Pub Date : 2023-05-10DOI: 10.15829/2713-0177-2023-9
A. Arefyeva, A. Volkova, A. Lisker, E. N. Ostroukhova, T. A. Kholudeeva
Klinefelter syndrome (KS) is a genetic disease associated with the presence of an extra X-chromosome in the karyotype of men. The most common karyotype is 47XXY, however, other genetic variants are also possible, as well as mosaic forms.The clinical picture is most often represented by bilateral gynecomastia, decreased in the volume testicles and infertility (azoospermia). Laboratory revealed hypergonadotropic hypogonadism. Testosterone replacement therapy is used to ensure virilization and the proper quality of life. Assisted reproductive technologies with preliminary hormonal preparation are used to restore fertility.This article presents a clinical case of KS and considers options for realization of reproductive plans in the case of non-obstructive azoospermia.
{"title":"Klinefelter syndrome: a case report","authors":"A. Arefyeva, A. Volkova, A. Lisker, E. N. Ostroukhova, T. A. Kholudeeva","doi":"10.15829/2713-0177-2023-9","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-9","url":null,"abstract":"Klinefelter syndrome (KS) is a genetic disease associated with the presence of an extra X-chromosome in the karyotype of men. The most common karyotype is 47XXY, however, other genetic variants are also possible, as well as mosaic forms.The clinical picture is most often represented by bilateral gynecomastia, decreased in the volume testicles and infertility (azoospermia). Laboratory revealed hypergonadotropic hypogonadism. Testosterone replacement therapy is used to ensure virilization and the proper quality of life. Assisted reproductive technologies with preliminary hormonal preparation are used to restore fertility.This article presents a clinical case of KS and considers options for realization of reproductive plans in the case of non-obstructive azoospermia.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116114025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/1560-4071-2023-12
T. Demidova, V. V. Titova
Primary hyperaldosteronism (PA) is a disorder with excessive secretion of aldosterone, uncontrolled of regulation of the renin-angiotensin system. Excess secretion of aldosterone leads to the development of hypertension, hypokalemia and specific damage to the cardiovascular system and kidneys. The prevalence of PA was previously underestimated, but at the moment, according to studies, it is the most common cause of secondary arterial hypertension. The most common causes of PA are adrenal adenoma and adrenal hyperplasia. The importance of timely diagnosis of PA lies not only in solving the problem of high blood pressure, but because of the extremely adverse effect of excess aldosterone on the cardiovascular system and kidneys, which can even lead to death. The aldosterone-to-renin ratio (ARR) has long been a selective test for PA screening, but the complexity of its interpretation, the lack of clear cut-off level, and the confusion of measurement units make it difficult to evaluate, which has led some researchers to look for new ways for PA screening. The distinction between idiopathic adrenal hyperplasia (IAH) and aldosterone-producing adenoma (APA) is important for choosing the appropriate treatment. Therefore, imaging exams such as computed tomography and invasive studies such as adrenal catheterization are required to identify the PA subtype. Depending on the subtype of PA, it is necessary to use the optimal treatment — surgical for APA or pharmacological for hypertension, using drugs such as mineralocorticoid receptor antagonists.
{"title":"Difficulties in diagnosing primary hyperaldosteronism","authors":"T. Demidova, V. V. Titova","doi":"10.15829/1560-4071-2023-12","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-12","url":null,"abstract":"Primary hyperaldosteronism (PA) is a disorder with excessive secretion of aldosterone, uncontrolled of regulation of the renin-angiotensin system. Excess secretion of aldosterone leads to the development of hypertension, hypokalemia and specific damage to the cardiovascular system and kidneys. The prevalence of PA was previously underestimated, but at the moment, according to studies, it is the most common cause of secondary arterial hypertension. The most common causes of PA are adrenal adenoma and adrenal hyperplasia. The importance of timely diagnosis of PA lies not only in solving the problem of high blood pressure, but because of the extremely adverse effect of excess aldosterone on the cardiovascular system and kidneys, which can even lead to death. The aldosterone-to-renin ratio (ARR) has long been a selective test for PA screening, but the complexity of its interpretation, the lack of clear cut-off level, and the confusion of measurement units make it difficult to evaluate, which has led some researchers to look for new ways for PA screening. The distinction between idiopathic adrenal hyperplasia (IAH) and aldosterone-producing adenoma (APA) is important for choosing the appropriate treatment. Therefore, imaging exams such as computed tomography and invasive studies such as adrenal catheterization are required to identify the PA subtype. Depending on the subtype of PA, it is necessary to use the optimal treatment — surgical for APA or pharmacological for hypertension, using drugs such as mineralocorticoid receptor antagonists.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131701490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/1560-4071-2023-22
F. Ushanova, T. Demidova, T. N. Korotkova
Cardiovascular disease is the leading cause of death in patients with diabetes mellitus. It has been established that the period of menopause, associated with an increase in age and a change in the metabolic background, increases the risk of developing cardiovascular diseases in women with diabetes mellitus. Despite tentative expectations, a number of studies have shown conflicting evidence regarding the beneficial effects of menopausal hormone therapy on CV risk markers in diabetes mellitus. In this connection, therapy with hormonal preparations containing estrogen is currently not recommended for the prevention of cardiovascular diseases in the absence of specific indications. At the same time, estrogen therapy can be used in this group to minimize menopausal symptoms. At the same time, the risk of adverse events associated with the use of menopausal hormone therapy can be estimated using calculation methods for determining cardiovascular risk and breast cancer risk using specific calculators, especially in the group of women with type 2 diabetes.The main principles of cardiovascular risk management continue to focus on lifestyle modification and achieving target levels of cardiovascular risk parameters such as lipid levels, glycemia, and blood pressure. The use of pharmacological therapy to address these risk factors, especially some pleiotropic antihyperglycemic drugs, may provide additional options for the prevention of cardiovascular disease.
{"title":"Principles of cardiovascular risk management in perimenopausal women with type 2 diabetes","authors":"F. Ushanova, T. Demidova, T. N. Korotkova","doi":"10.15829/1560-4071-2023-22","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-22","url":null,"abstract":"Cardiovascular disease is the leading cause of death in patients with diabetes mellitus. It has been established that the period of menopause, associated with an increase in age and a change in the metabolic background, increases the risk of developing cardiovascular diseases in women with diabetes mellitus. Despite tentative expectations, a number of studies have shown conflicting evidence regarding the beneficial effects of menopausal hormone therapy on CV risk markers in diabetes mellitus. In this connection, therapy with hormonal preparations containing estrogen is currently not recommended for the prevention of cardiovascular diseases in the absence of specific indications. At the same time, estrogen therapy can be used in this group to minimize menopausal symptoms. At the same time, the risk of adverse events associated with the use of menopausal hormone therapy can be estimated using calculation methods for determining cardiovascular risk and breast cancer risk using specific calculators, especially in the group of women with type 2 diabetes.The main principles of cardiovascular risk management continue to focus on lifestyle modification and achieving target levels of cardiovascular risk parameters such as lipid levels, glycemia, and blood pressure. The use of pharmacological therapy to address these risk factors, especially some pleiotropic antihyperglycemic drugs, may provide additional options for the prevention of cardiovascular disease.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"67 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122541791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/2713-0177-2023-18
V. Larina
The article discusses the modern approaches to a glycemic control among outpatients with prediabetes. The risk factors for prediabetes, the possibilities of its screening, and the issues of treatment non-adherence are discussed. An attention is paid to the aspects of teaching patients the skills of competent self-monitoring of glycemia, and the use of glucometers integrated with smartphones at home. Modern features and advantages of the glucometer for self-control over the disease are discussed.
{"title":"Glucometry and self-control skills as necessary components in the management of a patient with prediabetes in the outpatient settings","authors":"V. Larina","doi":"10.15829/2713-0177-2023-18","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-18","url":null,"abstract":"The article discusses the modern approaches to a glycemic control among outpatients with prediabetes. The risk factors for prediabetes, the possibilities of its screening, and the issues of treatment non-adherence are discussed. An attention is paid to the aspects of teaching patients the skills of competent self-monitoring of glycemia, and the use of glucometers integrated with smartphones at home. Modern features and advantages of the glucometer for self-control over the disease are discussed.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134287035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/2713-0177-2023-6
T. Demidova, K. Lobanova, T. N. Korotkova
Hypercalcemia is a common laboratory finding. The most common causes of high blood calcium are primary hyperparathyroidism, tertiary hyperparathyroidism, parathyroid cancer, malignant neoplasms, long-term therapy with lithium and thiazide diuretics, vitamin D intoxication, which require a different approach to treatment. Therefore, it is important for a doctor to be able to conduct a differential diagnostic search for hypercalcemia syndrome in order to establish the cause of high blood calcium and determine the correct tactics for managing patients.
{"title":"Hypercalcemia syndrome: differential diagnostic search and treatment tactics","authors":"T. Demidova, K. Lobanova, T. N. Korotkova","doi":"10.15829/2713-0177-2023-6","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-6","url":null,"abstract":"Hypercalcemia is a common laboratory finding. The most common causes of high blood calcium are primary hyperparathyroidism, tertiary hyperparathyroidism, parathyroid cancer, malignant neoplasms, long-term therapy with lithium and thiazide diuretics, vitamin D intoxication, which require a different approach to treatment. Therefore, it is important for a doctor to be able to conduct a differential diagnostic search for hypercalcemia syndrome in order to establish the cause of high blood calcium and determine the correct tactics for managing patients.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126381041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/2713-0177-2023-19
T. Demidova, D. Skuridina
SGLT-2 inhibitors first emerged as a new class of oral hypoglycemic drugs with modest efficacy in lowering HbA 1c levels, which were also capable of inducing weight loss and lowering blood pressure without a significant risk of hypoglycemia. However, an analysis of the results of studies conducted to assess cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) during iSGLT-2 therapy showed evidence of nephroprotection, which led to the initiation of trials on renal outcomes. The data obtained showed that the protective effects of iSGLT-2 against cardiovascular and renal complications of type 2 diabetes do not directly depend on their hypoglycemic activity, while their particular clinical significance is demonstrated in reducing the risk of hospitalization for heart failure (HF), progression of diabetic kidney disease (RDK), as well as a reduction in the incidence of major adverse cardiovascular events (MACE).Today it is known that against the background of diabetic nephropathy, cardiovascular consequences become more serious. CKD patients with diabetes are more likely to die from cardiovascular causes than from end-stage renal disease. Diabetic kidney disease appears to be not only a marker of increased cardiovascular risk, but also involved in the pathogenesis of cardiovascular disease. An increase in traditional risk factors such as hypertension, hyperlipidemia, and obesity cannot fully explain the worse cardiovascular and fatal outcomes in CKD.This review will focus on the role of iSGLT-2 in the outcomes of type 2 DM complicated by the development of CKD, and will highlight the putative mechanisms of the nephroprotective action of this group of drugs.
{"title":"The role of sodium-glucose cotransporter type 2 inhibitors on the path to cardiovascular well-being in type 2 diabetes mellitus and chronic kidney disease","authors":"T. Demidova, D. Skuridina","doi":"10.15829/2713-0177-2023-19","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-19","url":null,"abstract":"SGLT-2 inhibitors first emerged as a new class of oral hypoglycemic drugs with modest efficacy in lowering HbA 1c levels, which were also capable of inducing weight loss and lowering blood pressure without a significant risk of hypoglycemia. However, an analysis of the results of studies conducted to assess cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) during iSGLT-2 therapy showed evidence of nephroprotection, which led to the initiation of trials on renal outcomes. The data obtained showed that the protective effects of iSGLT-2 against cardiovascular and renal complications of type 2 diabetes do not directly depend on their hypoglycemic activity, while their particular clinical significance is demonstrated in reducing the risk of hospitalization for heart failure (HF), progression of diabetic kidney disease (RDK), as well as a reduction in the incidence of major adverse cardiovascular events (MACE).Today it is known that against the background of diabetic nephropathy, cardiovascular consequences become more serious. CKD patients with diabetes are more likely to die from cardiovascular causes than from end-stage renal disease. Diabetic kidney disease appears to be not only a marker of increased cardiovascular risk, but also involved in the pathogenesis of cardiovascular disease. An increase in traditional risk factors such as hypertension, hyperlipidemia, and obesity cannot fully explain the worse cardiovascular and fatal outcomes in CKD.This review will focus on the role of iSGLT-2 in the outcomes of type 2 DM complicated by the development of CKD, and will highlight the putative mechanisms of the nephroprotective action of this group of drugs.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126242326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/2713-0177-2023-23
M. Y. Izmailova, K. M. Belova, T. L. Bogacheva
The presented review describes a clinical case of a comorbid patient type 2 diabetes mellitus (T2DM), the severity of whose disease was due to the presence of COVID-19 infection suffered on the eve of hospitalization, as well as the presence of concomitant diseases from the cardiovascular and nervous systems. In the aggregate of simultaneously occurring pathological processes, a patient with type 2 diabetes had a picture of uncontrolled hyperglycemia. The lifeline for the comorbid patient was orientation towards a more effective triple combined hypoglycemic therapy consisting of a type 2 sodium-glucose cotransporter 2 inhibitor, a medcine from the aGLP-1 group and metformin.
{"title":"Comorbid patient with type 2 diabetes in the postcovid period: clinical case","authors":"M. Y. Izmailova, K. M. Belova, T. L. Bogacheva","doi":"10.15829/2713-0177-2023-23","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-23","url":null,"abstract":"The presented review describes a clinical case of a comorbid patient type 2 diabetes mellitus (T2DM), the severity of whose disease was due to the presence of COVID-19 infection suffered on the eve of hospitalization, as well as the presence of concomitant diseases from the cardiovascular and nervous systems. In the aggregate of simultaneously occurring pathological processes, a patient with type 2 diabetes had a picture of uncontrolled hyperglycemia. The lifeline for the comorbid patient was orientation towards a more effective triple combined hypoglycemic therapy consisting of a type 2 sodium-glucose cotransporter 2 inhibitor, a medcine from the aGLP-1 group and metformin.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122759469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/1560-4071-2023-25
M. N. Zatsepina, F. Ushanova, T. L. Bogacheva
Aim. To study the effect of type 2 diabetes mellitus (DM) on the clinical and anamnestic and laboratory and instrumental characteristics of patients with acute myocardial infarction (MI).Material and methods. 102 patients with MI (41 women and 61 men) were examined. 2 groups were formed: the main group — patients with MI and DM2 (n=66) (group 1), the control group — patients with MI without DM (n=36) (group 2). A comparative analysis of laboratory data, concomitant diseases, complications of myocardial infarction in groups was performed. Statistical data processing was performed using the Excel package (Microsoft), Statistica 10 program (Statsoft Inc).Results. The mean age of the general group was 68 [43;96] years, patients with DM2 68,5 [43;88] years, patients without DM 67,5 [47;96] years. The average duration of MI in the general group was 13,5 [1;48] years, among patients with DM — 23 [1;48] years, without DM — 8 [1;34] years. DM in patients was statistically significantly correlated with a history of exertional angina (Kramer’s V coefficient 0,272, p=0,005). At the same time, there was no significant relationship between DM and previous revascularization interventions, such as a history of stenting (p=0,088), coronary artery bypass grafting (CABG) (p=0,291), as well as with stroke (p=0,09). Mean body mass index (BMI) values are found in lesions and without DM — 29,7 [19,5;46,9] kg/m2 and 27,3 [21,3;41,5] kg/m2, respectively. An analysis of the frequency of determining CKD (eGFR level <60 ml/min/1,73 m2) in groups revealed that in patients with type 2 DM, CKD of high severity was detected in 59% of cases, and in the group without DM this indicator was detected in 53%. Mean eGFR in the DM group was lower than in group 2: 54,5 [24;95] ml/min/1,73 m2 versus 58 [21;117] ml/min/1,73 m2, but the difference was not statistically detected (p>0,05). DM necessarily correlated with the presence of CHF in patients (Cramer’s V coefficient 0,243, p=0,02). In the DM group, low ejection fraction was detected significantly more often according to echocardiography: 58% (n=11) in group 1 versus 42% (n=8) in group 2 (p=0,011). A statistically significant relationship was found between the presence of DM in patients and pulmonary hypertension according to echocardiography (Cramer’s V coefficient 0,3, p=0.003). And in a comparative analysis of lipid profile indicators, there was no statistically significant difference in the groups.Conclusion. DM in post-MI patients was more often associated with reduced renal function and the presence of CHF, as well as a history of exertional angina. In addition, patients with DM were more likely to be obese, although in general, the average weight of patients with and without DM, as well as the average age, were comparable. The data obtained may indicate a significant negative impact of DM on the condition and prognosis of patients who have undergone MI, which underlines the feasibility of a multifactorial combined approach in
{"title":"Features of the course and complications of acute myocardial infarction in type 2 diabetes mellitus","authors":"M. N. Zatsepina, F. Ushanova, T. L. Bogacheva","doi":"10.15829/1560-4071-2023-25","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-25","url":null,"abstract":"Aim. To study the effect of type 2 diabetes mellitus (DM) on the clinical and anamnestic and laboratory and instrumental characteristics of patients with acute myocardial infarction (MI).Material and methods. 102 patients with MI (41 women and 61 men) were examined. 2 groups were formed: the main group — patients with MI and DM2 (n=66) (group 1), the control group — patients with MI without DM (n=36) (group 2). A comparative analysis of laboratory data, concomitant diseases, complications of myocardial infarction in groups was performed. Statistical data processing was performed using the Excel package (Microsoft), Statistica 10 program (Statsoft Inc).Results. The mean age of the general group was 68 [43;96] years, patients with DM2 68,5 [43;88] years, patients without DM 67,5 [47;96] years. The average duration of MI in the general group was 13,5 [1;48] years, among patients with DM — 23 [1;48] years, without DM — 8 [1;34] years. DM in patients was statistically significantly correlated with a history of exertional angina (Kramer’s V coefficient 0,272, p=0,005). At the same time, there was no significant relationship between DM and previous revascularization interventions, such as a history of stenting (p=0,088), coronary artery bypass grafting (CABG) (p=0,291), as well as with stroke (p=0,09). Mean body mass index (BMI) values are found in lesions and without DM — 29,7 [19,5;46,9] kg/m2 and 27,3 [21,3;41,5] kg/m2, respectively. An analysis of the frequency of determining CKD (eGFR level <60 ml/min/1,73 m2) in groups revealed that in patients with type 2 DM, CKD of high severity was detected in 59% of cases, and in the group without DM this indicator was detected in 53%. Mean eGFR in the DM group was lower than in group 2: 54,5 [24;95] ml/min/1,73 m2 versus 58 [21;117] ml/min/1,73 m2, but the difference was not statistically detected (p>0,05). DM necessarily correlated with the presence of CHF in patients (Cramer’s V coefficient 0,243, p=0,02). In the DM group, low ejection fraction was detected significantly more often according to echocardiography: 58% (n=11) in group 1 versus 42% (n=8) in group 2 (p=0,011). A statistically significant relationship was found between the presence of DM in patients and pulmonary hypertension according to echocardiography (Cramer’s V coefficient 0,3, p=0.003). And in a comparative analysis of lipid profile indicators, there was no statistically significant difference in the groups.Conclusion. DM in post-MI patients was more often associated with reduced renal function and the presence of CHF, as well as a history of exertional angina. In addition, patients with DM were more likely to be obese, although in general, the average weight of patients with and without DM, as well as the average age, were comparable. The data obtained may indicate a significant negative impact of DM on the condition and prognosis of patients who have undergone MI, which underlines the feasibility of a multifactorial combined approach in ","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124755490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/1560-4071-2023-16
M. Y. Izmailova, K. M. Belova, S. V. Torosyan
Thyroid dysfunction, both in terms of the type of hypothyroidism and hyperthyroidism, illustrates the diversity of the clinical picture, which mimics various diseases from almost all systems and, therefore, timely diagnosis of thyroid diseases can often be difficult. This paper describes a clinical case of HD with the development of a thyrotoxic crisis. Late diagnosis led to the development of such a severe complication associated with high mortality.
{"title":"A clinical case of severe Graves’ disease","authors":"M. Y. Izmailova, K. M. Belova, S. V. Torosyan","doi":"10.15829/1560-4071-2023-16","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-16","url":null,"abstract":"Thyroid dysfunction, both in terms of the type of hypothyroidism and hyperthyroidism, illustrates the diversity of the clinical picture, which mimics various diseases from almost all systems and, therefore, timely diagnosis of thyroid diseases can often be difficult. This paper describes a clinical case of HD with the development of a thyrotoxic crisis. Late diagnosis led to the development of such a severe complication associated with high mortality.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133443215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.15829/2713-0177-2023-7
E. Bibik, E. Dobreva, A. Eremkina, N. Mokrysheva
Primary hyperparathyroidism (PHPT) is characterized by disorders of not only mineral metabolism, but also other kinds of the human metabolism. Due to the increased frequency of cardiovascular risk factors among patients with PHPT, the study of the carbohydrate metabolism pathology in this cohort of patients will allow developing optimal approaches to their timely diagnosis and treatment.Aim. To determine the frequency and describe the clinical features of carbohydrate metabolism disorders in patients with PHPT.Material and methods. A single-center retrospective study of adults with PHPT was carried out with an assessment of the main parameters of mineral and carbohydrate metabolism before surgical treatment of the disease. The exclusion criteria were the absence of PHPT remission or a recurrence of the disease after parathyroidectomy; pregnancy, lactation. The frequency of various disorders of carbohydrate metabolism in PHPT, the comparative characteristics of mineral parameters in patients with and without them, as well as the severity of type 2 diabetes mellitus in PHPT were determined. In addition, potential relationships between the parameters of various types of metabolism have been studied.Results. The study was based on a clinical information of 367 patients with PHPT, most of whom had a symptomatic form of the disease. The overall incidence of prediabetic disorders was 4,9% (95% CI: 3-8). Type 2 diabetes mellitus was previously diagnosed in 45 patients (12%, 95% CI: 9-16), there were no cases of first diagnosed diabetes mellitus. Individuals with impaired carbohydrate metabolism had a statistically significantly higher body mass index and lower values of osteocalcin (27,2 [24,2; 30,4] kg/m2 vs 32,7 [28,1; 39,4 kg/m2 and 48,1 [34; 76,3] ng/mL vs 33,1 [20,8; 51,8] ng/mL, respectively, for all parameters p<0,001). Among patients with type 2 diabetes mellitus, 36 people (80%) took hypoglycemic therapy, 14 of which received metformin monotherapy and 8 received two-component therapy, including metformin. 5 people were on insulin therapy. Diabetic nephropathy was diagnosed in 36,4% of patients, 15,4% had signs of diabetic retinopathy, symptoms of diabetic distal neuropathy were observed in 61,9% of patients with PHPT. Fasting glucose and glycated hemoglobin were negatively correlated with bone metabolism, and also expectedly depended on the glomerular filtration rate.Conclusion. Among patients with PHPT, type 2 diabetes mellitus is more common than in the general population. The likely reason of this may be insulin resistance, that can be caused by the effects of bone metabolites, primarily osteocalcin. In most cases, metformin makes it possible to achieve compensation for diabetes mellitus in PHPT.
{"title":"Pathology of carbohydrate metabolism in primary hyperparathyroidism: epidemiological and clinical characteristics","authors":"E. Bibik, E. Dobreva, A. Eremkina, N. Mokrysheva","doi":"10.15829/2713-0177-2023-7","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-7","url":null,"abstract":"Primary hyperparathyroidism (PHPT) is characterized by disorders of not only mineral metabolism, but also other kinds of the human metabolism. Due to the increased frequency of cardiovascular risk factors among patients with PHPT, the study of the carbohydrate metabolism pathology in this cohort of patients will allow developing optimal approaches to their timely diagnosis and treatment.Aim. To determine the frequency and describe the clinical features of carbohydrate metabolism disorders in patients with PHPT.Material and methods. A single-center retrospective study of adults with PHPT was carried out with an assessment of the main parameters of mineral and carbohydrate metabolism before surgical treatment of the disease. The exclusion criteria were the absence of PHPT remission or a recurrence of the disease after parathyroidectomy; pregnancy, lactation. The frequency of various disorders of carbohydrate metabolism in PHPT, the comparative characteristics of mineral parameters in patients with and without them, as well as the severity of type 2 diabetes mellitus in PHPT were determined. In addition, potential relationships between the parameters of various types of metabolism have been studied.Results. The study was based on a clinical information of 367 patients with PHPT, most of whom had a symptomatic form of the disease. The overall incidence of prediabetic disorders was 4,9% (95% CI: 3-8). Type 2 diabetes mellitus was previously diagnosed in 45 patients (12%, 95% CI: 9-16), there were no cases of first diagnosed diabetes mellitus. Individuals with impaired carbohydrate metabolism had a statistically significantly higher body mass index and lower values of osteocalcin (27,2 [24,2; 30,4] kg/m2 vs 32,7 [28,1; 39,4 kg/m2 and 48,1 [34; 76,3] ng/mL vs 33,1 [20,8; 51,8] ng/mL, respectively, for all parameters p<0,001). Among patients with type 2 diabetes mellitus, 36 people (80%) took hypoglycemic therapy, 14 of which received metformin monotherapy and 8 received two-component therapy, including metformin. 5 people were on insulin therapy. Diabetic nephropathy was diagnosed in 36,4% of patients, 15,4% had signs of diabetic retinopathy, symptoms of diabetic distal neuropathy were observed in 61,9% of patients with PHPT. Fasting glucose and glycated hemoglobin were negatively correlated with bone metabolism, and also expectedly depended on the glomerular filtration rate.Conclusion. Among patients with PHPT, type 2 diabetes mellitus is more common than in the general population. The likely reason of this may be insulin resistance, that can be caused by the effects of bone metabolites, primarily osteocalcin. In most cases, metformin makes it possible to achieve compensation for diabetes mellitus in PHPT.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131910255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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