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This article describes the history of knowledge management with special reference to primary and secondary osteoporosis, its epidemiology and diagnostics of different forms of this disease. The discussion is focused on therapeutic modalities for the treatment of osteoporosis based on the principles of evidence-based medicine. Special attention is given to the choice of optimal medicinal preparations for the management of primary osteoporosis taking into account results of multicenter randomized placebo-controlled clinical studies and the results of evaluation of the efficacy of various pharmaceutical for the treatment of secondary osteoporosis and its mixed forms. Some of these studies are carried out based at the Endocrinological Research Centre. Peculiarities of analysis of their results are discussed along with comparative characteristics of selected pharmaceuticals.

The present guidelines on diagnostics, differential diagnostics, and methods of treatment of Cushing’s disease have been developed by a group of Russian specialists.

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The present study included patients with confirmed diagnosis of ACTH-dependent hypercorticism admitted to the Department of Neuroendocrinology and Osteopathies, Endocrinological Research Centre, between 2008 and 2012. Selective blood sampling from the inferior petrosal sinuses was performed with the stimulation by decompressin administered intravenously at a dose of 8 mcg. The normalized ACTH/prolactin ratio was calculated by dividing the maximum ACTH gradient following decompressin stimulation by the ipsilateral prolactin gradient. The cut off values were calculated from the operating characteristic curves as follows: 1.5 for the prolactin gradient (sensitivity 92.5%, specificity 100%) and 1.18 for the normalized ACTH/prolactin ratio (sensitivity 85.9%; 95% CI 76.8-93.4, specificity 100%; 95% CI 60.9-100). In the study cohort (n=70), the normalized ACTH/prolactin ratio proved to be a more specific but less sensitive parameter than the routine analysis of the ACTH gradient (sensitivity 98.4%, specificity 83.3%). Areas under the operating characteristic curves were on the whole identical. However, comparison of the diagnostic value of selective blood sampling from the inferior petrosal sinuses in combination of the determination of the prolactin gradient and normalized ACTH/prolactin ratio with the results obtained in the patients in whom the catheter position was not controlled (n=47) revealed the advantages of the former approach in terms of both the number of unverified causes of hypercorticism (1 versus 6) and the area under the operating characteristic curves 0.964 (95% CI 0.897-1.032) among 70 patients and 0.910 (95% CI 0.821-0.998) among the first 47 patients (included in the analysis confined to the confirmed cases). It is concluded that the determination of the prolactin gradient and calculation of the normalized ACTH/prolactin ratio allow to increase the diagnostic value of selective blood sampling from the inferior petrosal sinuses under decompressin stimulation. This inference is especially true of doubtful cases.

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).

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To elucidate specific features of epidemiology of various forms of primary hyperparathyroidism (PHPT) in this country using the information about 561 patients accumulated for 19 years in the database of Federal state institution «Endocrinological Research Centre». The incidence of PHPT in Moscow estimated from the database of Endocrinological Research Centre for 2007 was 6.8 per 1 000 000 adult population and the prevalence as per 2009 was 3.1/100 000. These values are significantly lower than those reported by foreign authors. The men to women ratio among the patients with PHPT was 1:8. The disease largely affects subjects at the age from 50 to 60 years. By the year of 2004, the frequency of the mild form of PHPT did not exceed 20% of the total (based on 2002 Consensus criteria). It increased to 37% during the past 5 years. Conservative treatment of PHPT can be recommended to 14% of the patients presenting with sporadic disease and to 32% of those with MEN syndrome. The frequency of asymptotic PHPT and its normocalcemic forms is estimated at 5% and 9% respectively. The above results are the first data on epidemiology of PHPT in this country; however, they are insufficient to comprehensively evaluate the real significance of the problem. Large-scale epidemiological studies are needed to ensure adequate assessment of the situation.