A total of 60 patients given substitution treatment with levothyroxin for diffuse toxic goiter were examined within 3-7 years after iodine radiotherapy. The patients showing different TSH levels were allocated to three groups: (group 1: low normal TSH level: 0.4-2.25 mcIU/ml; group 2: high normal TSH level: 2.6-4.0 mcIU/ml; group 3, decompensated hypothyroidism: above 4.0 mcIU/ml but lower than 10 mcIU/ml). The quality of life was assessed with the use of the abridged version of the SF-36 questionnaire and the psychoemotional status based on the Beck depression inventory and the Spilberg-Khanin test. The patients presenting with compensated hypothyroidism showed better characteristics of the quality of life compared with the patients of other groups. Moreover, they were less frequently subjected to anxiety and depressive disorders. It is concluded that replacement therapy with levothyroxin designed to maintain the TSH level within the low normal values ensures a higher quality of life and lower incidence of depressive disorders than in the patients having TSH levels closer to the upper normal limit.
65 patients with nonalcoholic fatty liver disease (NAFLD) were included in open-label observative prospective cohort study. Mean age was 54.8 ± 10.5 y. o. All patients were treated with metformin before and during the study. All patients were treated by GLP-1 receptor agonist dulaglutide subcutaneously weekly 26 weeks. Patients of group with type 2 diabetes were treated with dulaglutide 0.75 mg weekly 2 weeks, than 1.5 weekly 24 weeks. Patients of group without diabetes were treated by dulaglutide 0.75 mg weekly 4 weeks, than 1.5 weekly 22 weeks. Both groups of patients were demonstrated significant reduce of body weight, BMI, waist circumference, glucose, HbA1c, insulin resistance indexes, transaminases and gamma-glutamyltranspeptidase activity. Fatty liver index and liver stiff ness also decreased after treatment. We can conclude that dulaglutide treatment in NAFLD patients decreases body wieight, improves glucose and lipid metabolism and decreases inflammatory activity of steatohepatitis.
Манифестный гиперкортицизм -редкое забо-левание, встречающееся с частотой 1-10 случаев на 1 млн в год. Полагают, что распространенность суб-клинического гиперкортицизма (СГ) гораздо выше и составляет около 8 случаев на 10 000 населения [1]. СГ характеризуется нарушением секреции кортизо-ла без специфических клинических признаков или симптомов гиперкортицизма. При СГ ожирение и/ или сахарный диабет 2-го типа (СД2) могут интер-претироваться врачом как самостоятельные заболе-вания, а не проявления гиперкортицизма. Вместе с тем, частота СГ при СД2 или при ожирении без СД2, по некоторым данным [2][3][4][5][6][7], достигает 9%. Таким образом, пациенты с СД2 и ожирением могут рас-сматриваться как группы риска для СГ.Цель настоящего исследования -уточнение распространенности СГ у больных СД2 или алимен-тарным ожирением (АО), а также разработка опти-мального алгоритма выявления СГ в этих группах. *e-mail: anastasiya-murzina@mail.ru
Материал и методыОбследовали 151 пациента, госпитализированно-го в отделение терапевтической эндокринологии МО-НИКИ им. М.Ф. Владимирского с направительными диагнозами СД2 (111 человек) и алиментарным ожи-рением (АО) (40). В табл. 1 указаны основные параме-тры включенных в исследование пациентов.Всем пациентам проведены рутинные лабора-торные исследования: биохимический анализ кро-ви, общий анализ крови и мочи, гликированный гемоглобин (HbA 1c ). Критерии исключения из ис-следования: 1) отсутствие информированного со-гласия на обследование, 2) возраст <18 лет, 3) бере-менность и лактация, 4) установленные ранее син-дром эндогенного гиперкортицизма, депрессия, хроническая почечная и/или печеночная недоста-точность, алкоголизм, 5) прием препаратов, влияю-щих на интерпретацию результатов [8]. Subclinical hypercorticism is characterized by increased cortisol secretion in the absence of the specific clinical manifestations of the disease. The prevalence of subclinical hypercorticism has been estimated at 8 cases per 10,000 population even though the frequency of subclinical hypercorticism may be higher among certain groups of the patients. We observed 111 patients presenting with type 2 diabetes mellitus and 40 ones with alimentary obesity. As a result, subclinical hypercorticism was diagnosed in 4 (10%) patients with obesity and in 12 (12%) ones with diabetes mellitus. In two of these cases, the diagnosis was later changed to clinically manifested hypercorticism. The imaging studies revealed pathological changes in pituitary and adrenal glands in six of the 16 patients presenting with subclinical hypercorticism. An algorithm for the examination of the patients with type 2 diabetes mellitus and alimentary obesity for the purpose of diagnostics of subclinical hypercorticism is proposed.
This paper summarizes the original clinical experience of the authors concerning differential diagnostics of ACTH-dependent hypercortisolism. A total of 8 patients were available for the estimation of the potential of such diagnostics with the use of the high-dose dexamethasone suppression test, pituitary MRI, and selective blood sampling from the inferior petrosal sinuses for the determination of the ACTH concentration gradient between central and peripheral compartments. It turned out that neither the high-dose dexamethasone suppression test nor pituitary MRI provided unambiguous information about the source of ACTH hypersecretion whereas the use of selective blood sampling allowed to confirm the primary diagnosis of Cushing's disease in 4 patients and revise it in 2 others. In all the patients having the diagnosis established based on the results of selective blood sampling, it was confirmed after transsphenoidal adenomectomy. At the same time, the diagnosis of ACTH-ectopic syndrome was confirmed by an immunohistochemical method only in 1 of the 2 patients. Thus, the results of the present study indicate that selective blood sampling from the inferior petrosal sinuses is a valuable diagnostic tool which should be recommended for a wider application in endocrinological practice. However, this method failed to reveal lateralization of the tumours in all the examined patients.
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