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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">problendo</journal-id><journal-title-group><journal-title xml:lang="ru">Проблемы Эндокринологии</journal-title><trans-title-group xml:lang="en"><trans-title>Problems of Endocrinology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">0375-9660</issn><issn pub-type="epub">2308-1430</issn><publisher><publisher-name>Endocrinology Research Centre</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.14341/probl13564</article-id><article-id custom-type="elpub" pub-id-type="custom">problendo-13564</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Клиническая эндокринология</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Clinical endocrinology</subject></subj-group></article-categories><title-group><article-title>Сложность дифференциального диагноза объемных образований надпочечника при врожденной дисфункции коры надпочечников: серия клинических случаев</article-title><trans-title-group xml:lang="en"><trans-title>Difficulty with differential diagnosis on adrenal lesions in congenital adrenal cortex dysfunction: a series of clinical cases</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5592-4794</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шевэ</surname><given-names>А.</given-names></name><name name-style="western" xml:lang="en"><surname>Chevais</surname><given-names>A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шевэ Анастасия, к.м.н.  </p><p>Москва </p></bio><bio xml:lang="en"><p>Anastassia Chevais, MD, PhD </p><p>Moscow </p></bio><email xlink:type="simple">anastassia93@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7965-9454</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тарбаева</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Tarbaeva</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тарбаева Наталья Викторовна, к.м.н.  </p><p>Москва </p></bio><bio xml:lang="en"><p>Natalya V. Tarbaeva, MD, PhD </p><p>Moscow </p></bio><email xlink:type="simple">ntarbaeva@inbox.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0270-4429</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Голубкина</surname><given-names>Ю. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Golubkina</surname><given-names>Y. Y.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Голубкина Юлия Юрьевна, н.с.  </p><p>Москва </p></bio><bio xml:lang="en"><p>Yulia Y. Golubkina, MD </p><p>Moscow </p></bio><email xlink:type="simple">dr.golubkina@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0000-0918-0544</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гаджимурадова</surname><given-names>М. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Gadzhimuradova</surname><given-names>M. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гаджимурадова Мансурат Мурадовна, аспирант  ссссссссссс</p><p>ул. Дмитрия Ульянова, д. 11, 117292 Москва </p></bio><bio xml:lang="en"><p>Mansurat M. Gadzhimuradova, MD</p><p>Moscow  </p></bio><email xlink:type="simple">mansurat@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0786-7809</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Иващенко</surname><given-names>К. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Ivashchenko</surname><given-names>K. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Иващенко Ксения Валерьевна, аспирант  </p><p>Москва </p></bio><bio xml:lang="en"><p>Kseniya V. Ivashchenko, MD </p><p>Moscow </p></bio><email xlink:type="simple">kseniya223@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6418-7060</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ладыгина</surname><given-names>Д. О.</given-names></name><name name-style="western" xml:lang="en"><surname>Ladygina</surname><given-names>D. O.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ладыгина Дарья Олеговна, к.м.н. </p><p>Москва </p></bio><bio xml:lang="en"><p>Daria O. Ladygina, MD, PhD </p><p>Moscow </p></bio><email xlink:type="simple">d8050005@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9124-294X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Воронцова</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Vorontsova</surname><given-names>M. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Воронцова Мария Владимировна, к.м.н. </p><p>Москва  </p></bio><bio xml:lang="en"><p>Maria V. Vorontsova </p><p>Moscow </p></bio><email xlink:type="simple">maria.vorontsova.endo@gmail.com</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9621-5732</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Безлепкина</surname><given-names>О. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Bezlepkina</surname><given-names>O. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Безлепкина Ольга Борисовна, д.м.н., профессор </p><p>Москва </p></bio><bio xml:lang="en"><p>Olga B. Bezlepkina, MD, PhD, Professor</p><p>Moscow  </p></bio><email xlink:type="simple">olga.bezlepkina@endocrincentr.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5634-7877</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мельниченко</surname><given-names>Г. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Melnichenko</surname><given-names>G. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мельниченко Галина Афанасьевна, д.м.н., профессор, академик РАН </p><p>Москва </p></bio><bio xml:lang="en"><p>Galina A. Melnichenko, MD, PhD, Prof, acad.</p><p>Moscow  </p></bio><email xlink:type="simple">teofrast2000@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9717-9742</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мокрышева</surname><given-names>Н. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Mokrysheva</surname><given-names>N. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мокрышева Наталья Георгиевна, д.м.н, профессор, академик РАН </p><p>Москва </p></bio><bio xml:lang="en"><p>Natalia G. Mokrysheva, MD, PhD, Prof, acad. </p><p>Moscow </p></bio><email xlink:type="simple">mokrisheva.natalia@endocrincentr.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр эндокринологии</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Endocrine Research Centre</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>I.M. Sechenov First Moscow State Medical University (Sechenov University)</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр эндокринологии; Московский государственный университет им. М.В. Ломоносова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Endocrine Research Centre; Lomonosov Moscow State University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>20</day><month>05</month><year>2025</year></pub-date><volume>71</volume><issue>2</issue><fpage>22</fpage><lpage>34</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Шевэ А., Тарбаева Н.В., Голубкина Ю.Ю., Гаджимурадова М.М., Иващенко К.В., Ладыгина Д.О., Воронцова М.В., Безлепкина О.Б., Мельниченко Г.А., Мокрышева Н.Г., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Шевэ А., Тарбаева Н.В., Голубкина Ю.Ю., Гаджимурадова М.М., Иващенко К.В., Ладыгина Д.О., Воронцова М.В., Безлепкина О.Б., Мельниченко Г.А., Мокрышева Н.Г.</copyright-holder><copyright-holder xml:lang="en">Chevais A., Tarbaeva N.V., Golubkina Y.Y., Gadzhimuradova M.M., Ivashchenko K.V., Ladygina D.O., Vorontsova M.V., Bezlepkina O.B., Melnichenko G.A., Mokrysheva N.G.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.probl-endojournals.ru/jour/article/view/13564">https://www.probl-endojournals.ru/jour/article/view/13564</self-uri><abstract><p>Врожденная дисфункция коры надпочечников (ВДКН) — это группа аутосомно-рецессивных заболеваний, характеризующихся дефектом одного из ферментов, принимающих участие в стероидогенезе, наиболее распространенным из которых является дефицит 21-гидроксилазы вследствие мутаций в гене CYP21A2. С момента внедрения заместительной терапии и программ неонатального скрининга в 1950-х годах наблюдается значительное улучшение показателей выживаемости среди новорожденных, страдающих ВДКН. Однако, несмотря на достигнутый прогресс, уровень смертности, связанный с данным заболеванием, продолжает оставаться на относительно высоком уровне. Терапевтическое лечение, направленное на достижение медикаментозной компенсации, представляет собой сложную задачу, что связано с различными долгосрочными осложнениями, возникающими как в результате самого заболевания, так и его лечения. Эти осложнения затрагивают целый ряд физиологических функций, включая метаболизм, рост и развитие, а также состояние сердечно-сосудистой системы и фертильность, что подчеркивает необходимость дальнейших исследований и совершенствования подходов к лечению названной патологии.</p><p>В данной статье представлена серия из 4 клинических случаев пациентов с ВДКН, длительно находившихся в состоянии декомпенсации глюко- и минералокортикоидной недостаточности, у которых наблюдалось развитие объемных образований надпочечников значительных размеров, а также TART опухолей яичек.</p></abstract><trans-abstract xml:lang="en"><p>Congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorders characterized by defects in enzymes critical for steroidogenesis, with 21-hydroxylase deficiency due to mutations in the CYP21A2 gene being the most prevalent form.</p><p>Since the introduction of replacement therapy and neonatal screening programs in the 1950s, there has been a significant increase in survival rates among newborns diagnosed with CAH. However, despite these advancements, mortality associated with this condition remains disproportionately high. Achieving optimal therapeutic compensation through medication remains a complex challenge, contributing to a range of long-term complications. These complications stem from both the underlying disease and its treatment, impacting key physiological functions, including metabolism, growth and development, cardiovascular health, and fertility. These multifaceted outcomes underscore the need for ongoing research and the refinement of therapeutic approaches to better manage this intricate condition. This article presents a series of four clinical cases of CAH characterized by the absence of sustained compensation for glucoand mineralocorticoid deficiencies. These cases were further complicated by the development of large adrenal masses and ectopic testicular adrenal rest tissue (TART), emphasizing the challenges in achieving long-term disease management.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>врожденная дисфункция коры надпочечников</kwd><kwd>TART</kwd><kwd>заместительная терапия</kwd><kwd>надпочечниковая недостаточность</kwd><kwd>надпочечники</kwd></kwd-group><kwd-group xml:lang="en"><kwd>congenital adrenal hyperplasia</kwd><kwd>TART</kwd><kwd>adrenal insufficiency</kwd><kwd>adrenal glands</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">Работа выполнена в рамках государственного задания «Разработка новых технологий диагностики и мониторинга опухолей коры надпочечников с использованием метаболомных и протеомных технологий». 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