The editorial examines modern trends and new technologies in the radiological diagnostics of adrenal tumors, such as dual-energy computed tomography and textural analysis methods utilizing machine learning. Particular attention is paid to the differential diagnosis of adrenal masses, including multi‑class differentiation. Research data demonstrating the high diagnostic efficacy of these approaches are presented, and the importance of an interdisciplinary and personalized approach in patient management is emphasized. The material reflects current achievements and future prospects for the development of radiological methods in endocrinology and oncology.

BACKGROUND: Multiple endocrine neoplasia syndrome type 1 (MEN-1) is a rare, autosomal dominant disorder resulting from inactivating mutations in the MEN1 gene. It demonstrates high penetrance, with the "classic triad" of manifestations comprising primary hyperparathyroidism (PHPT), gastrointestinal neuroendocrine neoplasms (NEN), and pituitary adenomas. Diagnosis relies on clinical, familial, and genetic criteria. However, significant phenotypic variability and the lack of a clear genotype-phenotype correlation complicate early diagnosis.

AIM: To investigate the clinical-epidemiological, laboratory-instrumental, and genetic characteristics of familial MEN-1 in the Russian population.

MATERIALS AND METHODS: We conducted a single-center, single-stage study (2015–2025) at the Endocrinology Research Centre enrolling 102 genetically confirmed MEN-1 patients from 43 families. Participants were stratified by age at PHPT onset (≤18 years, 19–40 years, and >40 years) and MEN1 mutation type/location. We compared groups using calcium-phosphorus metabolism parameters, disease progression patterns, PHPT surgical outcomes, and genotype-phenotype correlations.

RESULTS: Cohort baseline characteristics (sex, manifestations) were comparable (p>0,05), but we observed significant differences in NEN onset age (p<0,001) and a trend toward higher pituitary adenoma prevalence (p=0,003). Exon 10 mutation were associated with a 7,7-fold increased pituitary adenoma risk (OR=7,7; p=0,006), though mutation type did not predict broader phenotype. Groups did not differ in multiglandular involvement, surgical outcomes, or histopathology (p>0,05).

CONCLUSION: MEN-1 exhibits marked clinical heterogeneity in the Russian population, with exon 10 mutations significantly increasing pituitary adenoma risk. Early-onset PHPT predicts earlier NEN and pituitary adenoma development. These findings support proactive genetic screening and risk-stratified monitoring for MEN-1 families.

BACKGROUND: Adrenal incidentalomas are common, with a detection rate of up to 7% in patients over 70 years of age. Of these, up to 25% are functionally active, leading to the development of severe clinical manifestations. Challenges of insufficient diagnosis and a lack of a personalized approach to the management of such patients persist. To overcome these challenges, the use of CT image analysis is proposed to develop criteria for non-invasive diagnosis, which is a pathway towards improving personalized patient management.

AIM: Analysis of statistically significant correlations between clinical-laboratory parameters and contrast-enhanced (CE) CT imaging features of adrenal adenomas.

MATERIALS AND METHODS: A single-center, non-comparative, cross-sectional retrospective study analyzed preoperative images from four-phase CECT of adrenal adenomas. Hormonal workup included the determination of aldosterone, renin, cortisol levels during an overnight dexamethasone suppression test (DST), adrenocorticotropic hormone (ACTH), 24-hour urinary free cortisol (UFC); potassium and creatinine levels were also assessed. Clinical data included arterial hypertension, impaired carbohydrate metabolism, dyslipidemia, hypokalemia, and renal dysfunction. A comparative and correlation analysis was performed between clinical-laboratory parameters and CECT characteristics.

RESULTS: The study included 254 patients. Hormonal activity was detected in 226 (89.0%) patients; 28 (11.0%) patients had non-functioning adenomas. Hormonally inactive adenomas were characterized by larger size (43.0 mm [32.7; 51.2] vs. 29.0 mm [20; 36], p<0.001), higher native density (41.0 HU [36.0; 47.2] vs. 25.0 HU [12.0; 37.0], p<0.001), and lower venous phase contrast enhancement (141.6% vs. 283.7%, p=0.001). In primary aldosteronism (PA), adenomas were significantly smaller (20.0 mm [16.8; 25.0]) and had lower native density (14.0 HU [4.0; 24.0]) compared to cortisol-producing tumors (34.0 mm [30.0; 38.0], 35.5 HU [30.0; 44.0], p<0.001). The presence of calcifications was more frequently observed in cortisol hypersecretion compared to PA (p=0.011). Correlation analysis revealed negative associations between adenoma size and levels of aldosterone (r=–0.504, p<0.001) and ACTH (r=–0.419, p<0.001), and positive associations with post-DST cortisol levels (r=0.500, p<0.001), renin (r = 0.454, p<0.001), and potassium (r=0.458, p<0.001).

CONCLUSION: CT characteristics of adrenal adenomas vary depending on hormonal activity, type of secretion, and clinical manifestations.

Microchimerism — the phenomenon of the presence of genetically foreign cells within the body — holds significant interest for endocrinology. It develops as a result of transplacental cell exchange during pregnancy (fetal and maternal microchimeric cells) or iatrogenic interventions and may play an important role in the development of autoimmune endocrine diseases. The greatest amount of data has been accumulated regarding thyroid diseases: fetal microchimeric cells are detected in 38–83% of cases of autoimmune thyroiditis and Graves’ disease, with their levels correlating with the activity of the autoimmune process. Three main hypotheses have been proposed regarding their involvement in pathogenesis: initiation of a "graft-versus-host" reaction postpartum, molecular mimicry with thyroid antigens, or passive accumulation in inflammatory foci.

In type 1 diabetes mellitus, studies focus on maternal microchimeric cells, which are found in the pancreas of patients and can differentiate into β-cells; however, their pathogenic role remains controversial. Modern methods for detecting microchimeric cells — such as polymerase chain reaction (PCR) and immunofluorescent hybridization in situ (FISH) — are highly sensitive but require standardization. Promising research directions include studying the influence of HLA compatibility, long-term dynamics of microchimeric cells, and their potential therapeutic applications. Addressing these issues could lead to a revision of current understanding of the pathogenesis of endocrine diseases and the development of new treatment approaches.

This review examines the association between Parkinson’s disease (PD) and diabetes, two global epidemics closely linked to aging. The analysis is based on recent epidemiological data indicating that diabetes significantly increases the risk of developing PD and exacerbates its progression, affecting both motor and cognitive functions. The paper explores shared pathophysiological mechanisms, including impaired insulin signaling, insulin resistance, oxidative stress, mitochondrial dysfunction, chronic inflammation and neuroinflammation, dysregulated glucose metabolism, and gut microbiota dysbiosis. These interconnected processes create a vicious cycle in which each pathology reinforces the others, driving neurodegeneration, particularly in vulnerable dopaminergic neurons of the substantia nigra. The uniqueness of this review lies in the integration of current research, providing a dual-perspective approach to comorbidity — addressing both neurodegenerative and metabolic dysfunctions. Understanding these shared mechanisms opens avenues for developing multi-targeted therapeutic strategies, including dietary interventions, lifestyle modifications, and gut microbiota modulation. This approach distinguishes the present review from similar works by offering a comprehensive perspective on the issue and emphasizing the need for further studies to identify precise biomarkers and develop effective disease-modifying treatments.

Pituitary adenomas (PA) are the most common lesions of hypothalamic-pituitary region. Clinical presentations of PA depend on both hormonal activity and tumor growth characteristics. Despite the fact that PA are mostly benign, they can grow invasively and mechanically affect adjacent structures. With invasive growth of PA, radical removal is difficult and associated with a higher risk of surgical complications. Pathogenesis of PA invasiveness is not fully understood. Tumor cell invasion depends on both intercellular interactions within the tumor and interaction with extracellular matrix components (ECM). Major factors that play an important role in these processes include matrix metalloproteinase (MMP) family and tissue inhibitors of matrix metalloproteinases (TIMPs). Two MMPs were mostly studied in PA – types 2 and 9. These molecules are of interest, as they participate in degradation of type IV collagen, which is a key component of the ECM in hypothalamic-pituitary region. This review discusses the general concept of PA invasiveness, the characteristics of MMPs, and research of the relationship between these molecules and PA invasiveness.

Neurofibromatosis type 1 is a hereditary disease with a wide variability of clinical manifestations, from the almost complete absence of typical symptoms to a multisystem lesion of the body. One of the possible clinical manifestations of this pathology is a pheochromocytoma — a tumor of the adrenal gland with the possible development of considerable cardiovascular complications. The article describes four cases of patients with pheochromocytoma as part of familial neurofibromatosis type 1, differing in clinical course from asymptomatic form to vivid paroxysmal manifestations. At the same time, the presence and degree of arterial hypertension did not correlate with the level of metanephrines and the size of the pheochromocytoma. 3 out of 4 patients have a hereditary history of neurofibromatosis type 1. In 1 out of 4 cases, simultaneous bilateral damage to the adrenal glands was noted, while the radiation characteristics of pheochromocytomas, both with computed tomography and CT/PET with 18-FDG, differed from the "classic" ones. An objective examination with the identification of "erased" signs of neurofibromatosis type 1 made it possible to establish the diagnosis of bilateral pheochromocytoma even with questionable laboratory and imaging data. Knowledge of clinical manifestations, timely diagnosis of neurofibromatosis type 1, comprehensive treatment and subsequent regular monitoring of patients, as well as examination of blood relatives can significantly improve prognosis and survival.

BACKGROUND: In different regions of the Russian Federation, fluctuations in biomedical characteristics are ambiguous and often multidirectional, while one of the ways to understand the significance of these components is to study their effect on the human metabolic state, in particular, on carbohydrate metabolism, in groups with identical lifestyles, but living in different climatogeographic conditions

AIM: Assessment of the main indicators of carbohydrate metabolism in young residents of various climatic and geographical zones of residence (North-East, North-West, Central Russia).

MATERIALS AND METHODS: The assessment of the key characteristics of carbohydrate metabolism in 243 males living in various regions of the Russian Federation was carried out: 119 boys in the North-East of Russia (Magadan), 72 boys in the North-West of Russia (Murmansk) and 52 boys in the Middle of Russia (Ulyanovsk). The work used immunochemiluminescent, enzymatic method and immunochromatographic analysis.

RESULTS: It was found that with comparable diets, the average values of carbohydrate metabolism in the surveyed residents of different regions corresponded to optimal physiological ranges with the formation of regional features of the metabolic profile. A shift in the level of glycemia and glycosylated hemoglobin towards high values at low insulin concentrations was revealed only in the group of young men in the North-East of Russia against the background of elevated serum cortisol values observed only in the groups of northern boys. Natives of Northwestern and central Russia were characterized by activation of the pancreatic insulin apparatus, accompanied by an increase in insulin levels, a high incidence of signs of insulin resistance (up to 40% in the sample), accompanied by pronounced compensatory secretion of pancreatic beta cells. The data obtained indicate that the metabolic patterns observed in Northerners differ from the classical criteria of the "polar metabolic type", which is usually associated with hypoglycemia and hypoinsulinemia on the background of elevated serum cortisol levels. At the same time, the presence of signs of insulin resistance in a sample of young men from the North-West of Russia may be due to an imbalance towards a greater dominance of the sympathetic division of the autonomic nervous system.

CONCLUSION: The results obtained indicate that the identified changes in carbohydrate metabolism have pronounced «northern» features, but they manifest themselves differently in residents of the northwestern and northeastern regions of Russia. It has been established that living in various climatogeographic regions of the Russian Federation with their unique climatic, geographical and latitudinal conditions leads to the formation of diverse vegetative, endocrine and metabolic profiles.

On September 26, 2025, a meeting of an expert multidisciplinary working group was held in Vladikavkaz, dedicated to discussing ways to improve therapy adherence to modern incretin-based treatments in patients with overweight and obesity in real-world clinical practice.

Non-healing ulcers pose a serious problem for public health due to the high cost of treatment, prolonged disability of patients, and low efficacy of therapy. They are the leading cause of non-traumatic lower limb amputations.

The development of innovative bioengineering products is a significant step in the treatment of non-healing diabetic foot ulcers. One such product is a tissue-engineered acellular product made from highly regenerative human umbilical cord biomaterial. It contains growth factors, cytokines, and components of the extracellular matrix of Wharton’s jelly, which accelerates wound healing.

THE AIM of this clinical study is to evaluate the safety and efficacy of a tissue-engineered acellular product from Wharton’s jelly of the umbilical cord for the treatment of chronic non-healing lower limb ulcers in patients with diabetic foot syndrome.

RESULTS: a 60-year-old woman diagnosed with type 2 diabetes mellitus had chronic ulcers that had not responded to standard treatment for more than a year and a half. She was observed for 4 weeks in August 2024. As a result of the local application of an acellular product from human umbilical cord, signs of reduction in wound size and their complete healing were noted 4 weeks after the start of observation.

CONCLUSION: clinical observation has demonstrated the safety and efficacy of the acellular product from human umbilical cord for the treatment of chronic non-healing ulcers of diabetic origin.

BACKGROUND: Type 1 diabetes mellitus is the most common endocrine-metabolic disorder in childhood and adolescence. Some families may find it difficult to administer four daily injections, especially in young children, or to use the newer, expensive insulin analogs and pumps. For this reason, many physicians are still using the classical two-injection schedule, using premixed insulin in certain areas of the world.

AIM: To assess glycemic control and complication indicators in type 1 diabetic children on premixed or basal-bolus insulin.

METHODS: One hundred children aged 2–14 years with type 1 diabetes mellitus were studied at multiple diabetes care centers; fifty were receiving premixed insulin, and the other fifty were on a basal-bolus insulin regimen. Evaluations were made based on HbA_1c levels, occurrences of hypoglycemia, ketoacidosis, and other complications.

RESULTS: The study revealed significant improvements in HbA_1c levels in the basal-bolus insulin group compared to premixed insulin patients three and six months after treatment (p=0.048 and p=0.005, respectively). Patients using the premixed regimen experienced more frequent hypoglycemia attacks (p=0.001) and injection site complications, such as hypertrophy (p=0.001).

CONCLUSIONS: It has been revealed that a basal-bolus regimen (MDI) improves children’s and teenagers’ glycemic control with fewer complications.

BACKGROUND: Cockayne syndrome is an ultra-rare (1:2.5 million) hereditary disease from the group of progeroid syndromes caused by pathogenic and probable-pathogenic variants in DNA repair genes (ERCC8, ERCC6, XPB (ERCC3), XPD (ERCC2) and XPG (ERCC5)) and characterized by abnormal photosensitivity, congenital cataract, microcephaly, sensorineural hearing loss, nervous system pathology and other multisystem changes. In this manuscript, for the first time in the Russian Federation, we present the results of a clinical and genetic study and follow-up of a Russian cohort of patients.

MATERIALS AND METHODS: During 2 years, from 2023 to 2025, 7 patients with Cockayne syndrome (4 girls and 3 boys) aged from 3 years 11 months to 16 years 3 months were under clinical observation, of whom 3 patients were diagnosed with Cockayne syndrome type A (causative variants in ERCC8 gene) and 4 patients with type B (causative variants in ERCC6 gene). All patients underwent a comprehensive multidisciplinary examination with evaluation of the results of laboratory and instrumental methods of investigation.

RESULTS: Based on observational data, we confirmed the incomplete correlation between genotype and phenotype previously described in the literature. With the genotype of Cockayne syndrome type B, previously correlated with severe course of the disease, only one patient had a severe course of the syndrome, two patients had a moderate course, and one patient had a mild course, indicating the variability of the clinical picture within a single gene lesion, and the severity of the course correlated rather with the age of the disease debut: early onset (before 1 year of age) was associated with faster disease progression. Also, regardless of the genotype and severity of the disease course, major diagnostic criteria were identified in all patients: congenital cataract was diagnosed in 5 of 7 observed patients, sensorineural hearing loss in two patients of moderate and mild course of the disease, progressive pathology of the nervous system in 6 of 7 patients, and microcephaly was diagnosed in all patients.

CONCLUSION: This study expands our understanding of the natural course of Cockayne syndrome and our knowledge of the variability of clinical manifestations and severity of the disease course within a single gene lesion. Timely diagnosis and personalized approach of a multidisciplinary team of specialists can slow the progression of complications and improve the quality of life of patients. The work is of value for physicians of various specialties involved in the diagnosis and treatment of orphan genetic diseases, as well as researchers studying the mechanisms of DNA repair and premature aging.