The present work was designed to study parameters of calcium and vitamin D metabolism in the patients presenting with morbid obesity (MO) including those who had undergone biliopancreatic diversion bypass (BPD). The patients were allocated to three groups. Group 1 was comprised of the patients with BMI in excess of 40 kg/sq.m. (n=22), group 2 included the patients after BPD (n=23), and group 3 (control) consisted of the healthy volunteers having normal body weight in the absence of signs of obesity (n=22). The three groups were significantly different in terms of consumption of vitamin D (p<0.001). Four 4 (18%) patients with morbid obesity and 12 (52%) patients in group 2 had elevated parathyroid hormone (PTH) levels that remained normal in all the subjects of group 3. The comparison of the incidence of secondary hyperparathyroidism (SHPT) in the patients of groups 1 and 2 confirmed its higher occurrence among the operated patients (p=0.029). In other words, the patients with MO significantly more frequently experience deficiency of vitamin D than the subjects of the control group (p=0.007). Examination of the patients who had undergone biliopancreatic diversion bypass demonstrated a higher incidence of SHPT developing in the late postoperative period.

We have studied the frequency of antibodies, markers of coeliac disease, in the children presenting with type 1 diabetes mellitus and obtained clinical and metabolic characteristics of seropositive and seronegative groups. The study included 499 diabetic children and adolescents admitted to the Pediatric Department of the Endocinological Research Centre. They were examined for the presence of anti-gliadin antibodies (anti-GL) and antibodies against tissue transglutaminase (anti-TG). These serological markers of coeliac disease were detected in 7.4% of the patients. More specific anti-TG occurred in 3.2% of the cases. As many as 29.7% of the seropositive patients with DM1 had gastrointestinal symptoms, such as stool disturbances, abdominal distension and pain, vomiting, and reduced appetite. Similar symptoms were documented in 11.7% of the seronegative children. Iron deficiency anemia was diagnosed in 24.3 and 8.6% of the seropositive and seronegative patients respectively (p<0.05). There was no significant difference between the children with type 1 diabetes mellitus having serological markers of coeliac disease and the seronegative patients in terms of anthropometric characteristics, plasma levels of glycated hemoglobin and vitamin D. It is concluded that the presence of serological markers of coeliac disease is association with a number of clinical manifestations confirms the necessity of immunological screening for coeliac disease among patients with DM1.

Stage 1 of the present study was designed to estimate the incidence of abdominal obesity among 878 schoolchildren aged between 7 and 13 years using the percentile tables for the waist circumference (WC) in the children's population of the United Kingdom and from the WC/height ratio that makes it possible to identify children at the highest risk of metabolic disturbances. The incidence of abdominal obesity based on the criterion of WC≤90th percentile (PC) for the age and the sex was estimated to be 33.1% for the entire group in the absence of significant difference between boys and girls (30.7% vs 35,5%). The incidence of abdominal obesity based on the criterion of WC/height ratio with a threshold value of ≤0.5 was 9.9% for both sexes in the entire group; it was significantly higher in the boys than in the girls (13.1% vs 6.9%). At the second stage of the study, the group of the children having WC≤90th percentile (n=51) showed significantly higher systolic and diastolic arterial pressure, blood triglyceride and insulin levels and HOMAIR index but lower HDL levels than control patients with WC < 90th percentile (n=28). The results of the study suggest the high incidence of abdominal obesity among young schoolchildren residing in large cities. Moreover, such children tend to develop metabolic disturbances and are at risk of cardiovascular diseases.

The objective of the present study was to estimate the frequency of defects of AR and SRD5A2 genes in the 46XY patients of the Russian population with abnormal sex formation and disturbed peripheral action of androgens. Moreover, we assessed the diagnostic value of hormonal characteristics for the differentiation between the above patients and those having 46XY and normal testosterone secretion.

The objective of the present study was to evaluate the efficacy and safety of the application of the new soluble pharmaceutical form of Rastan for subcutaneous injections at a dose of 15 IU/ml and compare its action with that of Rastan lyophilisate, 4 IU, designed to prepare solutions for subcutaneous administration. The two dosage forms are used to treat children suffering from growth hormone deficiency. The study included patients at the age from 4 to 12 years presenting with idiopathic growth hormone deficiency; they were randomized into two groups. During the first three months, the patients of both groups were treated with different pharmaceutical forms of recombinant growth hormone (rGH). The children in group 1 were given Rastan for subcutaneous injections and those in group 2 received Rastan lyophilysate for the preparation of solutions for the subcutaneous administration. Either form of GH was used at an equal daily dose of 0.033 mg/kg b.w. The patients of both groups showed marked improvement of the parameters of linear growth within the first three months. The difference in the growth rates was not significantly different between the two groups which suggests the identical effect of the two forms of rGH. During the next 9 months when the patients of both groups were treated only with the rGH for subcutaneous injections, the absolute growth response, height SDS, and the level of insulin-like growth factor 1 (IGF-1) continued to increase. It points out to the stable growth-promoting effect of Rastan for subcutaneous injections. No clinically significant abnormal changes in the results of complete blood cell count and biochemical analysis of blood were apparent during 12 months of therapy with this form of rGH. The same was true of the levels of free T4, cortisol, and prolactin in the blood. No adverse effects attributable to the therapy with rGH were documented.

The introduction of novel insulin analogs into medical practice requires clinical data confirming their comparability with the currently used preparations. The objective of present work was to compare the hypoglycemic action of a single injection of Rinsulins NPH and P (Natsional'nye tekhnologii, Russia) on the one hand and insulins Protaphane and Actrapid (Novo Nordisk, Denmark) on the other hand in 18 insulin-naïve patients with type 2 diabetes mellitus treated in the hospital environment. The tested analogs were randomly administered to the patients within 4 days after hospitalization. Blood glucose levels were measured ten times each day. No significant difference in the dynamics of glycemia between the patients treated with either group of preparations was documented.

Aim: to elucidate causes of primary refractoriness to phosphodiesterase type 5 inhibitors. Materials and methods: 28 men aged from 38 to 59 (mean 46) years suffering from erectile dysfunction and primary refractoriness to the treatment with phosphodiesterase type 5 inhibitors were interviewed using the International Index of Erectile Function (IIEF-5) questionnaire. In addition, they were examined by ultrasound dopplerography of penile vessels, subjected to neurologic testing and measurement of blood testosterone, TSH, prolactin, and glucose levels. Results and discussion: The primary refractoriness to the treatment with phosphodiesterase type 5 inhibitors was attributable to hypothyroidism in 3.5% of the cases, to diabetic neuropathy in 3.5%, to complications of radical prostatectomy in 3.5%, to hyperprolactinemia in 7%, to atherosclerosis of cavernous arteries in 7%, to venogenic erectile dysfunction in 7%, to hypogonadism in 11%, to combination of hypogonadism, diabetic neuropathy and angiopathy in 57%. Hypothyroidism, hyperprolactinemia, hypogonadism, and type 2 diabetes mellitus (12.5% of the cases) were detected for the first time in the examined patients. Pathogenetic therapy resulted in the elimination of erectile dysfunction in the patients presenting with hypothyroidism, hyperprolactinemia, and isolated hypogonadism. Combined treatment of erectile dysfunction with Nebido and Levitra proved efficacious in 14 of the 16 patients with combined hypogonadism, diabetic neuropathy, and angiopathy. Conclusion: The main causes of primary refractoriness to phosphodiesterase type 5 inhibitors appear to be endocrinopathies and diabetic neuro/angiopathy. Combined examination of the patients in these conditions makes it possible to reveal dangerous disorders. Self-treatment with phosphodiesterase type 5 inhibitors is undesirable. Medicamental therapy (including combined application of testosterone preparations and phosphodiesterase type 5 inhibitors) permits to cope with erectile dysfunction in 75% of the patients.

Carcinoid syndrome develops as a sequel of enhanced secretion of vasoactive substances from neuroendocrine tumours (NET). Somatostatinoma is an extremely rare variant of NET that manifests itself in cholelithiasis, steatorea, and diabetes mellitus. Somatostatinoma is usually diagnosed in adult subjects. Carcinoid syndrome is not a typical consequence of somatostatinoma. We present the first case report of somatostatinoma that was diagnosed in a child having carcinoid syndrome. The diagnosis was made difficult by the negative results of the search for biochemical markers of carcinoid syndrome and the small size of the primary tumour that could not be visualized by computed tomography. The immunohistochemical studies demonstrated secretion of somatostatin and calcitonin. The treatment of the child with somatostatin analogs proved inefficient which can be accounted for by the late diagnosis of the disease and the extensive metastatic process.

We have studied the role of pregnancy hormone (chorionic gonadotropin, CG) in the control of expression of Foxp3 (a marker of T-regulatory lymphocytes, Treg), synthesis of interleukin-4 (IL-4) and interferon-gamma (IFH-γ) in lymphocytes, and secretion of indolamine-2,3-dioxygenase (IDO) by monocytes. Moreover, we evaluated the phagocytic and oxidative activities of these cells. It was shown that incubation of CG at a dose of 100 IU/ml with mononuclear cells from peripheral blood (MPC) resulted in a rise in the relative number of IL-4+CD3+CD4+T-lymphocytes whereas the number of IFN-γ+CD3+CD4+T-cells remained unaltered; the intracellular production of IFN-γ and IL-4 in the subpopulation of CD3+CD8+T-lymphocytes did not change either. In vitro, CG (10 and 100 IU/ml) significantly increased percentage of CD4+CD25 brightFoxp3+ cells and enhanced activity of indolamine-2,3-doxygenase in lipopolysaccharide-stimulated MPC. CG suppressed phagocitosis of E. coli lux+ by monocytes and simultaneously inhibited the production of active oxygen species in the reaction of spontaneous luminol-dependent chemiluminescence. Taken together, these properties of CG account for its role in the promotion of the formation of immunological tolerance during pregnancy.

The present review concerns diagnostics of Cushing's disease in the children with special reference to its different stages, relevant pharmacological tests and instrumental methods used for the purpose. The clinical course of the disease is described.

This review considers the role of adenovirus 36, Chlamydia pneumoniae, Helicobacter pylori, and Trypanosoma cruzi in pathogenesis of obesity. Infection with either of the three microorganisms leads to the development of obesity in animals. The infected people usually have antibodies to these bacteria. One of the causes of obesity is believed to be activation of the receptors of the innate immune system (TLR2 and TLR4) by certain factors of the microorganisms; these receptors are known to localize in the adipose tissue. Saturated fatty acids as well as lipoploysaccharides (components of the microbial cells) are the ligands of TLR2 and TLR4. Activation of TLR2 and TLR4 promotes the development of both inflammation in the adipose tissue and insulin resistance and thereby leads to obesity. The mechanism of action of activated TLR2 and TLR4 during microbial infection consists of the suppression of sensitivity of adipose, hepatic, and muscular cells to insulin in conjunction with the enhancement of the blood glucose and fatty acid levels to produce the energy-rich substrates necessary to maintain the immune processes. The fact that saturated fatty acids and components of microbial cells can function as ligands for the receptors of the innate immune system and induce identical reactions gives evidence of the possible cumulative action of both excessively consumed dietary items and certain species of microorganisms.