Pub Date : 2023-05-10DOI: 10.15829/1560-4071-2023-13
E. V. Kiseleva, E. Pigarova, N. Mokrysheva
Obesity is currently an important medical and social problem due to the multiple associated conditions that worsen the health of the population. Thus, there is a need for the development of accurate and non-invasive methods of body composition assessment for the purposes of diagnosing and monitoring the treatment of this disease. According to the estimates of the World Obesity Federation, by 2025 the prevalence of this disease will reach 21% in women, and 18% in men. This literature review is dedicated to the subject of various methods for assessing the degree of obesity, as well as determining the composition of the body in the context of historical achievements and a critical assessment of new technologies.
{"title":"The evolution of body composition assessment: from body mass index to body composition profiling","authors":"E. V. Kiseleva, E. Pigarova, N. Mokrysheva","doi":"10.15829/1560-4071-2023-13","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-13","url":null,"abstract":"Obesity is currently an important medical and social problem due to the multiple associated conditions that worsen the health of the population. Thus, there is a need for the development of accurate and non-invasive methods of body composition assessment for the purposes of diagnosing and monitoring the treatment of this disease. According to the estimates of the World Obesity Federation, by 2025 the prevalence of this disease will reach 21% in women, and 18% in men. This literature review is dedicated to the subject of various methods for assessing the degree of obesity, as well as determining the composition of the body in the context of historical achievements and a critical assessment of new technologies.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"27 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":"133453721","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: 10.15829/2713-0177-2023-27
E. V. Kovaleva, A. K. Eremkina, N. Mokrysheva
Hypoparathyroidism is a relatively rare endocrine disorder caused by the absence production of parathyroid hormone, leading to the classical biochemical features such as hypocalcaemia and hyperphosphataemia.The data from Europe, the USA and Asian countries shows that the long course of chronic postsurgical and non-surgical hypoparathyroidism can lead to many complications from different organs and systems. Hypoparathyroidism increases the risk of kidney disease, including kidney failure, neuropsychiatric disorders and infections. The frequency and degree of disease complications depend on its etiology. Non-surgical hypoparathyroidism is associated with an increased risks of cataracts, cardiovascular diseases and vertebral fractures; however, the pathogenesis of these disorders is not fully understood. Various parameters of mineral homeostasis were discussed in the context of identified complications. For example, persistent hypercalciuria and intake of large doses of calcium and vitamin D supplements were associated with the structural pathology of the kidneys (nephrolithiasis, nephrocalcinosis).This review covers the issue of the clinical manifestations and complications of chronic hypoparathyroidism, as well as predictors of their development.
{"title":"Chronic hypoparathyroidism: clinical manifestations, complications and impact on the quality of life","authors":"E. V. Kovaleva, A. K. Eremkina, N. Mokrysheva","doi":"10.15829/2713-0177-2023-27","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-27","url":null,"abstract":"Hypoparathyroidism is a relatively rare endocrine disorder caused by the absence production of parathyroid hormone, leading to the classical biochemical features such as hypocalcaemia and hyperphosphataemia.The data from Europe, the USA and Asian countries shows that the long course of chronic postsurgical and non-surgical hypoparathyroidism can lead to many complications from different organs and systems. Hypoparathyroidism increases the risk of kidney disease, including kidney failure, neuropsychiatric disorders and infections. The frequency and degree of disease complications depend on its etiology. Non-surgical hypoparathyroidism is associated with an increased risks of cataracts, cardiovascular diseases and vertebral fractures; however, the pathogenesis of these disorders is not fully understood. Various parameters of mineral homeostasis were discussed in the context of identified complications. For example, persistent hypercalciuria and intake of large doses of calcium and vitamin D supplements were associated with the structural pathology of the kidneys (nephrolithiasis, nephrocalcinosis).This review covers the issue of the clinical manifestations and complications of chronic hypoparathyroidism, as well as predictors of their development.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"55 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":"127695276","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: 10.15829/1560-4071-2023-15
T. Demidova, A. Kochina
The management of diabetes in the elderly requires careful consideration of concomitant geriatric syndromes and chronic diseases that increase the risk of complications, including severe hypoglycemia. An individualized approach to the treatment of elderly patients includes the establishment of less strict goals of glycemic control, blood pressure control, taking into account impaired self-care abilities, cognitive abilities and loss of vision. The goals of diabetes treatment in the elderly are considered to maintain the quality of life and minimize symptomatic hyperglycemia, the risk of hypoglycemia and side effects of medications. In this regard, the concept of deprescribing in the treatment of elderly patients is gaining more and more popularity.
{"title":"Pecularities of treatment of elderly patients with type 2 diabetes mellitus","authors":"T. Demidova, A. Kochina","doi":"10.15829/1560-4071-2023-15","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-15","url":null,"abstract":"The management of diabetes in the elderly requires careful consideration of concomitant geriatric syndromes and chronic diseases that increase the risk of complications, including severe hypoglycemia. An individualized approach to the treatment of elderly patients includes the establishment of less strict goals of glycemic control, blood pressure control, taking into account impaired self-care abilities, cognitive abilities and loss of vision. The goals of diabetes treatment in the elderly are considered to maintain the quality of life and minimize symptomatic hyperglycemia, the risk of hypoglycemia and side effects of medications. In this regard, the concept of deprescribing in the treatment of elderly patients is gaining more and more popularity.","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":"125279881","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: 10.15829/1560-4071-2023-21
N. Pervyshin, E. Lebedeva, S. Bulgakova, R. A. Galkin
Aim. To develop an applied clinical calculator for the prognosis of rapid progression of CKD in patients with type 2 diabetes, which allows to identify a group of patients at risk of a high rate of decrease in GFR of diabetes in outpatient admission, to assess its informativeness, resolution and diagnostic significance.Material and methods. A single-stage cross-observational study of clinical status indicators was performed in a population sample of patients with type 2 diabetes. Primary medical data were collected using the AWPE 2.0 program; 150 protocols of outpatient consultations, including 69 clinical indicators, were selected according to the compliance criteria. Based on the results of a comprehensive analysis of the relationship between the indicators of clinical status and the stages of development of CKD in type 2 diabetes, the most significant factors of progression of diabetic kidney damage are identified; the original diagnostic parameter "GFR reduction Index" is proposed and clinically justified, which allows to give an objective quantitative characteristic of the dynamics of the pathological process; the measure of the influence of diagnostically significant predictors on the rate of GFR reduction is determined by regression analysis; a logistic model is constructed, on the basis of which a prognostic calculator for rapid progression of CKD is developed.Results. Quantitative assessment of the contribution of individual clinical indicators to the rate of progression of CKD allowed us to identify the following significant factors: duration of diabetes and insulin therapy, acute myocardial infarction in history, age, BMI, concomitant retinopathy, pulsation on the popliteal artery, risk group IV hypertension, treatment with sulfonylureas (without differentiated assessment by pharmacological groups), calcium antagonists; when evaluating the informativeness and predictive ability of the calculator, the area under the AUC ROC curve was 0,90 (0,82; 0,98), p<0,001, which characterizes the quality of the diagnostic technique as very high.Conclusion. The original diagnostic parameter "Glomerular filtration Rate reduction Index" allows us to get a more detailed and accurate idea of the patterns of progression of CKD in DM, the applied clinical calculator of rapid progression of CKD allows us to identify a group of patients at risk of a high rate of GFR reduction, with a high level of diagnostic significance in outpatient settings.
{"title":"Clinical calculator for the prognosis of rapid progression of chronic kidney disease in patients with type 2 diabetes mellitus","authors":"N. Pervyshin, E. Lebedeva, S. Bulgakova, R. A. Galkin","doi":"10.15829/1560-4071-2023-21","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-21","url":null,"abstract":"Aim. To develop an applied clinical calculator for the prognosis of rapid progression of CKD in patients with type 2 diabetes, which allows to identify a group of patients at risk of a high rate of decrease in GFR of diabetes in outpatient admission, to assess its informativeness, resolution and diagnostic significance.Material and methods. A single-stage cross-observational study of clinical status indicators was performed in a population sample of patients with type 2 diabetes. Primary medical data were collected using the AWPE 2.0 program; 150 protocols of outpatient consultations, including 69 clinical indicators, were selected according to the compliance criteria. Based on the results of a comprehensive analysis of the relationship between the indicators of clinical status and the stages of development of CKD in type 2 diabetes, the most significant factors of progression of diabetic kidney damage are identified; the original diagnostic parameter \"GFR reduction Index\" is proposed and clinically justified, which allows to give an objective quantitative characteristic of the dynamics of the pathological process; the measure of the influence of diagnostically significant predictors on the rate of GFR reduction is determined by regression analysis; a logistic model is constructed, on the basis of which a prognostic calculator for rapid progression of CKD is developed.Results. Quantitative assessment of the contribution of individual clinical indicators to the rate of progression of CKD allowed us to identify the following significant factors: duration of diabetes and insulin therapy, acute myocardial infarction in history, age, BMI, concomitant retinopathy, pulsation on the popliteal artery, risk group IV hypertension, treatment with sulfonylureas (without differentiated assessment by pharmacological groups), calcium antagonists; when evaluating the informativeness and predictive ability of the calculator, the area under the AUC ROC curve was 0,90 (0,82; 0,98), p<0,001, which characterizes the quality of the diagnostic technique as very high.Conclusion. The original diagnostic parameter \"Glomerular filtration Rate reduction Index\" allows us to get a more detailed and accurate idea of the patterns of progression of CKD in DM, the applied clinical calculator of rapid progression of CKD allows us to identify a group of patients at risk of a high rate of GFR reduction, with a high level of diagnostic significance in outpatient settings.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"1 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":"129591270","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: 10.15829/2713-0177-2023-11
M. V. Yaroslavtseva, Y. A. El-Taravi, O. Bondarenko, A. Povaliaeva, E. Pigarova
Patients with multiple complications of diabetes mellitus often have significant deviations in the parameters of calcium-phosphorus and bone metabolism. The multifactorial nature of the pathogenesis of such disorders makes it difficult to manage patients with a long and complicated course of diabetes mellitus. This article describes a clinical case of a patient with a long history of type 1 diabetes mellitus, kidney transplantation as a result of terminal renal failure, and diabetic neuroosteoarthropathy. The features of vitamin D metabolism, the importance of timely diagnosis of phosphorus-calcium disorders and the features of patient therapy are discussed.
{"title":"Vitamin D metabolism in patient with type 1 diabetes, chronic kidney disease, and charcot foot: a case report","authors":"M. V. Yaroslavtseva, Y. A. El-Taravi, O. Bondarenko, A. Povaliaeva, E. Pigarova","doi":"10.15829/2713-0177-2023-11","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-11","url":null,"abstract":"Patients with multiple complications of diabetes mellitus often have significant deviations in the parameters of calcium-phosphorus and bone metabolism. The multifactorial nature of the pathogenesis of such disorders makes it difficult to manage patients with a long and complicated course of diabetes mellitus. This article describes a clinical case of a patient with a long history of type 1 diabetes mellitus, kidney transplantation as a result of terminal renal failure, and diabetic neuroosteoarthropathy. The features of vitamin D metabolism, the importance of timely diagnosis of phosphorus-calcium disorders and the features of patient therapy are discussed.","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":"116572051","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: 10.15829/1560-4071-2023-26
V. S. Mozgunova, G. V. Semikova, A. Volkova, E. N. Ostroukhova, B. G. Lukichev
Type 2 diabetes mellitus and obesity are two socially significant diseases, the prevalence of which has now assumed pandemic proportions. Obesity, as a rule, precedes the development of type 2 diabetes, being the most powerful risk factor for the development of this disease. In patients with obesity and type 2 diabetes with a BMI >35 kg/m2, bariatric surgery is recommended if glycemic control cannot be achieved after several attempts at non-surgical treatment of obesity. There is no doubt the effectiveness of bariatric surgery not only in the treatment of obesity, but also in achieving remission of type 2 diabetes. It seems relevant to study the predictors of achieving remission of type 2 diabetes, as well as factors that can worsen the prognosis. The purpose of the review: to study the effectiveness of metabolic surgery in achieving remission of type 2 DM, as well as predictors of remission of type 2 DM in obese patients after bariatric surgery.
{"title":"Role of metabolic surgery in remission of type 2 diabetes mellitus in patients with obesity","authors":"V. S. Mozgunova, G. V. Semikova, A. Volkova, E. N. Ostroukhova, B. G. Lukichev","doi":"10.15829/1560-4071-2023-26","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-26","url":null,"abstract":"Type 2 diabetes mellitus and obesity are two socially significant diseases, the prevalence of which has now assumed pandemic proportions. Obesity, as a rule, precedes the development of type 2 diabetes, being the most powerful risk factor for the development of this disease. In patients with obesity and type 2 diabetes with a BMI >35 kg/m2, bariatric surgery is recommended if glycemic control cannot be achieved after several attempts at non-surgical treatment of obesity. There is no doubt the effectiveness of bariatric surgery not only in the treatment of obesity, but also in achieving remission of type 2 diabetes. It seems relevant to study the predictors of achieving remission of type 2 diabetes, as well as factors that can worsen the prognosis. The purpose of the review: to study the effectiveness of metabolic surgery in achieving remission of type 2 DM, as well as predictors of remission of type 2 DM in obese patients after bariatric surgery.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"374 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":"132775044","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: 10.15829/2713-0177-2023-17
T. Demidova, D. Skuridina, E. S. Pervushina
All over the world, the number of patients suffering from type 2 diabetes mellitus, non-alcoholic fatty liver disease and cardiovascular diseases is increasing every day. At the same time, they not only coexist as independent diseases, but also have many points of intersection in pathogenesis and progression, such as dyslipidemia, prothrombotic processes, insulin resistance and hyperglycemia, chronic subclinical inflammation. Thus, they make each other’s course heavier and increase the number of adverse outcomes, including general and cardiovascular mortality. All this is an incentive for a more detailed study of the complex relationship of these diseases, in order to optimize diagnostics and treatment. Due to the urgency of this issue, the effect of most of the currently existing hypoglycemic drugs on non-alcoholic fatty liver disease and cardiovascular diseases has already been reflected in many studies and meta-analyses. This review will cover the main groups of drugs, namely biguanides, thiazolidinediones, sodium-glucose cotransporter type 2 inhibitors, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists. The use of which is approved in comorbid patients according to these conditions pathogenesis.
{"title":"Type 2 diabetes mellitus, non-alcoholic fatty liver disease and cardiovascular disease: causal relationships and the role of anti-diabetic drugs","authors":"T. Demidova, D. Skuridina, E. S. Pervushina","doi":"10.15829/2713-0177-2023-17","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-17","url":null,"abstract":"All over the world, the number of patients suffering from type 2 diabetes mellitus, non-alcoholic fatty liver disease and cardiovascular diseases is increasing every day. At the same time, they not only coexist as independent diseases, but also have many points of intersection in pathogenesis and progression, such as dyslipidemia, prothrombotic processes, insulin resistance and hyperglycemia, chronic subclinical inflammation. Thus, they make each other’s course heavier and increase the number of adverse outcomes, including general and cardiovascular mortality. All this is an incentive for a more detailed study of the complex relationship of these diseases, in order to optimize diagnostics and treatment. Due to the urgency of this issue, the effect of most of the currently existing hypoglycemic drugs on non-alcoholic fatty liver disease and cardiovascular diseases has already been reflected in many studies and meta-analyses. This review will cover the main groups of drugs, namely biguanides, thiazolidinediones, sodium-glucose cotransporter type 2 inhibitors, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists. The use of which is approved in comorbid patients according to these conditions pathogenesis.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"50 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":"127375973","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: 10.15829/1560-4071-2023-24
T. Demidova, V. M. Plakhotnyaya
It’s well known, that diabetes mellitus predisposes to more rapid development and progression of cardiovascular disease (CVD) and cardiomyopathy. However, the pathological changes underlying them begin to form much earlier — at the stage of prediabetes. Individuals with prediabetes have a higher risk of atherosclerosis and chronic heart failure, as well as increased rates of mortality from CVD and all-cause death. This review is devoted to the analysis of pathophysiological mechanisms that lead to developing CVD in patients with early prediabetes. In addition, the article highlights the issues of preventing the development of cardiovascular pathology in this group of patients with an emphasis on the active impact on the main factors of cardiovascular risk.
{"title":"Prediabetes: a risk factor for cardiovascular diseases and a window of opportunity for their prevention","authors":"T. Demidova, V. M. Plakhotnyaya","doi":"10.15829/1560-4071-2023-24","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-24","url":null,"abstract":"It’s well known, that diabetes mellitus predisposes to more rapid development and progression of cardiovascular disease (CVD) and cardiomyopathy. However, the pathological changes underlying them begin to form much earlier — at the stage of prediabetes. Individuals with prediabetes have a higher risk of atherosclerosis and chronic heart failure, as well as increased rates of mortality from CVD and all-cause death. This review is devoted to the analysis of pathophysiological mechanisms that lead to developing CVD in patients with early prediabetes. In addition, the article highlights the issues of preventing the development of cardiovascular pathology in this group of patients with an emphasis on the active impact on the main factors of cardiovascular risk.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"1 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":"128267750","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: 10.15829/2713-0177-2023-20
F. Ushanova, T. Demidova, T. N. Korotkova
Adrenal insufficiency (AI) is a life-threatening disease characterized by a decrease in the production of hormones by the adrenal cortex and requires lifelong replacement therapy with glucocorticoids (GCs) and, in some cases, mineralocorticoids (MCs). The number of individuals with primary and secondary AI in Europe is estimated at 20-50 per 100 thousand people, the increase in the number of cases of this disease in the world may be partly due to the rapid increase in the frequency of use of GC in various clinical strategies, including in oncological diseases.In AI, hormone replacement therapy is vital, but long-term use of GC may be associated with various adverse effects, especially at non-physiological concentrations of GC. This review provides a brief overview of the current therapeutic possibilities of AI hormone therapy, which contributes to the prevention of the development of adrenal crises, as well as promising opportunities for more effective imitation of the physiological profile of cortisol, aimed at preventing the development of undesirable effects of therapy. Several different forms of AI are currently available, differing in profile, duration of action, and route of administration. The most preferred currently in the treatment of AI are GCs with a short half-life, which provides a more manageable action profile and a lower risk of side effects. Promising substitution therapy options include modified-release hydrocortisone preparations, as well as new methods of drug administration using an insulin pump, which will better mimic the physiological effects of endogenous cortisol.
{"title":"Modern possibilities and prospects in the treatment of adrenal insufficiency","authors":"F. Ushanova, T. Demidova, T. N. Korotkova","doi":"10.15829/2713-0177-2023-20","DOIUrl":"https://doi.org/10.15829/2713-0177-2023-20","url":null,"abstract":"Adrenal insufficiency (AI) is a life-threatening disease characterized by a decrease in the production of hormones by the adrenal cortex and requires lifelong replacement therapy with glucocorticoids (GCs) and, in some cases, mineralocorticoids (MCs). The number of individuals with primary and secondary AI in Europe is estimated at 20-50 per 100 thousand people, the increase in the number of cases of this disease in the world may be partly due to the rapid increase in the frequency of use of GC in various clinical strategies, including in oncological diseases.In AI, hormone replacement therapy is vital, but long-term use of GC may be associated with various adverse effects, especially at non-physiological concentrations of GC. This review provides a brief overview of the current therapeutic possibilities of AI hormone therapy, which contributes to the prevention of the development of adrenal crises, as well as promising opportunities for more effective imitation of the physiological profile of cortisol, aimed at preventing the development of undesirable effects of therapy. Several different forms of AI are currently available, differing in profile, duration of action, and route of administration. The most preferred currently in the treatment of AI are GCs with a short half-life, which provides a more manageable action profile and a lower risk of side effects. Promising substitution therapy options include modified-release hydrocortisone preparations, as well as new methods of drug administration using an insulin pump, which will better mimic the physiological effects of endogenous cortisol.","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":"132431450","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: 10.15829/1560-4071-2023-14
S. Dora, O. Dygun, E. N. Ostroukhova, M. B. Gudieva, A. Volkova
Postoperative hypothyroidism is a consequence of thyroidectomy. However, observation of patients with diffuse toxic goiter (DTG) after thyroidectomy shows that achieving euthyroidism while taking L-thyroxine, as well as maintaining weight in some cases, is difficult or not possible at all. Thus, the study of thyroid function and body weight dynamics in the first year after thyroidectomy remains an urgent task of clinical thyroidology.Aim. To study thyroid function and body weight dynamics in patients with DTG after various types of surgical treatment.Material and methods. The study included 310 patients with DTG (234 women — 75,5% and 76 men — 24,5%), the average age was 46,46±0,99 years. In all patients with DTG before surgery, after 1 month and 1 year after the operation, the results of hormonal examination (levels of thyroid-stimulating hormone (TSH), free T4), body weight dynamics were evaluated. Levels of TSH and free T4 was determined by enzyme immunoassay. To assess the dynamics of body weight one year after the operation, depending on the change in weight, the patients were divided into 3 groups: group 1 — body weight decreased by more than 5%; group 2 — body weight did not change; group 3 — body weight increased by more than 5%. Statistical analysis of the study results was performed using the SPSS 16.0 program (SPSS Inc., USA).Results. Before surgical treatment, blood TSH levels were normal in all patients, and there were no differences between the groups (p=0,94). In patients after subtotal resection, the average level of TSH in the blood after 1 month. after surgery was significantly higher (p=0,02) than in patients who underwent extirpation of the thyroid gland (TG). Blood TSH was monitored in all patients 1 year after surgery. In patients with thyroid extirpation, the level of TSH in the blood was significantly higher compared to patients who underwent organ-preserving surgery (p=0,01).Next, the body mass index (BMI) was analyzed in the examined groups of patients. When analyzing the BMI of patients before and after surgery, there were no significant differences in both groups: group 1 — before surgery BMI 25,67±0,57 kg/m2, after surgery 25,87±0,60 kg/m2; group 2 — before surgery BMI 25,13±0,40 kg/m2, after surgery 25,67±0,46 kg/m2. In group 1, there was a decrease in weight after surgery during the first year in 14,9% of patients, while in group 2 only in 7,2% of patients (p=0,01). Weight gain was high in both groups: in group 1 — 20,7%, in group 2 — 29,0%, but in the group after thyroidectomy was significantly higher (p=0,04). In patients with weight gain, a positive correlation was found between weight gain during the year and blood TSH 1 year after surgery (p=0,02, r=0,247).Conclusion. The obtained results suggest that after thyroidectomy performed for DTG, patients have a significantly greater increase in BMI and uncompensated hypothyroidism is more common than in patients after subtotal resection of the thyroid gland.
{"title":"Postoperative hypothyroidism and body weight dynamics in patients operated on for diffuse toxic goiter","authors":"S. Dora, O. Dygun, E. N. Ostroukhova, M. B. Gudieva, A. Volkova","doi":"10.15829/1560-4071-2023-14","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-14","url":null,"abstract":"Postoperative hypothyroidism is a consequence of thyroidectomy. However, observation of patients with diffuse toxic goiter (DTG) after thyroidectomy shows that achieving euthyroidism while taking L-thyroxine, as well as maintaining weight in some cases, is difficult or not possible at all. Thus, the study of thyroid function and body weight dynamics in the first year after thyroidectomy remains an urgent task of clinical thyroidology.Aim. To study thyroid function and body weight dynamics in patients with DTG after various types of surgical treatment.Material and methods. The study included 310 patients with DTG (234 women — 75,5% and 76 men — 24,5%), the average age was 46,46±0,99 years. In all patients with DTG before surgery, after 1 month and 1 year after the operation, the results of hormonal examination (levels of thyroid-stimulating hormone (TSH), free T4), body weight dynamics were evaluated. Levels of TSH and free T4 was determined by enzyme immunoassay. To assess the dynamics of body weight one year after the operation, depending on the change in weight, the patients were divided into 3 groups: group 1 — body weight decreased by more than 5%; group 2 — body weight did not change; group 3 — body weight increased by more than 5%. Statistical analysis of the study results was performed using the SPSS 16.0 program (SPSS Inc., USA).Results. Before surgical treatment, blood TSH levels were normal in all patients, and there were no differences between the groups (p=0,94). In patients after subtotal resection, the average level of TSH in the blood after 1 month. after surgery was significantly higher (p=0,02) than in patients who underwent extirpation of the thyroid gland (TG). Blood TSH was monitored in all patients 1 year after surgery. In patients with thyroid extirpation, the level of TSH in the blood was significantly higher compared to patients who underwent organ-preserving surgery (p=0,01).Next, the body mass index (BMI) was analyzed in the examined groups of patients. When analyzing the BMI of patients before and after surgery, there were no significant differences in both groups: group 1 — before surgery BMI 25,67±0,57 kg/m2, after surgery 25,87±0,60 kg/m2; group 2 — before surgery BMI 25,13±0,40 kg/m2, after surgery 25,67±0,46 kg/m2. In group 1, there was a decrease in weight after surgery during the first year in 14,9% of patients, while in group 2 only in 7,2% of patients (p=0,01). Weight gain was high in both groups: in group 1 — 20,7%, in group 2 — 29,0%, but in the group after thyroidectomy was significantly higher (p=0,04). In patients with weight gain, a positive correlation was found between weight gain during the year and blood TSH 1 year after surgery (p=0,02, r=0,247).Conclusion. The obtained results suggest that after thyroidectomy performed for DTG, patients have a significantly greater increase in BMI and uncompensated hypothyroidism is more common than in patients after subtotal resection of the thyroid gland.","PeriodicalId":274852,"journal":{"name":"FOCUS. Endocrinology","volume":"1 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":"128880501","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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