常VDR表达的频率(高达7-13%),p<;0.01.这一机制是在局部水平上实现的,其变异性在RRT的影响下发生变化,在THPT患者中达到统计学显著差异。结论:该研究证明了在甲状旁腺多发病变的PHPT中CaSR和VDR表达变化的特征。显示了这些受体的表达与甲状旁腺功能亢进症的临床变异、形态学基质、主要实验室参数和肾功能之间的关系。
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引用次数: 0
[Calcitonin measurement in fine-needle washout fluids in detecting medullary thyroid cancer]. 细针冲洗液降钙素测定在甲状腺髓样癌检测中的应用
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.14341/probl13236
Z T Zuraeva, L V Nikankina, G S Kolesnikova, F M Abdulhabirova, D G Beltsevich, N M Malysheva, A A Mikheenkov

Background: The diagnostic value of calcitonin measurement in fine-needle aspiration biopsy wash-out fluid is a promising tool in the diagnosis of medullary thyroid cancer.

Aims: We assessed the potential usefulness and the diagnostic significance of Ct-FNAB alone in comparison with cytology in the diagnosis and localization of primary or metastatic MTC.

Materials and methods: For this purpose, we retrospectively examined data from 67 patients with suspicious thyroid nodules and/or lymph nodes who ultimately underwent surgical treatment at the Endocrinology Research Centre in 2015-2020. The primary endpoint of the study was to evaluate the diagnostic accuracy of Ct-FNAB when compared to cytological examination. The secondary endpoint was to determine the optimal diagnostic level for use in clinical practice.

Results: The obtained results showed that high Ct-FNAB concentrations were present in all histologically proven MTC, either in thyroid gland (sensitivity 92.5%, specificity 100%) or neck masses (sensitivity 88.5%, specificity 100%). The optimal diagnostic threshold for Ct-FNAB values from thyroid nodes was > 122 pg/ml, from lymph nodes >35.8 pg/ml.

Conclusions: Our findings suggest that Ct-FNAB is a highly reliable diagnostic procedure to identify primary and recurrent/metastatic MTC. The actual relevance of this technique in the management of MTC needs further longitudinal studies in a larger number of patients.

背景:细针穿刺活检冲洗液降钙素测定在甲状腺髓样癌的诊断中具有重要价值。目的:我们评估单独Ct-FNAB与细胞学检查在原发性或转移性MTC的诊断和定位中的潜在有用性和诊断意义。材料和方法:为此,我们回顾性分析了2015-2020年在内分泌研究中心最终接受手术治疗的67例可疑甲状腺结节和/或淋巴结患者的数据。该研究的主要终点是评估Ct-FNAB与细胞学检查相比的诊断准确性。次要终点是确定临床实践中使用的最佳诊断水平。结果:所有经组织学证实的MTC均存在高Ct-FNAB浓度,无论是甲状腺(敏感性92.5%,特异性100%)还是颈部肿块(敏感性88.5%,特异性100%)。甲状腺淋巴结Ct-FNAB值的最佳诊断阈值为>122 pg/ml,淋巴结;35.8 pg/ml。结论:我们的研究结果表明,Ct-FNAB是一种高度可靠的诊断方法,可以识别原发性和复发/转移性MTC。该技术在MTC管理中的实际相关性需要在更多患者中进行进一步的纵向研究。
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引用次数: 0
[Professor D.Ya. Shurygin - the founder of military endocrinology (to the 100th anniversary of his birth)]. [D.Ya教授。Shurygin——军事内分泌学的创始人(纪念他诞辰100周年)。
Q4 Medicine Pub Date : 2023-05-21 DOI: 10.14341/probl13308
V V Salukhov, S B Shustov

In 2023 it would have been 100 years since the birth of a prominent Soviet endocrinologist, Honored Scientist of the RSFSR, chief endocrinologist of the USSR Ministry of Defense (1962-1982), head of the Department of Therapy No. 1 for the improvement of doctors of the Military Medical Academy. CM. Kirov (1972-1982), Professor and Major General of the Medical Service Dorofei Yakovlevich Shurygin.

2023年是一位杰出的苏联内分泌学家诞辰100周年,他是俄罗斯联邦社会主义共和国社会主义共和国荣誉科学家,苏联国防部首席内分泌学家(1962-1982年),军事医学院医生进步第一治疗科主任。厘米。基洛夫(1972-1982年),多罗菲·雅科夫列维奇·舒里金教授和少将。
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引用次数: 0
[Replicative and biochemical ageing features among females with primary ovarian insufficiency]. [原发性卵巢功能不全女性的生殖和生化老化特征]。
Q4 Medicine Pub Date : 2023-05-12 DOI: 10.14341/probl13253
R K Mikheev, E N Andreeva, O R Grigoryan, E V Sheremetyeva, Yu S Absatarova, E V Loginova

Background: One of the most dangerous reproductive pathologies is primary ovarian insufficiency (POI). Except manifestation in the age <40 years old it leads to demographical losses, decrease of chances for healthy aging. POI can be characterized as summary of secondary amenorrhea, total estrogenic deficiency and hypergonadotropic hypogonadism. Hence, POI has probably harmful effect on telomere length. Telomere length determining and sex steroid replacement therapy may be promising and effective to prevent decrease of life quality/ longevity among females with POI.

Aim: To evaluate features of replicative (telomere length) and biochemical (metabolic syndrome) markers among females with primary ovarian insufficiency.

Materials and methods: Research has been provided in collaboration between Endocrinology Research Centre of the Russian Ministry of Health and Lomonosov Moscow State University Medical Research and Educational Centre in the period since 10.01.2021 until 01.08.2022. Females with non-iatrogenic hypergonadotropic hypogonadism caused by primary ovarian insufficiency (n=33); healthy females of reproductive age (18-49 y.o.; n=24). Patients have undergone laboratory genetic (leucocyte telomere length), biochemical analyses. DNA extraction - with Qiagen DNA blood mini kit (Germany).Leukocyte telomere length - with real-time polymerase chain reaction PCR (Flow-fish). Soft program IBM SPSS Statistics (version 26,0 for Windows).

Results: Females with POI due to estrogenic deficiency have slightly shorter mean telomere length (10,0 [7,9-10,7] kB, than healthy females of reproductive age (10,8 [10,0-13,1] кБ, р<0,001). Females with POI due to estrogenic deficiency have higher chances for development of carbohydrate metabolism disturbances (prediabetes) (р<0,043), increasement of FSH level (р<0,001). FSH level correlates moderately and negatively (ρ=0,434) with leukocyte telomere length (р<0,001).

Conclusions: Female with POI and receiving sex steroid replacement therapy have decrease of telomere length and increase of chances for carbohydrate metabolism disturbances in opposite to healthy reproductive females.

背景:原发性卵巢功能不全(POI)是最危险的生殖疾病之一。除在40岁表现外,它导致人口损失,减少健康老龄化的机会。POI可表现为继发性闭经、总雌激素缺乏和促性腺功能亢进。因此,POI可能对端粒长度有不利影响。端粒长度测定和性类固醇替代治疗可能对预防POI女性患者生活质量/寿命下降有希望和有效。目的:探讨原发性卵巢功能不全女性生殖(端粒长度)和生化(代谢综合征)指标的特点。材料和方法:自2021年1月10日至2022年1月8日期间,俄罗斯卫生部内分泌学研究中心和罗蒙诺索夫莫斯科国立大学医学研究和教育中心合作开展了研究。原发性卵巢功能不全引起的非医源性促性腺功能亢进症女性(n=33);健康育龄女性(18-49岁);n = 24)。患者进行了实验室遗传(白细胞端粒长度)、生化分析。DNA提取-使用Qiagen DNA血液迷你试剂盒(德国)。白细胞端粒长度-实时聚合酶链反应PCR (Flow-fish)。软件程序IBM SPSS统计(版本26,0为Windows)。结果:雌激素缺乏导致POI的女性端粒平均长度(10,0 [7,9-10,7]kB)略短于育龄健康女性(10,8 [10,0-13,1]кБ, < 001)。由于雌激素缺乏导致的POI女性有更高的机会发展为碳水化合物代谢紊乱(前驱糖尿病)( < 0.0043), FSH水平升高( < 0.001)。FSH水平与白细胞端粒长度呈中度和负相关(ρ=0,434)(0.01)。结论:与生殖健康的女性相比,接受性类固醇替代治疗的POI女性端粒长度减少,碳水化合物代谢紊乱的可能性增加。
{"title":"[Replicative and biochemical ageing features among females with primary ovarian insufficiency].","authors":"R K Mikheev,&nbsp;E N Andreeva,&nbsp;O R Grigoryan,&nbsp;E V Sheremetyeva,&nbsp;Yu S Absatarova,&nbsp;E V Loginova","doi":"10.14341/probl13253","DOIUrl":"https://doi.org/10.14341/probl13253","url":null,"abstract":"<p><strong>Background: </strong>One of the most dangerous reproductive pathologies is primary ovarian insufficiency (POI). Except manifestation in the age &lt;40 years old it leads to demographical losses, decrease of chances for healthy aging. POI can be characterized as summary of secondary amenorrhea, total estrogenic deficiency and hypergonadotropic hypogonadism. Hence, POI has probably harmful effect on telomere length. Telomere length determining and sex steroid replacement therapy may be promising and effective to prevent decrease of life quality/ longevity among females with POI.</p><p><strong>Aim: </strong>To evaluate features of replicative (telomere length) and biochemical (metabolic syndrome) markers among females with primary ovarian insufficiency.</p><p><strong>Materials and methods: </strong>Research has been provided in collaboration between Endocrinology Research Centre of the Russian Ministry of Health and Lomonosov Moscow State University Medical Research and Educational Centre in the period since 10.01.2021 until 01.08.2022. Females with non-iatrogenic hypergonadotropic hypogonadism caused by primary ovarian insufficiency (n=33); healthy females of reproductive age (18-49 y.o.; n=24). Patients have undergone laboratory genetic (leucocyte telomere length), biochemical analyses. DNA extraction - with Qiagen DNA blood mini kit (Germany).Leukocyte telomere length - with real-time polymerase chain reaction PCR (Flow-fish). Soft program IBM SPSS Statistics (version 26,0 for Windows).</p><p><strong>Results: </strong>Females with POI due to estrogenic deficiency have slightly shorter mean telomere length (10,0 [7,9-10,7] kB, than healthy females of reproductive age (10,8 [10,0-13,1] кБ, р&lt;0,001). Females with POI due to estrogenic deficiency have higher chances for development of carbohydrate metabolism disturbances (prediabetes) (р&lt;0,043), increasement of FSH level (р&lt;0,001). FSH level correlates moderately and negatively (ρ=0,434) with leukocyte telomere length (р&lt;0,001).</p><p><strong>Conclusions: </strong>Female with POI and receiving sex steroid replacement therapy have decrease of telomere length and increase of chances for carbohydrate metabolism disturbances in opposite to healthy reproductive females.</p>","PeriodicalId":20433,"journal":{"name":"Problemy endokrinologii","volume":"69 2","pages":"92-98"},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10204785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9822448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
[Clinical and laboratory characteristics of arginine vasopressin resistance, caused by a new homozygous mutation p.R113C in AQP2]. [AQP2新纯合突变p.R113C引起精氨酸抗利尿素耐药的临床和实验室特点]。
Q4 Medicine Pub Date : 2023-05-12 DOI: 10.14341/probl13188
N A Makretskaya, U S Nanzanova, I R Hamaganova, E R Eremina, A N Tiulpakov

Congenital nephrogenic diabetes insipidus (CNDI, arginine vasopressin resistance) is a rare inherited disorder characterized by insensitivity of the kidney to the antidiuretic effect of vasopressin. NDI is clinically characterized by polyuria with hyposthenuria and nocturia and polydipsia. In the majority of cases, about 90%, nephrogenic diabetes insipidus is an X-linked recessive disorder caused by mutations in the AVP V2 receptor gene (AVPR2). In the remaining cases, about 10%, the disease is autosomal recessive or dominant and, for these patients, mutations in the aquaporin 2 gene (AQP2) have been reported. To date, the nucleotide variants registered in AQP2 were sporadic, there is no data on the presence of «frequent» mutations and the prevalence of the disease both among the global population and among individual ethnic groups. In this paper, we describe 12 cases of arginine vasopressin resistance caused by a new homozygous mutation p.R113C in AQP2 presented among the indigenous population of the Republic of Buryatia.

先天性肾源性尿崩症(CNDI,精氨酸抗利尿素)是一种罕见的遗传性疾病,其特征是肾脏对利尿素的抗利尿作用不敏感。NDI的临床特征为多尿伴少尿、夜尿和烦渴。在大多数病例中(约90%),肾源性尿崩症是一种由AVP V2受体基因(AVPR2)突变引起的x连锁隐性疾病。其余病例中,约10%为常染色体隐性遗传或显性遗传,据报道,这些患者的水通道蛋白2基因(AQP2)发生突变。迄今为止,在AQP2中登记的核苷酸变异是零星的,没有关于存在“频繁”突变和该疾病在全球人口和个别种族群体中流行的数据。本文报道了布里亚特共和国土著人群中由AQP2基因p.R113C纯合突变引起的12例精氨酸抗利尿素耐药病例。
{"title":"[Clinical and laboratory characteristics of arginine vasopressin resistance, caused by a new homozygous mutation p.R113C in AQP2].","authors":"N A Makretskaya,&nbsp;U S Nanzanova,&nbsp;I R Hamaganova,&nbsp;E R Eremina,&nbsp;A N Tiulpakov","doi":"10.14341/probl13188","DOIUrl":"https://doi.org/10.14341/probl13188","url":null,"abstract":"<p><p>Congenital nephrogenic diabetes insipidus (CNDI, arginine vasopressin resistance) is a rare inherited disorder characterized by insensitivity of the kidney to the antidiuretic effect of vasopressin. NDI is clinically characterized by polyuria with hyposthenuria and nocturia and polydipsia. In the majority of cases, about 90%, nephrogenic diabetes insipidus is an X-linked recessive disorder caused by mutations in the AVP V2 receptor gene (AVPR2). In the remaining cases, about 10%, the disease is autosomal recessive or dominant and, for these patients, mutations in the aquaporin 2 gene (AQP2) have been reported. To date, the nucleotide variants registered in AQP2 were sporadic, there is no data on the presence of «frequent» mutations and the prevalence of the disease both among the global population and among individual ethnic groups. In this paper, we describe 12 cases of arginine vasopressin resistance caused by a new homozygous mutation p.R113C in AQP2 presented among the indigenous population of the Republic of Buryatia.</p>","PeriodicalId":20433,"journal":{"name":"Problemy endokrinologii","volume":"69 2","pages":"75-79"},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10204789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9812893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
[Efficacy of treatment with glucagon-like peptide receptor agonists-1 in Asian patients with type 2 diabetes mellitus]. [胰高血糖素样肽受体激动剂-1 对亚洲 2 型糖尿病患者的疗效]。
Q4 Medicine Pub Date : 2023-05-11 DOI: 10.14341/probl13245
L Yu Khamnueva, L S Andreeva

Background: The projected 68% increase in patients with type 2 diabetes mellitus (T2D) in the upcoming decades and the specific pathophysiological course of the disease are critical factors for the development of optimal disease management tactics in the Asian population. It is now known that β-cell dysfunction is dominant in the pathogenesis of T2D in Asians. In a number of Asian countries, incretin therapy is the leading therapy.

Aim: To review literature on glucagon-like peptide-1 (GLP-1) secretion and clinical trial results of GLP-1 receptor agonist class (GLP-1RA) drugs as well as to evaluate their effectiveness in Asian population with T2D.

Materials and methods: A review of studies on pathophysiological aspects of GLP-1 secretion and evaluation of the efficacy of therapy with GLP-1RA preparations registered and used in clinical practice in Asian regions.

Results: Several studies in Asian countries have shown that intact GLP-1 levels were significantly lower in both T2D patients and healthy Japanese volunteers; as well as in patients with impaired glucose tolerance. It is suggested that either impaired secretion of GLP-1 in the gut, accelerated processing by dipeptidyl peptidase-4, or a combination of both are responsible for the decrease in GLP-1. The greater efficacy of GLP-1RA treatment in achieving glycemic control in Asian T2D patients was presented by Kim Y.G. et al. in a meta-analysis of 15 randomised controlled trials, the reduction in HbA1c on GLP-1RA treatment averaged -1.16% in Asian-dominated studies and -0.83% in non-Asian-dominated studies. In the PIONEER 9 clinical programme, similar results were obtained, with oral semaglutide having a more pronounced effect on glycaemic control in Japanese patients. Thus, the mean change in HbA 1c was -1.1%, 7 mg -1.5%, and 14 mg -1.7% at the 3 mg dose; whereas in the PIONEER 1 study in the global population, the mean change in HbA1c was -0.6%, -0.9% and -1.1% for 3, 7, 14 mg semaglutide, respectively. The PIONEER 10 study concluded that oral semaglutide was well tolerated by Japanese patients with T2D. Oral semaglutide reduced HbA1c (14 mg dose) and body weight (7 and 14 mg doses) more significantly compared to dulaglutide at 0.75 mg dose. Results of a pooled analysis of long-acting GLP-1RA showed a more significant reduction in cardiovascular event risk in the Asian subpopulation.

Conclusion: The presented review describes benefits in glycemic control as well as in the reduction of relative cardiovascular event risks with GLP-1RA treatment in the Asian population, which requires further in-depth research and implies optimal management tactics in patients with T2DM.

背景:预计在未来几十年中,2 型糖尿病(T2D)患者将增加 68%,该疾病的特殊病理生理过程是为亚洲人群制定最佳疾病管理策略的关键因素。目前已知,β 细胞功能障碍在亚洲人 T2D 的发病机制中占主导地位。目的:综述有关胰高血糖素样肽-1(GLP-1)分泌的文献和GLP-1受体激动剂类药物(GLP-1RA)的临床试验结果,并评估其在亚洲T2D患者中的疗效:综述有关 GLP-1 分泌的病理生理学方面的研究,并评估在亚洲地区注册并用于临床实践的 GLP-1RA 制剂的疗效:结果:在亚洲国家进行的多项研究表明,T2D 患者和健康的日本志愿者以及糖耐量受损患者体内的完整 GLP-1 水平明显较低。有研究认为,肠道中 GLP-1 的分泌受阻、二肽基肽酶-4 加速处理或两者共同作用是导致 GLP-1 减少的原因。Kim Y.G. 等人对 15 项随机对照试验进行了荟萃分析,结果表明,GLP-1RA 治疗对亚洲 T2D 患者血糖控制的疗效更佳,在以亚洲人为主的研究中,GLP-1RA 治疗的 HbA1c 平均降低了-1.16%,而在以非亚洲人为主的研究中,平均降低了-0.83%。在 PIONEER 9 临床项目中也得出了类似的结果,日本患者口服塞马鲁肽对血糖控制的效果更为明显。因此,3 毫克剂量的 HbA 1c 平均变化率为-1.1%,7 毫克为-1.5%,14 毫克为-1.7%;而在 PIONEER 1 全球人群研究中,3、7、14 毫克塞马鲁肽的 HbA 1c 平均变化率分别为-0.6%、-0.9% 和-1.1%。PIONEER 10 研究认为,日本 T2D 患者对口服塞马鲁肽的耐受性良好。与剂量为 0.75 毫克的度拉鲁肽相比,口服塞马鲁肽能更显著地降低 HbA1c(14 毫克剂量)和体重(7 毫克和 14 毫克剂量)。对长效 GLP-1RA 的汇总分析结果显示,亚洲亚群的心血管事件风险降低更为显著:本综述介绍了在亚洲人群中使用 GLP-1RA 治疗在控制血糖和降低心血管事件相对风险方面的益处,这需要进一步深入研究,并意味着 T2DM 患者的最佳管理策略。
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引用次数: 0
[Acromegaly in the differential diagnosis of hearing loss]. 【肢端肥大症在听力损失的鉴别诊断】。
Q4 Medicine Pub Date : 2023-05-11 DOI: 10.14341/probl13249
L K Dzeranova, L I Lepeshkina, A S Shutova, M A Perepelova, E A Pigarova, V N Azizyan, P V Akopyan, Е G Przhialkovskaya, G A Melnichenko, N G Mokrysheva

Acromegaly is a multifactorial neuroendocrine disease caused by hyperproduction of growth hormone (GH). In more than 95% of cases the reason of acromegaly the GH-secreting pituitary adenoma. In patients with this neuroendocrine disease, a slowly developing complex of symptom can manifest with concomitant pathological conditions, including auditory function disordersDiagnostic difficulties of acromegaly at the ambulatory stage determine the importance of doctor`s awareness in different medical specialties.Here we demonstrate a clinical case of the improvement of the auditory function due to combined surgical and medical treatment of a patient with the pituitary macroadenoma, acromegaly and hearing loss.Anamnesis features: a patient with an active stage of acromegaly and a pituitary macroadenoma measuring 57x35x32 mm with ante-, supra-, infra-, parasellar spread, (Knosp III(D), Knosp IV(S) noted a violation of auditory function. She was consulted by an otolaryngologist, sensorineural hearing loss on the right of the 3rd degree was diagnosed, on the left of the 1st degree. The patient underwent surgical treatment of pituitary adenoma, noted a significant improvement in auditory function in the early postoperative period. Six months later, repeated audiometry was performed, marked regression of hearing damage was noted.The case described by us indicates the reversibility of a rare complication of acromegaly - hearing loss and the importance of an interdisciplinary approach in the management of patients with this pathology.

肢端肥大症是一种由生长激素(GH)分泌过多引起的多因素神经内分泌疾病。在95%以上的病例中,肢端肥大症的病因是gh分泌垂体腺瘤。在这种神经内分泌疾病的患者中,一个缓慢发展的复杂症状可以表现为伴随的病理状况,包括听觉功能障碍。肢端肥大症在门诊阶段的诊断困难决定了不同医学专业医生认识的重要性。我们在此报告一例垂体大腺瘤、肢端肥大症及听力丧失患者经外科及内科联合治疗后听觉功能改善的临床病例。回顾性分析:患者为肢端肥大症活动期,伴有垂体大腺瘤,尺寸为57x35x32mm,鞍前、鞍上、鞍下扩散,(Knosp III(D)、Knosp IV(S),注意到听觉功能受损。她咨询了耳鼻喉科医生,诊断为3度右侧的感觉神经性听力损失,1度左侧的感觉神经性听力损失。患者接受垂体腺瘤手术治疗,术后早期听觉功能有明显改善。6个月后复查听力学,发现听力损伤明显消退。我们所描述的病例表明可逆性肢端肥大症罕见的并发症-听力损失和跨学科方法的重要性,在患者的管理与这种病理。
{"title":"[Acromegaly in the differential diagnosis of hearing loss].","authors":"L K Dzeranova,&nbsp;L I Lepeshkina,&nbsp;A S Shutova,&nbsp;M A Perepelova,&nbsp;E A Pigarova,&nbsp;V N Azizyan,&nbsp;P V Akopyan,&nbsp;Е G Przhialkovskaya,&nbsp;G A Melnichenko,&nbsp;N G Mokrysheva","doi":"10.14341/probl13249","DOIUrl":"https://doi.org/10.14341/probl13249","url":null,"abstract":"<p><p>Acromegaly is a multifactorial neuroendocrine disease caused by hyperproduction of growth hormone (GH). In more than 95% of cases the reason of acromegaly the GH-secreting pituitary adenoma. In patients with this neuroendocrine disease, a slowly developing complex of symptom can manifest with concomitant pathological conditions, including auditory function disordersDiagnostic difficulties of acromegaly at the ambulatory stage determine the importance of doctor`s awareness in different medical specialties.Here we demonstrate a clinical case of the improvement of the auditory function due to combined surgical and medical treatment of a patient with the pituitary macroadenoma, acromegaly and hearing loss.Anamnesis features: a patient with an active stage of acromegaly and a pituitary macroadenoma measuring 57x35x32 mm with ante-, supra-, infra-, parasellar spread, (Knosp III(D), Knosp IV(S) noted a violation of auditory function. She was consulted by an otolaryngologist, sensorineural hearing loss on the right of the 3rd degree was diagnosed, on the left of the 1st degree. The patient underwent surgical treatment of pituitary adenoma, noted a significant improvement in auditory function in the early postoperative period. Six months later, repeated audiometry was performed, marked regression of hearing damage was noted.The case described by us indicates the reversibility of a rare complication of acromegaly - hearing loss and the importance of an interdisciplinary approach in the management of patients with this pathology.</p>","PeriodicalId":20433,"journal":{"name":"Problemy endokrinologii","volume":"69 2","pages":"31-37"},"PeriodicalIF":0.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10204780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10004435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Features of steroidogenesis and arterial hypertension in men in different types of "physiological" male hyperandrogenism]. [不同类型“生理性”男性高雄激素症男性类固醇生成和动脉高血压的特点]。
Q4 Medicine Pub Date : 2023-05-11 DOI: 10.14341/probl13226
V A Filatova, R V Rozhivanov, I Z Bondarenko, V A Ioutsi, E N Andreeva, G A Mel'nichenko, N G Mokrysheva

Aim: To reveal the peculiarities of steroidogenesis and arterial hypertension in «physiological» hyperandrogenism in men.

Materials and methods: One-stage simultaneous study. The groups of men with hyperandrogenism caused by increased total testosterone (n=34) and those with hyperandrogenism caused by increased dihydrotestosterone (DHT) (n=66) were compared. In determining the type of hyperandrogenism and allocating patients to groups, DHT and total testosterone levels were determined by enhanced chemiluminescence. Subgroups of men with and without arterial hypertension were compared in the group of patients with hyperandrogenism due to an increase in total testosterone. Body mass index, waist circumference, systolic and diastolic blood pressure, pulse, and LH, SBHG, estradiol, blood multisteroid levels by isotope dilution liquid chromatography/tandem mass spectrometry, glucose, blood lipid spectrum, uric acid, creatinine, renin, potassium, sodium, and blood chloride were assessed in all patients. Patients with arterial hypertension additionally underwent daily BP monitoring, albuminuria assessment, electrocardiography, ocular fundus examination. The baseline threshold level of significance was p<0.05. For multiple comparisons, the p significance level was calculated using the Bonferroni correction.

Results: Statistically significant differences were found in the levels of 17-hydroxypregnenolone, 17-hydroxyprogesterone, and androstenedione, which were higher in men with elevated levels of total testosterone. No statistically significant differences in other laboratory parameters were found. No cases of increased blood pressure were detected in the group of men with elevated DHT. In the group of men with elevated total testosterone, 23,5% of men with arterial hypertension without targetorgan lesions were identified, while hyperandrogenism was associated with 17,6% of cases. Arterial hypertension associated with hyperandrogenism was characterized by a rise in blood pressure in the early morning hours. Estradiol levels, while remaining within normal limits, were statistically significantly lower in patients with arterial hypertension compared with men with elevated testosterone but without hypertension.

Conclusion: No cases of arterial hypertension were observed in «physiological» hyperandrogenism due to elevated DHT levels, whereas its incidence in «physiological» hyperandrogenism due to elevated total testosterone was 23,5%. The features of steroidogenesis were increased production of 17-hydroxypregnenolone, 17-hydroxyprogesterone, and androstenedione in men with testosterone hyperandrogenism and decreased estradiol production in patients with arterial hypertension compared with patients without testosterone hyperandrogenism.

目的:揭示男性“生理性”高雄激素症中类固醇生成和动脉高血压的特点。材料与方法:一期同步研究。比较总睾酮升高引起的高雄激素症组(n=34)和双氢睾酮(DHT)升高引起的高雄激素症组(n=66)。在确定高雄激素症的类型和分配患者组时,DHT和总睾酮水平通过增强化学发光测定。在总睾酮升高引起的高雄激素症患者组中,对有和无动脉高血压的男性进行亚组比较。评估所有患者的体重指数、腰围、收缩压和舒张压、脉搏、LH、shhg、雌二醇、同位素稀释液相色谱/串联质谱法测定的血液多种类固醇水平、葡萄糖、血脂谱、尿酸、肌酐、肾素、钾、钠和血氯。动脉性高血压患者还接受每日血压监测、蛋白尿评估、心电图、眼底检查。基线阈值显著性水平为p<0.05。对于多重比较,使用Bonferroni校正计算p显著性水平。结果:17-羟基孕烯醇酮、17-羟基孕酮、雄烯二酮水平差异有统计学意义,总睾酮水平升高的男性其含量较高。其他实验室参数差异无统计学意义。在DHT升高的男性组中没有发现血压升高的病例。在总睾酮水平升高的男性组中,23.5%的男性动脉高血压患者没有靶器官病变,而高雄激素症患者的比例为17.6%。动脉高血压与高雄激素血症相关,其特征是清晨血压升高。动脉高血压患者的雌二醇水平虽然保持在正常范围内,但与睾酮升高但无高血压的男性相比,有统计学意义的雌二醇水平明显降低。结论:由于DHT水平升高而引起的“生理性”高雄激素症中未发现动脉高血压病例,而由于总睾酮水平升高而导致的“生理性”高雄激素症中动脉高血压的发生率为23.5%。甾体生成的特征是,与未患睾酮高雄激素症的患者相比,患有睾酮高雄激素症的男性体内17-羟基孕烯醇酮、17-羟基孕酮和雄烯二酮的分泌增加,而动脉高血压患者体内雌二醇的分泌减少。
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引用次数: 0
[Diagnosis and new treatment options for pituitary adenomas]. [垂体腺瘤的诊断和新治疗方案]。
Q4 Medicine Pub Date : 2023-05-11 DOI: 10.14341/probl13199
A Yu Grigoriev, V N Azizyan, O V Ivashchenko, G Yu Starkov

Currently, the treatment of pituitary adenomas is inextricably linked with transsphenoidal neurosurgical intervention. Modern technologies used in surgery for this pituitary pathology, such as endoscopy using angled optics, as well as the use of specialized instruments, sealing and hemostatic materials, increase the effectiveness of surgical treatment of pituitary adenomas and reduce the incidence of intraand postoperative complications. The development of radiation methods of diagnostics, such as MRI, makes it possible to more accurately identify the formation of the pituitary gland, assess its size, direction of growth, and the degree of invasion of surrounding tissues. The authors of the article described in detail the modern technique of transsphenoidal removal of pituitary adenoma using an endoscope. Each stage of the operation is described step by step, taking into account various anatomical features and illustrated. This article discusses the MRI characteristics of pituitary adenomas: size of the tumor, the direction of its growth, the degree of invasion of the cavernous sinuses, the compression effect on the structures of the chiasmal-sellar region. The use of treatment methods, knowledge of the features of MRI diagnostics described in this article greatly increase the effectiveness of the treatment of patients with pituitary adenomas and reduce the risk of complications after neurosurgical intervention in such patients.

目前,垂体腺瘤的治疗与经蝶神经外科干预密不可分。在垂体病理学手术中使用的现代技术,如使用角度光学的内窥镜,以及专用器械、密封和止血材料的使用,提高了垂体腺瘤手术治疗的有效性,降低了术中和术后并发症的发生率。核磁共振成像等放射诊断方法的发展使人们有可能更准确地确定垂体的形成,评估其大小、生长方向和对周围组织的侵犯程度。文章作者详细描述了使用内窥镜经蝶窦切除垂体腺瘤的现代技术。文章结合各种解剖学特征,逐步描述了手术的每个阶段,并配有图解。本文讨论了垂体腺瘤的磁共振成像特征:肿瘤大小、生长方向、对海绵窦的侵犯程度、对椎管-星状区结构的压迫效应。利用本文所述的治疗方法和磁共振成像诊断特征知识,可大大提高垂体腺瘤患者的治疗效果,并降低此类患者神经外科干预后出现并发症的风险。
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引用次数: 0
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Problemy endokrinologii
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