The Department of Childhood and Adolescence Endocrinology, Russian Medical Academy of Postgraduate Training, Ministry of Health of the Russian Federation, examined 529 patients with type 1 diabetes mellitus (DM) whose age was 5 to 22 years. The study was undertaken to examine the prevalence and severity of diabetic peripheral polyneuropathy (DPN) in children, adolescents, and young individuals who fell ill with DM in childhood, to characterize the symptoms and neurological manifestations of this complication, and to choose adequate studies for their examination. DPN is most common in adolescents and young individuals having a longer history of the disease and worse values of compensation of carbohydrate metabolism. The specific feature of DPN in these age groups are the absence of severe forms of the disease and the presence of mainly the sensory pattern of disorders. The study defined the required scope of a neurological examination for early diagnosis of DPN in children and adolescents, which should include a thorough analysis of a patient’s complaints and a test by the Total Symptoms Score, a neurological examination by the modified Neuropathy Impairment Score for the Lower Extremities, stimulation electromyography of the sensory and motor nerves of the leg. By taking into account a poor DM compensation in the absolute majority of children and adolescents, the neurological examination should be regular at least once a year.

The purpose of the study was to compare the clinical significance of two parameters of insulin resistance (HOMA_R and ISI) in children and adolescents with obesity. Sixty-six children and adolescents aged 11-16 years, including 48 individuals with obesity and 18 healthy individuals, were examined. Anthropometric indices, the time course of changes in the concentrations of insulin and glucose during a three-hour oral glucose test, and the fasting serum concentrations of triglycerides, cholesterol, high- and low- density lipoproteins, and leptin were determined. The evaluation of the clinical significance of HOMA_R and ISI consisted of three stages. A relationship between HOMA_R and ISI to the most studied risk factors of insulin resistance (IR), such as obesity and the pattern of fatty tissue distribution, was studied at the first stage. Correlations of HOMA_R and ISI with the anthropometric obesity indices and hormonal and metabolic parameters whose impairment is pathognomonic for IR were determined at the second stage. The spread of IR-associated disorders in children and adolescents with normal and abnormal HOMA_R and ISI were compared at the third stage. The analysis has indicated that in obese children and adolescents, HOMA_R is higher and ISI is lower than those in normally weighing children and adolescents of the same age, the value of ISI being inversely proportional to the excess of fatty tissue. It has been found that ISI is more closely related with the anthropometric and hormonometabolic signs of IR than HOMA_R. The findings have led to the conclusion that in children and adolescents with obesity, a decrease in ISI is a more significant indicator of IR than an increase in HOMA_R.

The fact that there is a high prevalence of depressions among patients with diabetes mellitus (DM) is well known. However, the relationships between the nosological entities of depressions and the clinical characteristics of DM are little studied. The study was undertaken to search for such relationships. A hundred and fifty outpatients with DM (out of them 38 males, Type 2 DM was diagnosed in 102 patients) the median age was 54.0 years (25 and 75 percentiles: 43.0-61.5), the median duration of diabetes was 7.2years (2.0-15.0); the median level of HbAlc was 8.6% (7.49.7%). Depression was revealed in 50 (33%) patients. Their comparison with patients without depression indicated that there was no association with the main clinical characteristics of MD (the type and duration of the disease, the prevalence of acute and chronic complications, insulin therapy). At the same time, a comparison of three groups of patients with the major clinical forms (nosogenic, cyclothymic, and dysthymic) of diagnosed depression by using x² revealed the following associations: between DM-1 and cyclothymic depression and between DM-2 and nosogenic and dysthymic depression (р = 0.01). Cyclothymic and dysthymic depression showed no associations with clinical characteristics of DM. The prevalence of nosogenic depression was significantly higher in patients with a history of second-three grade diabetic retinopathy (p = 0.02), arterial hypertension (p = 0.001), proteinuria (p = 0.02), myocardial infarction (p = 0.04), and foot ulcerative defects (p = 0.04). The results show that nosogenic depression are mental responses to the severe course of DM, namely to the severity of micro- and macrovascular complications. The associations between the types of DM and the clinical types of depression -cyclothymia and dysthymia - await further study. Overall general predisposition may be discussed as a possible explanation.

1п 1989-1990, a total of 94 children (43 boys and 51 girls) aged 2-15 years from radionuclide-polluted areas (Zones 2 to 4) divided into zones according to the level of contamination after the Chernobyl accident were examined. Obvious deviations in the children’s physical and mental development were not observed. There was a family history of diabetes mellitus (DM) (n= 1) and arterial hypertension (n - 1). Individual dosimetric data were absent. The basal levels of glucose, insulin, C-peptide, glucagon, thyroxine, prolactin, and insulin-binding serum activity (IBSA) were determined in blood. According to the blood concentration of insulin, the children were divided into 3 groups: 1) children with normal basal levels; 2) those with not more than twice higher levels than the upper normal range; and 3) those with twice or more higher than the range (there was no correlation of the content of insulin with age, sex, the levels of glucagon, thyroxine, and IBSA). In all the groups, body-mass index (BMI), the levels of C-peptide and glucose, and IBSA were in the normal range. Group 3 children were tallest. The children from more polluted areas (Zones 2-3) had higher insulin levels. Adult victims without a family history of DM made up 2 groups. Group 1 included 119 liquidators of accident consequences (LA Cs) aged 22-48years at its moment who had been exposed to radioecological and psychogenic factors for a short space of time (not more than 3 months in Zone 1' in 1988 to early 1987) (SELACs). The basal blood concentrations of glucose, insulin, C-peptide, glucagon were measured at the stages of the 1988-1992follow-up. There were gradual increases in the levels of insulin and C-peptide with their peak in 1990 and subsequent decreases to normal values in 1992. Following 5-6years after the accident, the insulin test showed no hypoglycemic effect of the hormone in LACs with the normal BMI. Following 11-12 years after the accident, the oral glucose tolerance test (OGT) revealed enhanced insulin production. Group 2 comprised 78 LACs who had been exposed to radioecological and psychogenic factors in the zone of the Chernobyl atomic power station from 1986-1987 to 1993-1994) (LELACs). Of them, 16 LELACs suffered from type 2 DM within 3 years. The baseline blood concentrations of glucose and insulin were determined. The baseline level of insulin was increased, in patients with DM in particular. Thus, all the examined children and LACs were found to have hyperinsulinemia that might be directly or indirectly associated with the influence of radioecological factors of the accident and be a cause of metabolic syndrome X in both adults and children.

The study whose purpose was to examine the time course of changes in the function of thyroid gland (TG) in pregnant women with mild iodine deficiency enrolled 218 females in different periods of pregnancy in accordance with the following criteria: the absence of dysfunction (of TG). In 128 patients of them, baseline TG pathology was absent; 90 patients were found to have these or those types of euthyroid goiter. Some women received iodine preventive therapy (150-200 mcg of potassium iodide daily) on an individual basis. Comparison of the levels of TTH and T4 in women receiving and no receiving iodine preventive therapy revealed that by the end of pregnancy, those receiving 150-200 pg of potassium iodide had significantly lower TTN levels and higher T4 levels. Comparing the time course of changes in the volume of TG between these groups showed that they did not increase to a significantly greater extent in the females receiving no iodine preventive therapy. Whether potassium iodide was used, there were no changes in the size of TG nodal masses during pregnancy. In the control group, active smokers were fewer than those in the goiter group (p = 0.035). Six-ten months after labor, the volume of TG further increased in the females without iodine preventive therapy group while that substantially decreased in those receiving 150-200 pg of iodine daily. It is concluded that pregnancy in the presence of mild iodine deficiency is accompanied by a higher risk of the development and progression of goiter, and by a risk for gestational hypothyroxinemia, which is prevented by an individual iodine preventive therapy with 150-200 pg of potassium iodide daily. Furthermore, pregnancy is not accompanied by a risk of increases in the size of nodal euthyroid colloid goiter that does not itself entail an additional risk for gestational hypothyroxinemia.

The paper evaluates the perinatal period of the mental, intellectual, and neurological status of children with prior transient neonatal hypothyroidism (TNH). The study involved 60 children aged 5-7years who had been born in Moscow; they had thyroidstimulating hormone (TSH) levels of 20 m U/I. In 56 children of them, spontaneous normalization of TSH levels occurred following 1-6 months by the moment of retesting. Four children in whom no normalization occurred by the moment of serum testing received levothyroxine therapy for 5 months to 4.5 years. A control group comprised 25 children who were parity by all signs and had normal TSH levels at birth. Examination of children included the assessment of their obstetric histories, neonatal TSH, the estimation of the neurological and psychointellectual development at the age of 5-7years. The results have indicated that the children with prior TNH have neurological and psychointellectual features (speech disorders, diminished intellectual operations that characterize logic and image thinking) that may exert a negative impact on the subsequent development of a child and lead to social disadaptation, which makes it necessary to follow up this group of children.

То identify patients with autoimmune thyroiditis (AIT) in a random sample of children, a stepwise clinical examination was conducted among 427 ninth-form pupils (aged 14-15 years) from 4 Yekaterinburg districts. Among 58 children with goiter as shown by ultrasonography, 18 were initially diagnosed as having hypertrophic AIT; 38patients had diffuse euthyroid goiter; one patient had diffuse toxic goiter; and mixed euthyroid goiter was detected in one case. At one-year follow-up, re-examination rejected the diagnosis of AIT in 13 of the 18 patients. It was concluded that: (1) the follow-up of children with a presumptive diagnosis of AIT suggests that the latter plays a much less role in the etiological pattern of diffuse euthyroid goiter as compared with the data of the primary examination; (2) most changes originally interpreted as manifestations of AIT are reversible, which suggests that it is preferable to follow-up children with a presumptive diagnosis of AIT in the phase of euthyrosis under active therapeutic intervention.

The purpose of the study was to define indications for surgical treatment and its scope in patients with secondary hyperparathyroidism in the presence of end-stage chronic renalfailure. The authors examined 80 patients who had a history of long-term procedures of hemo- or peritoneal dialysis. The patients’ mean age was 47±3.2 years. Measurements of the levels of alkaline phosphatase, ionized and total calcium, phosphorus, parathyroid hormone, ultrasound of the parathyroid glands, densitometry and X-ray study were made in all the patients. All the patients received alfacalcidole therapy during different periods of time. Clinical, laboratory, and morphological correlations were made to establish indications for surgical treatment. The sensitivity ofpreoperative ultrasonography was 72.5% and that of intraoperative ultrasound study was as high as 98.4%. The sensitivity of intraoperative revision was 75%. Sixteen of the 20 patients operated on underwent total parathyroidectomy by autografting a fragment of one of the least glands into the muscle. Subtotal parathyroidectomy was made in 3 patients; 3 parathyroid glands were removed in 1. Emergency and planned studies were performed in all the patients. The duration of the patients operated on averaged 14 months. Three patients undergone total parathyroidectomy with autografiing developed signs of hyperparathyroidism following 6, 12, and 13 months, in this connection graft resection was made in these patients. In the follow-up periods of 3 to 6 months, the level of parathyroid hormone became normal after resurgery in 2 of these patients, hypoparathyroidism developed in one patient. Two months after surgery, recurrent secondary hyperthyroidism was detected in 2 of the 3 patients who had undergone subtotal parathyroidectomy (4 and 7 months after the occurrence of signs of transient hypoparathyroidism) and in 1 patient in whom 3 parathyroid glands had been removed. Four of the 20 patients operated on were observed to have hypoparathyroidism that was compensated by calcium preparations and active forms of vitamin D3. Thus, a good result was noted in 70% of the patients after surgical treatment.

The papers examines the specific features ofsteroidogenesis in the adrenal cortex ofpatients with different types of tumors and analyzes the ratio of ∆₄- to ∆₅-pathways of corticosteroid biosynthesis, which is a governing factor in the development of adrenal cortical hyperfunction. The levels of all major corticosteroids (cortisol, aldosterone, androgens of the adrenals) and their precursors were studied in the peripheral blood of patients with corticosteroma, aldosteroma, androsteroma, and hormonally inactive tumors (in the morning and in the evening). Based on the calculation of the mean daily concentration of steroids and the ratio of product/substrate of an enzymatic reaction in the biosynthesis of corticosteroids, the authors determined the activity of some enzymes and analyzed the changes found in this activity as compared with the normal values.

The findings indicate that in corticosteroma, the higher activity of 11β-hydroxylase and the lower activity of 17,20-desmolase leads to a biosynthesis shift to ∆₄-pathway; in virilizing tumor, the enhanced activity of Зβ-olsteroid dehydrogenase results in the same shift; in aldosteroma, the ratio of biosynthesis pathways does not differ from the normal values. The significant scatter in the individual values when the blood concentrations were determined in patients with hormonally inactive tumors fails to make an unambiguous conclusion about the activity of steroidogenic enzymes and about the direction of biosynthesis in these patients.

The article is devoted to the current methods for diagnosis of primary hyperparathyroidism.

The article is devoted to the clinical recommendations of the Russian Association of Endocrinologists for the diagnosis and treatment of autoimmune thyroiditis in adults.

The article is devoted to the clinical recommendations of the Russian Association of Endocrinologists for the diagnosis and treatment of autoimmune thyroiditis in children.

The article is devoted to the q-infarction in a female patient with thyrotoxicosis.

Placement of a sexually receptive female mouse behind a partition that prevents physical contacts, but permits it to see and smell caused an increase in the blood levels of testosterone in male mice. The selective 5-HTIA-serotonin receptor agonist 08-OH- DPAT (0.1 mg/kg) and the mixed 5-HTIA/IB agonist eltoprazine, 3.0 and 10.0 mg/kg, blocked the activating effect of female exposure on the male pituitary-testicular system. The 5-HT/-receptor agonist p-MPPI (0.2 mg/kg) prevented the inhibitory effects of 8-OH-DPATand eltoprazine. The 5-HT/B-receptor agonist CGS- 12066A (1.0 and 2.0 mg/kg) exerted no effect while the mixed 5-HTIB/2C-receptor agonist TFMPP (5.2 mg/kg) inhibited a female-induced increase in the levels of male blood testosterone. The 5-HT/-receptor agonist keranserin (1.0 and 2.0 mg/kg) prevented a female-induced increase in the levels of testosterone. The 5-HT3-receptor agonist ondansetron (0.05 and 0.1 mg/kg) elevated the baseline level of plasma testosterone, but blocked receptive female-induced activation of the male hypothalamic-pituitary-testicular system (HPTS). It is concluded that 5-HTIA-receptors are involved in the control of male sexual activation. At the same time different types and even subtypes of the same type of 5-HT-receptors produce varying inhibitory and activating effects on the receptive female-induced activation of HPTS. Blocking of the female-induced activation of HPTS seems to be realized by involving 5-HTu- and 5-HT2C-receptors and its activation occurs with the participation of 5-HT^- and 5- HT3-receptors.

Experiments on non-inbred male mice used a model of rotational stress to examine the impact of δ-, μ- κ-opiate receptor blockade on antibody formation, delayed-type hypersensitivity (DTH), changes in the count of antibody-forming cells (AFC) and nucleated cells of lymph nodes and spleen during a local immune response. Rotational stress was found to cause a slightly pronounced inhibition of immune inflammation in DTH, a considerable increase in the count of AFC and nucleated cells in the regional lymph nodes, without changing the titers of antibodies from peripheral blood. Naloxone blockade of δ-, μ- κ-opiate receptors abolished these effects of stress. It has been suggested that abolishment of the promoting effect of rotational stress on the count of AFC and on the depression of DTH may be associated with the blockade of effects of β-endorphin and met-enkephalin that act predominantly via stimulation of δ-receptors.

The article is devoted to the thyroid nodal masses.