The final glycated products forming in diabetes contribute to the higher atherogenic oxidative modification of low-density lipoproteins (LDL). The impact of glycemic control on the parameters of free radical oxidation was comparatively studied in patients with type 2 diabetes who received metformin (Glucophage, Nycomed) (Group 1, n = 40) and sulfanylurea preparations (Group 2, n — 30, out of them 15 patients took maninil and 15 had diabeton) good glycemic control caused the magnitude of oxidative stress to reduce, which appeared as the decreased levels of primary (lipid hydroperoxides) and secondary (malonic dialdehyde) products of free radical oxidation in LDL and as the enhanced activity of antioxidative defense enzymes. However, with the identical degree of glycemic control, which was determined by the level concentrations of Hb_A1c and lipids in both groups, the plasma levels of lipid peroxides decreased by more than 5 times in Group 1 patients receiving metformin than in Group 2 patients and the rate of LDL oxidability reduced by 4.5 times. Such a marked effect of metformin on the attenuated manifestations of oxidative stress is indicative of its antioxidative effect independent of the hypoglycemic effect of the drug.

The right of a patient to self-determination is a right to non-intervention; a right to take a decision on his life, by precluding the others' control. The patient's personality independence is physical and mental immunity when health care is delivered. In practice, this right Is exercised through the principle of informed consent (1С). To adapt 1С to the specific pediatric task, attention should be drawn: to the form of providing information to parents and their child; individual deviation from a general form; 1С as the parents' obligations; 1С as a document - status, coverage; cases when it is necessary to get a child's approval for the manipulations to be performed. The paper considers whether it is expedient to strengthen the fixed minimum information standard by statutory acts for each specific clinical case by the example of diabetes mellitus in pediatric care.

A number of today's analytical methods for postprandial glycemia in the oral glucose tolerance test (OGTT) still remain to be substantiated. The standard OGTT using 75 g of glucose was performed in 42 type 2 diabetes mellitus (DM-2) patients who received diet therapy. The concentration of Hb A_1c has been found to correlate with absolute levels of glycemia during 1- and 2-hour OGTT. However, exclusion of fasting glycemia from the level of glycemia at 1 and 2 hours of OGTT leads to cession of the correlation of HbA_1c with these values of the test. Only 7 out of the 8 today's parameters for calculating the areas under the glycemic curve in OGTT correlate with the level of HbA_1c. Moreover, 5 out of these 7 parameters are equivalent (r - 1; p < 0.05). The recently proposed two new parameters for calculating the areas under the glycemic curve in OGTT, one of which is constant 6.1, have proved to be equivalent (r= 1; p < 0 05) and to be actually reduced to one. The correlation with Hb A_h holds if any other constants from 5 to 11 mmоl/l are inserted instead of the constant 6.1 for calculating the area, the highest coefficient correlation with Hb A_1c is achieved at the constant equal to 6.1. The correlation usually detectable at DM-2 between the concentration of Hb A,_c and the absolute level of postprandial glycemia (glycemic spike in particular) Is mainly determined by its implicit inclusion of fasting glycemia. A set of 4 nonequivalent OGTT parameters should be used when the relationship of diabetes mellitus complications to the OGTT parameters that correlate with HbA,_cis studied. The constants 5.6 and 6.1 reflect different aspects of the development of complications in diabetes mellitus when they are included in the calculation of an area in OGTT.

Twenty-five patients with type 2 diabetes (DM-2) and its moderate initial decompensation (8.83±1.85%) were examined. The mean age of the examinees was 53.16±8.92 years; the duration of the disease was 2.50±3.06 years. There were 18 females (mean age 54.11 ±9.67 years) whose disease duration was 2.71±3.08 years and 7 males (mean age 50.7 1±6.63 years) with a disease duration of 1.95±3.17 years. Before prescribing metformin, all the patients received diet therapy, but without making a special monitoring of the calorie content of a diet. All the patients were given metformin in an initial daily dose of 500 mg. Later on the daily dose of metformin was increased up to 1000-1500 mg. Metformin treatment was performed during low-calorie diet (as high as 1200 kcal daily); compliance was monitored by an individual dietary diary. In patients with DM-2, metformin exerted a positive effect on fasting glycemia (p = 0.001) and postprandial hyperglycemia (absolute and relative areas under the curve in the oral glucose tolerance test (OGTT)). At the same time there were no perceptible changes in the level of glycated hemoglobin (p = 0.533). Although metformin caused a noticeable decrease from 5.75±4.72 to 3.97±2.71, it was yet statistically insignificant (p = 0.181). In patients with DM-2, metformin therapy enhanced a low-calorie diet-induced body weight loss, most markedly within the first three months of therapy. At the same time, a meta-analysis has shown that this effect of metformin is rather moderate (p = 0.02). Metformin treatment for MD-2 during low-calorie diet improves lipid metabolism, by significantly decreasing the levels of total cholesterol and low-density lipoproteins, and lowers systolic blood pressure.

Obesity is one of the urgent problems of modern health care. In the 21st century, obesity, one of the most common chronic diseases, takes on the character of a global epidemic, covering almost all countries and peoples of the world. WHO experts suggest that the number of people with obesity by 2005 compared with 2000 will increase by almost 2 times and amount to more than 300 million people. Every year, the situation is getting worse, obesity is getting younger, it becomes a problem not only for adults, but for children and adolescents. Currently, in developed countries, up to 20% of adolescents are overweight, and 15% are obese. In the Russian Federation, 5.5% of children living in rural areas and 8.5% of children in urban areas are obese. Obesity is a social problem, as it leads to early disability and reduces the average life expectancy. Finally, obesity accompanies diseases such as type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, as well as insulin resistance and hyperinsulinemia.

The daily time course of changes In the secretion of dehydroepiandrosterone, its sulfate, and Cortisol, as well as their precursors (17-α-hydroxypregnenolone, 17-α-hydroxyprogesterone, and 11-deoxycortisol) was studied in patients with Itsenko-Cushing syndrome and disease. The mean daily blood concentrations were calculated for each hormone. The activity of the enzymatic systems of steroidogenesis was estimated from the ratio of the mean daily concentrations of the precursor of an enzymatic reaction to those of its product. The findings suggest that production of elevated concentrations of corticosteroids (both Cortisol and androgens) through the Δ⁵-pathway with the enhanced activity of 11β-hydroxylase and sulfatase is characteristic of patients with Itsenko-Cushing disease. In patients with Itsenko-Cushing syndrome, the generation of higher Cortisol levels is accomplished through the Δ⁴-pathway whereas the synthesis of androgens through the Δ⁵-pathway is minimal due to the decreased activity of 17,20-desmolase.

The paper deals with the problems In the biochemical diagnosis of congenital adrenal hyperplasia caused mainly by adrenal 21-hydroxylase deficiency. It presents data on the adrenal cortical synthesis of corticosteroids and discusses whether different biochemical markers, including the levels of blood deoxycortisol and those of urinary pregnantriol and pregnantriolone, may be used in neonatal screening and later diagnosis of congenital adrenal hyperplasia.

The levels of the methylated catecholamine derivatives (MCD) metanephrine and normetanephrine were measured in 46 patients operated on. The patients were divided into 2 groups: 1) 24 patients in whom chromaffinoma was histologically detected; their age varied from 9 to 75 years (mean 37.8 years); 2) 22 patients who had undergone adrenal cortical tumors or retroperitoneal tumors of extraadrenal genesis; their age ranged from 11 to 67 years (mean 44.3 years). In this group of patients, a histological study revealed aldosteromas in 7 cases, hormonally inactive adrenal cortical adenomas in 6, adrenocortical carcinoma in 5, corticosteroma in 1, adrenal lymphosarcoma in 1, adrenolypoma in 1, and renal cancer in 1. In all the patients from Group 1, there was an increase of one MCD index for instance of less than 110% of the upper normal range. The average excess of MCD levels over the upper normal range is 456% for metanephrine and 574% for normetanephrine. No increase in the level of daily MCD excretion was found in 21 out of the 22 Group 2 patients with nonchromaffin adrenal and retroperitoneal tumors. In this group, 1 patient with histologically verified mixed-cell adenocarcinoma of the adrenal cortex was observed to have a daily metanephrlne excretion increase by 17% above the upper reference range. Thus, the sensitivity of the method was 100%; its specificity was 95.5%. The lower confidence diagnostic interval for the values of daily MCD excretion was 714 ng/day for metanephrlne and 1500 ng/day for normetanephrine. The procedure for determining free MCD in plasma has a high sensitivity and specificity and may be once used as a screening for the symptomatic nature of disease in patients with arterial hypertension.

The purpose of the study was to estimate the incidence of thyroid dysfunction and cardiovascular diseases in perimenopausal females. The cross-sectional study covered 554 females (mean age 52.6±6.1 years). The levels of thyroid-stimulating hormone (TSH), total cholesterol (TC), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL), the incidence of arterial hypertension (AH), coronary heart disease, chronic heart failure, myocardial infarction, cerebral circulatory disorders, and the severity of menopausal syndrome (MS) were determined. The study detected euthyroldism in 381 (68.8%) patients, hypothyroidism in 168 (30.3%), out of them 35 (20.8%) patients having primary hypothyroidism, and hyperthyroidism in 5 (0.9%) females. Out of the 133 patients receiving L-thyroxine therapy, hypothyroidism was compensated. In 78(58.7%) cases, the dose of L-thyroxine was inadequate. The level of LDL was significantly higher in hypothyroidism; the median of TC was higher than the normal levels in both groups. There were no differences in the incidence of vascular disease between the groups. In both groups, AH was encountered In more than 60% of cases. The females with hypothyroidism had a more severe course of MS. With the adequate dose of L-thyroxine, the level of HDL was significantly higher and that of triglycerides and VLDL was lower than in hypothyroidism. It is expedient to include the measurement of TSH levels into the algorithm of examination of patients with severe MS.

The purpose of the study was to estimate the incidence of thyroid dysfunction and cardiovascular diseases in perimenopausal females. The cross-sectional study covered 554 females (mean age 52.6±6.1 years). The levels of thyroid-stimulating hormone (TSH), total cholesterol (TC), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL), the incidence of arterial hypertension (AH), coronary heart disease, chronic heart failure, myocardial infarction, cerebral circulatory disorders, and the severity of menopausal syndrome (MS) were determined. The study detected euthyroldism in 381 (68.8%) patients, hypothyroidism in 168 (30.3%), out of them 35 (20.8%) patients having primary hypothyroidism, and hyperthyroidism in 5 (0.9%) females. Out of the 133 patients receiving L-thyroxine therapy, hypothyroidism was compensated. In 78(58.7%) cases, the dose of L-thyroxine was inadequate. The level of LDL was significantly higher in hypothyroidism; the median of TC was higher than the normal levels in both groups. There were no differences in the incidence of vascular disease between the groups. In both groups, AH was encountered In more than 60% of cases. The females with hypothyroidism had a more severe course of MS. With the adequate dose of L-thyroxine, the level of HDL was significantly higher and that of triglycerides and VLDL was lower than in hypothyroidism. It is expedient to include the measurement of TSH levels into the algorithm of examination of patients with severe MS.

An attempt was made to interpret the mechanism responsible for the occurrence of pituitary tumors - prolactinoma in persons of different sex. The presence or absence of androgenic receptors in the tumors was studied. Analysis of the concentration of nuclear receptors, estrogen ones in particular, showed their higher concentration in prolactin-positive pituitary adenomas than in inactive pituitary adenomas. Androgen receptors were detected in the gonadotropic and lactotropic cells of the Intact pituitary. Analysis of the concentration of nuclear testosterone receptors in different morphological types of pituitary adenomas revealed no differences in the luteinizing hormone/follicle-stimulating hormone-positive and prolactin-positive tumors

The growth of a child has a significant impact on its development and adaptation in modern society. In various periods of life, the growth process depends on many exogenous and endogenous factors. Impaired development at any stage of life can lead to stunting, which affects up to 3% of the adult and children's population.

What is the significance of stunting in a child’s life? Does the quality of life of a child depend on his height? These issues are actively debated.

In 2005, the Vidar Publishing House published a monograph "Diseases of the thyroid gland in the region of mild iodine deficiency" authored by a doctor of medical sciences, associate professor of the endocrinology department of the Moscow Medical Academy named after I. M. Sechenova Valentin V. Fadeyev.

The monograph devoted to one of the most important sections of endocrinology - thyroidology, is based on the author’s own materials accumulated during the work on his doctoral dissertation, and largely reflects the author’s personal views.

75 years have passed since the birth and 50 years of medical activity of the outstanding Russian endocrinologist, professor, doctor of medical sciences, laureate of the State Prize of the Russian Federation Yevgenia I. Marova.