problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl10246problendo-10246Research ArticleКлиническая эндокринологияClinical endocrinologyОсобенности клинических проявлений и диагностики вторичной надпочечниковой недостаточности после комплексного лечения внегипофизарных опухолейClinical features and diagnosis of secondary adrenal insufficiency followed complex treatment nonpituitary brain tumorshttps://orcid.org/0000-0002-4704-8453ЮдинаАлла ЕвгеньевнаYudinaAlla E.

Аспирант, врач-эндокринолог, кафедра эндокринологии

Postgraduate student, M.D. Chair of endocrinology

alla1301@yandex.ruhttps://orcid.org/0000-0001-6073-328XПавловаМария ГеннадиевнаPavlovaMaria G.

К.м.н., врач-эндокринолог, кафедра эндокринологии

Ph.D., M.D.endocrinologist, Chair of endocrinology

mgpavlova68@rambler.ruhttps://orcid.org/0000-0003-0498-314XСотниковВладимир МихайловичSotnikovVladimir M.

доктор медицинских наук, профессор, ведущий научный сотрудник, заведующий отделением лучевых и комбинированных методов лечения

MD, PhD, Professor, Leading Researcher, Head of the X-ray and combined therapy methods department

vmsotnikov@mail.ruhttps://orcid.org/0000-0002-4704-8453ЮдинаАлла ЕвгеньевнаYudinaAlla E.

Аспирант, врач-эндокринолог, кафедра эндокринологии

Postgraduate student, M.D. Chair of endocrinology

alla1301@yandex.ruhttps://orcid.org/0000-0002-7000-0095СычЮлия ПетровнаSychYulia P.

к.м.н.

MD, PhD

juliasytch@mail.ruhttps://orcid.org/0000-0002-0428-0498МазеркинаНадежда АлександровнаMazerkinaNadezhda A.

Д.м.н., врач-эндокринолог

P.h.d., M.D.endocrinologist

nmazer@nsi.ruhttps://orcid.org/0000-0002-8607-3635ЖелудковаОльга ГригорьевнаZheludkovaOlga G.

Д.м.н., врач-онколог

PhD, MD, oncologist

clelud@mail.ruhttps://orcid.org/0000-0001-8535-8535ТеряеваНадежда БорисовнаTeryaevaNadezhda B.

к.м.н. ст.науч.сотрудник

Phd

nteryaeva@nsi.ruhttps://orcid.org/0000-0003-4549-7172ГерасимовАндрей НиколаевичGerasimovAndrey N.

Д.ф-м.н., заведующий кафедрой медицинской информатики и статистики

PhD, DSc., Head of the department of Medical Statistics and Informatics

andr-gerasim@yandex.ruhttps://orcid.org/0000-0002-0681-4772МартыноваЕвгения ЮрьеванаMartynovaEvgeniya

врач-эндокринолог

MD

doctor.martynova@gmail.comhttps://orcid.org/0000-0001-7879-8495КимЕкатерина ИгоревнаKimEkaterina I.

студентка лечебного факультета

medical student

kat-alex2007@mail.ruhttps://orcid.org/0000-0003-4974-7765БерковскаяМарина АроновнаBerkovskayaMarina A.abaitamar@gmail.comПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationРоссийский научный центррентгенорадиологииРоссияRussian Scientific Center of Roentgeno-RadiologyRussian FederationНациональный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. БурденкоРоссияN.N. Burdenko National Scientific and Practical Center for NeurosurgeryRussian FederationРоссийский научный центр рентгенрадиологииРоссияRussian Scientific Center of RoentgenoradiologyRussian Federation201923112019655330340Copyright © Юдина А.Е., Павлова М.Г., Сотников В.М., Юдина А.Е., Сыч Ю.П., Мазеркина Н.А., Желудкова О.Г., Теряева Н.Б., Герасимов А.Н., Мартынова Е.Ю., Ким Е.И., Берковская М.А., 20192019Юдина А.Е., Павлова М.Г., Сотников В.М., Юдина А.Е., Сыч Ю.П., Мазеркина Н.А., Желудкова О.Г., Теряева Н.Б., Герасимов А.Н., Мартынова Е.Ю., Ким Е.И., Берковская М.А.Yudina A.E., Pavlova M.G., Sotnikov V.M., Yudina A.E., Sych Y.P., Mazerkina N.A., Zheludkova O.G., Teryaeva N.B., Gerasimov A.N., Martynova E., Kim E.I., Berkovskaya M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/10246Обоснование

Обоснование. Большинство проведенных на сегодняшний день исследований включает группы пациентов, различные по этиологии вторичной надпочечниковой недостаточности (ВНН), либо рассматривает ВНН в общей структуре отдаленных последствий лучевой терапии.

Цель

Цель: описать клинические проявления и особенности диагностики ВНН у взрослых пациентов, перенёсших комплексное лечение внегипофизарных опухолей головного мозга в детском возрасте.

Методы

Методы. Одномоментное, сплошное исследование. Включен 31 пациент после комплексного лечения внегипофизарных опухолей головного мозга в детском возрасте; группу контроля составили сопоставимые c основной по полу и возрасту 20 здоровых добровольцев. Оценивались биохимический и общеклинический анализ крови, уровни кортизола, АКТГ, ДГЭА-С. Тест с инсулиновой гипогликемией (ТИГ) проведен всем пациентам и 11-ти добровольцам.

Результаты

Результаты. Распространенность ВНН по ТИГ составила 45,2%. У пациентов без ВНН по сравнению с группой ВНН и добровольцами выявлен достоверно более высокий уровень базального кортизола (БК) (505 [340;650] vs 323 [233;382] и 372 [263;489] нмоль/л; рбез_внн-внн=0,001; рбез_внн-здоров=0,04). У группы ВНН уровень ДГЭА-С оказался достоверно ниже, чем в других группах обследованных (3,1 [1,8; 3,4] vs 5,1[2,5; 6,4] и 6,8 [4,1;8,9]; рбез_внн- внн=0,036; рвнн- здоров=0,001). ROC-анализ показал, что БК и ДГЭА-С могут быть использованы как качественные скрининговые тесты для оценки ВНН (AUC=89,3% и 88,3 %). На фоне ТИГ максимальный уровень кортизола (656 [608-686] vs 634 [548-677]; р=1) и время его повышения (45 и 60 мин) не отличались у пациентов без ВНН и добровольцев. Нежелательные явления: отсроченная гипогликемия отмечена у 4/14 пациентов группы ВНН через 40–90 мин после купирования гипогликемии в тесте введением 60–80 мл 40% раствора глюкозы.

Заключение

Заключение. После краниоспинального облучения по поводу внегипофизарных опухолей ВНН развивалась в 45,2% случаев и проявлялась снижением уровня ДГЭА-С. У 52,9% пациентов без ВНН отмечался высоконормальный уровень базального кортизола. Базальные уровни ДГЭА-С и кортизола могут быть использованы при динамическом наблюдении за пациентами для своевременного исключения ВНН.

BACKGROUND

BACKGROUND: The most of the current studies include patients who are different by the etiology of secondary adrenal insufficiency (SAI), or investigate SAI among other late effects of the radiation therapy.

AIMS

AIMS: To describe the features of SAI and to select the best method of screening SAI in adult patients followed complex treatment of nonpituitary brain tumors in childhood.

MATERIALS AND METHODS

MATERIALS AND METHODS: It was the retrospective cross-sectional study. 31 patients after the complex treatment of nonpituitary brain tumors in childhood and 20 healthy volunteers were examined. Age and sex ratio were comparable between the groups. Biochemical and clinical blood tests, levels of cortisol, ACTH, DHEA-C were evaluated. The insulin tolerance test (ITT) was performed for all patients and 11 volunteers.

RESULTS

RESULTS: The prevalence of SAI by ITT was 45.2%. The levels of basal cortisol (BC) were significantly higher in patients without SAI in comparison with the SAI group and volunteers (505 [340; 650] vs 323 [233; 382] and 372 [263; 489] nmol / l; pSAI- without_SAI=0.001; pwihtout_SAI-healthy = 0.04). The SAI group had DHEA-C significantly lower than in other groups one (3.1 [1.8; 3.4] vs 5.1 [2.5; 6.4] and 6.8 [4.1; 8.9]; рSAI- without_SAI = 0.036; pSAI-healthy = 0.001). ROC analysis showed that BC and DHEA-S can be used as high-quality screening tests for SAI (AUC = 89.3% and 88.3%). The maximum level of cortisol (656 [608-686] vs 634 [548-677]; p = 1) and the time of its increase (45 and 60 min) did not differ during ITT in patients without SAI and volunteers. Side effects: delayed hypoglycemia occurred in 4/14 patients of the SAI group 40–90 minutes late of injection 60-80 ml of 40% glucose solution for stopping hypoglycemia in the test.

CONCLUSIONS

CONCLUSIONS: 45.2% of patients followed craniospinal irradiation had SAI that is characterized by a decrease in DHEA-C levels. A highly normal level of basal cortisol was observed in 45% of patients without SAI. DHEA-C and blood cortisol can be used for SAI screening.

надпочечниковая недостаточностьгипоталамо-гипофизарно-надпочечниковая осьмолодые взрослыелучевая терапияопухоли головного мозгаотдаленные последствиякортизол кровидегидроэпиандростерон-сульфатadrenal insufficiencypituitary-adrenal function testsyoung adultbrain neoplasmsradiotherapyfollow-uppituitary-adrenal systemdehydroepiandrosteronehydrocortisoneИсследование выполнено при поддержке гранта № 8801 Министерства образования и науки РФ «Медико-социальная реабилитация мужчин и женщин, перенесших комбинированное лечение онкологических заболеваний в детстве», а также благотворительного фонда «Подари жизнь».The study was carried out with the support of Grant No. 8801 of the Ministry of Education and Science of the Russian Federation "Medical and social rehabilitation of men and women who have undergone combined treatment of cancer in childhood," as well as the charitable foundation "Give life."ReferencesChen Y, Lin Y, Chen S, et al. 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The authors declare that there are no conflicts of interest present.