The objective of the present retrospective study was to evaluate the results of the long-term treatment of the patients suffering from active acromegaly with octreotide. It included a total of 48 patients at the age from 30 to 77 years (15 men and 33 women) of whom 18.7% and 81.2% presented with pituitary microadenoma and macroadenoma respectively. All the patients were given long-acting octreotide either as primary or as adjuvant therapy at a dose of 20-40 mg once every 28 days for 3 years. The treatment resulted in the remission in 9 (100%) patients having pituitary microadenoma and 9 (23%) ones with macroadenoma. By the end of the 3-year treatment period the clinically significant decease of the tumour volume was documented in 9 (100%) and 32 (82%) patients presenting with microadenoma and macroadenoma, respectively.

Scarce clinical manifestations of prolactin-secreting pituitary tumors in children and adolescents make it difficult to timely diagnosis. Girls have more prevalence of microprolactinomas, manifests as a rule, menstrual irregularities. In males, the greater incidence of macroadenomas results in the presence of neuroophthalmologic signs. The diagnosis of prolactinomas requires both radiographic evidence of pituitary adenoma and laboratory analysis of sustained hyperprolactinemia.

The risk of devolvement of type 1 diabetes mellitus (DM1) remains a challenging problem because neither etiology of the disease nor its prognosis and genetic predisposition to this condition are clearly understood. The development of any autoimmune process starts from the disturbance of subtle molecular mechanisms involved in the regulation of the immune system. Therefore, the genes controlling the function of its major components are at the same time the potential candidate genes encoding for the predisposition to DM1. Their association with the disease was studied by means of comparative analysis of the frequency distribution of alleles and genotypes of the polymorphous rs3087243 (G6230A) marker of the CTLA4 gene encoding for antigen-4 of cytotoxic T-lymphocytes. The present study included 257 patients presenting with type 1 diabetes mellitus and 526 healthy subjects. Genotypes were identified by the "real time" amplification technique. The AA genotype was found to occur less frequently in the diabetic patients than in the control group (11.3% and 22.1% respectively). In contrast, the frequency of the GG genotype was higher in the patients with DM1 than in the healthy subjects (44.7% and 37.5% respectively). It is concluded that the polymorphous rs3087243 marker of the CTLA4 gene is significantly associated with the predisposition to the development of type 1 diabetes mellitus in the patients of Russian descent.

Type 2 diabetes mellitus (DM2) is the most common form of diabetes characterized by the disturbances of carbohydrate, protein, and lipid metabolism including dyslipidemia and elevation of the low-density lipoprotein (LDLP) levels. Lipoprotein-X (LP-X) represents an anomalous subclass of LDLP a distinctive feature of which is the high content of phospholipids and non-esterified cholesterol coupled with the low level of cholesterol ethers, triglycerides, and proteins. LP-X was detected in the blood of the patients with various diseases of the liver and biliary ducts associated with cholestasis. The results of our previous investigations suggest the presence of LP-X in the blood of the patients with familial Mediterranean fever and ischemic stroke complicated by concomitant diabetes mellitus. The objective of the present work was to elucidate whether LP-X actually occurs in the blood of the patients presenting with type 2 diabetes mellitus. We used the method of polyanionic precipitation of LDLP preliminarily separated by agar gel electrophoresis. The study has demonstrated for the first time the presence of LP-X in the blood of the patients with type 2 diabetes mellitus. Its possible pathogenetic role and mechanisms of LP-X generation in DM2 are discussed.

The objective of the present work was to estimate the degree of rigidity of the vascular wall and endothelial function in the patients with type 1 diabetes mellitus at different stages of diabetic retinopathy and in its absence. The study included 118 patients at the age from 18 to 40 years presenting with type 1 diabetes mellitus more than 5 years in duration. The patients were divided into several groups based on the stage of diabetic retinopathy (DR). The control group was comprised of 23 healthy subjects. The contour pulsed wave analysis and the reactive hyperemia test were performed with the use of an Angioscan device. All the patients gave the informed consent to participate in the study. The aortic stiffness index (SI) in all groups of the patents with DM1 and DR was higher than in the healthy subjects. However, the SI values remained normal in the DM1 patients without DR. An increase of SI values was unrelated to the presence of arterial hypertension. The analysis of RI values revealed no statistically significant differences between the groups. The reactive hyperemia test has demonstrated a decrease in the increment of the post-occlusive signal amplitude in a large number of patients suggesting endothelial dysfunction. This decrease was apparent even in the patients exhibiting no signs of retinal damage. However, despite the overall decrease of this parameter, many patients showed its paradoxically high values that probably reflected the elevated baseline level of nitric oxide. The increase of aortic stiffness index with the progression of diabetic retinopathy may be used as an early marker of macrovascular complications even in the patients without arterial hypertension. The lowering of the increment of the post-occlusive signal amplitude in the patients having no signs of retinal damage is indicative of endothelial dysfunction as early as the preclinical stage of DR development. The paradoxically high increment of the signal amplitude is supposed to be associated with the elevation of the baseline level of nitric oxide that in its turn reflects the severity of inflammation and is a factor of high risk of progression of angiopathies.

This work was designed to study the relationship between the disturbances of carbohydrate metabolism (DCHM) and insulin resistance (IR) on the one hand and body mass index (BMI) and waist circumference (WC) on the other hand in the patients presenting with acute and cicatrical myocardial infarction (MI). It was shown that WC in all the patients exceeded the upper gender norm. The clinical manifestations of metabolic syndrome were documented in 65.6% of the patients with normal BMI, 85,7% of those with excess BMI, and in 96.3% of the patients with obesity. In all the groups the WC measures positively correlated with the glucose blood level at admittance to the hospital and on days 1 (r=0.34; p=0.01), 2 (r=0.38; p =0.0002), and 3 (r=0.68; p=0.002) after it. Similar correlation was observed with the insulin level 2 hours post-prandially on days 1 (r=0.42; p=0.01), 2 (r=0.5; p=0.0002), and 3 (r=-0.95; p=0.0003). The relationship between metabolic disorders and WC values indicates that visceral fat plays an important role in the regulation of metabolic processes and suggests the necessity of the treatment for the correction of WC.

The results of analysis of the legislation pertaining to the quality of provision of medicines for the patients with diabetes mellitus and bronchial asthma (SWOT analysis) are presented with special reference to its current status in the Republic of Kazakhstan.

The present review is concerned with the up-to-date methods currently available for diagnostics of endogenous hypercorticism. The clinical picture of this condition is considered in conjunction with the epidemiological data, identification of risk groups and the choice of the patients for the screening studies. The main attention is given to the diagnostic modalities of the highest informative value, technically simple and providing readily interpretable results, viz. measurement of cortisol in daily urine, minor dexamethasone test, determination of cortisol in evening saliva). The estimation of sensitivity of these techniques, their specificity, and cut-off values is discussed. The procedures and limitations of each test are described in much detail. In addition, an algorithm for the performance of two or more tests is proposed allowing to lower the maximum sensitivity and specificity levels of the determination. The methods of screening are presented in such a way as to facilitate their practical application by the general practitioners and specialists in related disciplines for the establishment of diagnosis of endogenous hypercorticism (but not elucidation of its origin).

According to publications in the foreign literature, the incidence of secondary testicular structures in the patients with congenital adrenal cortical dysfunction (CACD) amounts to 90%. In this country, the scheduled screening for TART tumours in the male patients presenting with CACD is not carried out. At the same time, the late consequences of this pathology (infertility, obstructive testicular diseases) require increasingly more attention starting from the early childhood.

Obesity, type 2 diabetes mellitus, and atherosclerosis are associated with the development of "metabolic" inflammation. The proinflammatory mechanisms in adipocytes and macrophages are initiated by both extracellular mediators (cytokines, saturated fatty acids) and intracellular processes (endoplasmic reticulum stress, excessive production of free radicals). An important role in the development of "metabolic" inflammation is played by protein transporters of fatty acids ("fatty acid-binding proteins").

The results of clinical and experimental studies of a new group of medications are presented, with special emphasis laid on the inhibitors of sodium-glucose co-transporter SGLT2 employed for the treatment of type 2 diabetes mellitus. The mechanism of action of these inhibitors consists of the stimulation of glucosuria and the subsequent decrease of hyperglycemia. The new group of pharmaceutical products being considered is characterized by high therapeutic efficacy, safety, and the narrow spectrum of side effects. The most important adverse reactions are infectious lesions in the urinary tract and genital organs.

This review discusses publications on the usage of biphasic analogue insulin aspart 30/70 (NovoMix 30) in the treatment of patients with type 2 diabetes mellitus. Data on the clinical and pharmaco-economic advantages of NovoMix 30 versus biphasic human insulin was analyzed. The problems of doctor's clinical inertia and patient's psychological insulin resistance, as well as possible solutions to key problems of insulin therapy with help of biphasic insulin aspart 30/70 were discussed.