The article is devoted to diagnostic and therapeutic policy in nodal lesions of the thyroid.

Clinical and morphological characteristics of 27 patients with clinical symptoms of acromegaly (20 females, 7 males, mean age 40.2 ± 10.6 years), who transsphenoidal adenomectomy in 1997 to 2001 were investigated. The histological, immunohistochemical, electron microscopy studies of removed adenomas were carried out. 12 cases (11 females, 1 male) were immunopositive with anti-STH antibodies, 3 of whom had hyperprolactinemia. Detected in 14 (51,8%) patients (8 females, 6 males) positive immunoperoxidase response to, antibodies to 2 hormones - STH and PRL was proved, in 4 cases by the electron microies. Hyperprolactinemia was determined in half of these cases, i. e. there was diversity of hormonal and immunohistochemical data. At was revealed also that in females with the STH/PRL positive clinical syndrome disorders of menses were significantly more frequent (p < 0,05), among all the patients there was hyperprolactinemia in higher percent in comparison with STH-positive group. There was no correlation between the activity of immunoperoxidase response in adenoma cells and degree of elevation of the blood serum hormone’s levels. In patients with acromegaly combined with hyperprolactinemia the type of pituitary adenoma can be established just after implementing immunohistochemical study and/or electron microscopy.

Basing on the results of complex examination of 120 patients (53 children and 67 adults), hypothalamic-pituitary structures in congenital growth hormone (GH) deficiency in different age periods were analysed. Isolated growth hormone ing deficiency (1GHD) was diagnosed in 34,2%> of cases (25 children and 16 adults), the diagnosis of multiple adenohypophyseal hormone deficiency (MAHD) was made in 65,8% of patients (52 children and 81 adults). Organic lesions of hypothalamic-pituitary system were revealed in 91,7%> of patients. On MR images 3 main anomalies in the hypothalamic-pituitary region could be detected: pituitary hypoplasia (28,4%>), empty sella turcica (22,5%o) and triad of lesions including ectopia of the neurohypophysis in combination with hypoplasia of the adenohypophysis, and crus hypoplasia or aplasia (40,8%o). In children pituitary hypoplasia in combination with hypoplasia of the hypophysial crus, and ectopia of the neurohypophysis, in adults - pituitary hypoplasia were observed more frequently. In IGHD the rate of different abnormalities of pituitary development did not depend on age. In MAHD adults had more tuguently pituitary hypoplasia MAHD children - the triad of lesions (p < 0,05). In children with pituitary hypoplasia the hypophysis sizes in IGHD were larger than in MAHD (p < 0,02). In pituitary hypoplasia hypophysis sizes did not differ significantly in children and adults.

The study was made of alteration in mental state and behavior in the 18 females aged 19-43 years with hyperprolactinemic hypogonadism during treatment with interpersonal psychotherapy. Psychotherapy was directed to overcoming the dominant in such patients instinctive "parental style of behavior". Psychotherapy resulted in clinically and statistically significant improvements in subjective and objective symptoms, restoration of menses, reduction of sexual disorders, attenuasion of headache. In two cases pregnancy came easily. The patients improved prycholosically due to weaker anxiety, tension and neuro-vegetative symptoms. The Hamilton Rating Scale for Anxiety declined from 13,8 to 9,3. Lower profile by MMPY by 0, 2 and 6 scales indicated improvement in overall social functioning, reduction of circumspection, affective rigidity and depressive symptoms. There was no substantial influence of psychotherapy on the prolactin level and galactorrhea.

At the background of the complex clinical, hormonal and instrumental examination of 96 patients with diagnosis of Itsenko-Cushing’s disease the detailed analysis of MR tomographic picture and study of the clinical status in dependence on structural changes of the pituitary were carried out. MRI-examination revealed different pituitary pathology in 91,7% of patients with Cushing’s disease: in 7,3%o of cases the polymorphous adenohypophysis structure was detected, in 6,2% of cases the picture of empty sella turcica was disclosed, in 78%> of patients there was found pituitary adenoma, including microadenoma in 58,3%> of cases and macroadenoma- in 19,8%> of patients. The analysis did not show any correlation between sizes and corticotropinoma features discovered by MRI-examination and its hormonal activity.

The estimation of the efficacy of the preventive program of iodine deficiency disease has been carried out in the Republic of Tyva. The goiter rate in schoolchildren decreased nearly 2-3 times. Just for the same time the median of iodine concentration in urine elevated to normal value, i. e. more than 100 mcg/l in all the regions except Sutkholsky region where it amounted 91 mcg/l. Frequency distribution data showed that most of the children (about 50%) had iodine concentration in urine in the range from 100 to 300 mcg/l. The disparity in goiter rate and iodine excretion level may be related with slow regression of goiter at the background of iodine prophylaxis. The results testify to possibility of effective control of iodine deficiency and necessity of regular monitoring of the program.

Glucose-associated oxidation damage of the cell membranes due to enhanced lipid peroxidation in reduction offunctioning of enzymatic (catalase, CuZn) and non-enzymatic (thiol groups, glutathione) antioxidant defenses is established in pregnant patients with diabetes mellitus. Oxidative stress in pregnant patients with type I diabetes mellitus reduces insulin-binding capacity of blood cells as a result of membrane protein's polymerization, of such insulin receptor as protein kinase, in particular.

Medical compianee of patients with diabetes mellitus (DM) responsible in many cases for the disease outcome forms under impact of a number ofpsychological and social factors, concomitant mental illnesses. Among the laffer most frequently were anxious and depressive states, but their relationship with patient ’s attitude to treatment remains disputable. To specify the relationship between symptoms of depression and anxiety, revealed in patients with diabetes mellitus, and their attitude to diabetic specific treatment. 31 patients with DM type 1 and 2 were examined (mean age - 53,9 ± 2,2years, mean disease duration - 6,3 ± 3,1 years, mean А_1с level - 8,4 ± 2,2%). The results of the study indicate a high rate of depressive states (29%) and anxious-phobiac states (45%) in patients with DM and association of these disorders with different variants of attitude to treatment. Depression represents "fatalistic" and "medical" ’locus of control’ (LOC). In addition, feedback on independent LOC is discovered. Such type of altitude will negatively affect efforts of the patient of achieve carbohydrate metabolism compensation, e. g., in the educational process. Therefore, intensive education measures should be preceded by treatment of depression. Anxiety is represented by self- sufficient type of ’locus of control’, which does not impede the patient’s active participation in the process of control and management of the disease.

The study was made to compare the effects of treatment with orlistat on metformin for 6 months on anthropometric parameters, carbohydrate and lipid metabolism, blood pressure, insulin resistance and insulin secretion in patients with type 2 diabetes mellitus. Open study with parallel groups included a total of 60 patients with type 2 diabetes mellitus, aged 40 to 75 years. Before the study all the patients were or diet alone, or not more than 1 tablet of medication of sulphonylurea, their fasting plasma glucose was < 12 mmol/l, they had hypercholesterinemia and or hypertriglyceridemia. Each individual was assigned randomly to receive 120 mg orlistat three times daily or metformin, in the initial dosage 500 mg, and successive increment of the dosage to the therapeutic level. Both groups received the same dietary counseling. Initially and 1, 2, 3 and 6 months later body mass, body mass index, blood pressure, the levels of fasting blood glucose levels, Нb А_1с, triglycerides, cholesterin, low- density lipoprotein (LDL), high-density lipoproteis (HDL) were determined. Initially and after treatment an oral glucose tolerance test was performed with estimation of glycemia and insulin levels with calculation of index of insulin resistance assessed by the homeostasis model for assessment of insulin resistance (HOMA). From orlistat group 2 patients and from metformin group 5patients were withdrawn, but in no case because of side-effects. In the orlistat group there was more pronounced positive dynamics in trend of anthropometric parameters alteration than in the metformin group. The orlistat group lost 8,4 ± 3,7% of initial body mass vs. 4.5 ± 2.7% in the metformin group (P < 0.001), decline of body mass index was 3,3 ± 1,8 and 1,6 ± 0,9 kg/m² (p < 0,001), decrement of waist circumference was -8,9 ± 4,6 and 5,2 ± 3,8 cm respectively (p < 0,003). Both therapeutic groups showed significantly reduced systolic and diastolic blood pressure values, fasting blood glucose levels, total cholesterd, low-density lipoprotein (LDL) cholesterol, triglycerides levels in patient with initial hypertriglyceridaemia without any difference between the two groups. Initial Нb А_1с levels in orlistat and metformin groups reached 9,2 ± 1,5% and 9,1 ± 2,0%, treatment with orlistat was followed by significant statistical and clinically significant decrease of Нb А_1с levels to 8,0 ± 1,5% (p < 0,001), in the metformin group it did not change significantly (8,7 ± 1,7%, p > 0,05). The part of the patients with Нb А_1с in the metformin group before and after treatment was equal 20% and 23,3% respectively, in the orlistat group, respectively, 16,5% and 30%, although the tendency in both groups did not reach statistical significance. The glycemia level during GTT reduced significantly in both groups, IRI levels did not change. In the metformin group there was significant improvement in sensitivity to insulin (IR-HOMA decreased from 6,1 ± 4,6 to 4,2 ± 2,6 (p = 0,024). In the orlistat group mean IRI-HOMA did not change, but there was significant increase in the part of patients with normal sensitivity to insulin (from 10% to 33,3%, p - 0,035), that was not seen in the metformin group. Orlistat is not inferior to metformin in the ability for reducing plasma glucose level and as remedy for correction of dislipidemia and may be used as medication of choice in patients with type 2 diabetes mellitus with excessive body weight and obesity.

The article is devoted to ectopic ACTH production by tumor of the lung.

The article is devoted to the ACTH-ectopic syndrome caused by bronchial carcinoid.

The article is devoted to the clinical morphological characteristics of hormonally active pituitary adenomas.