A view at postbariatric hypoglycemia by endocrinologist

The obesity epidemic has led to the growing number of bariatric operations and the expansion of indications for this operation as the most effective method of treatment, that’s why endocrinologists are increasingly faced the challenge of late complications, including postbariatric hypoglycemia. Postbariatric hypoglycemia is a rare but severe metabolic disorder that occurs months or years after upper gastrointestinal surgery. Postbariatric hypoglycemia can be accompanied by severe clinical symptoms and lead to disability and decreasing of the life’s quality. It is difficult to assess the prevalence of hypoglycemia after bariatric surgery due to the lack of clear diagnostic criteria, often a hidden clinical picture and ignorance of doctors and patients about this complication. Hypoglycemia in this case has postprandial and hyperinsulinemic nature. The mechanisms of development of this complication have recently been actively discussed. The exchange of incretins and dysregulation of insulin secretion are the subject of constant research in this area. Understanding the mechanisms of development of this condition makes it possible to develop optimal methods of diagnosis and treatment. The issues of pathophysiology, basic principles of diagnosis and treatment of post-bariatric hypoglycemia will be considered in this review

Bariatric patient: what is the key to success? Case from practice

Surgical treatment in the scope of laparoscopic gastric bypass for morbid obesity and type 2 diabetes mellitus (DM 2) with careful preoperative preparation, a gradual expansion of the diet with the obligatory observance of the recommendations of a nutritionist on the balance of micro- and macronutrients, a gradual increase in the amount of available physical activity in the postoperative period allows not only significantly reduce body weight, but also achieve compensation for obesity-related diseases. The expected development of micro- and macronutrient deficiencies requires an active search for and compensation for these conditions both at the pre- and postoperative stages. The development of postbariatric hypoglycemia confirms the need to comply with dietary recommendations not only at the stage of conservative treatment of obesity and DM 2, but also, no less important, after bariatric surgery

Синдром фон Гиппеля–Линдау: клинический случай

The study of the genetic aspects of endocrine diseases is based on the aspiration to develop the methods of early diagnosis, treatment and observation of patients. Von Hippel-Lindau syndrome is genetically determined disease characterized by damage of various organs and systems. The article presents a clinical case of treatment of a patient with retinal detachment who was first admitted to the surgical department of the Federal State Budgetary Institution «NMIC of Endocrinology» of the Ministry of Health of Russia with complaints of dry mouth, general weakness. Further examination, revealed pathological changes in the adrenal glands, kidneys, brain, pancreas, spleen, spinal cord. The presented clinical case demonstrates the need for a multidisciplinary approach to the management of patients with von Hippel-Lindau syndrome.В основе изучения генетических аспектов заболеваний органов эндокринной системы лежит стремление разработать методы ранней диагностики, лечения и наблюдения пациентов. Синдром фон Гиппеля–Линдау является генетически детерминированным заболеванием, характеризующимся поражением различных органов и систем. В статье приведен клинический случай лечения пациента с отслойкой сетчатки, который впервые поступил в хирургическое отделение ФГБУ «НМИЦ эндокринологии» Минздрава России с жалобами на сухость во рту, общую слабость. При дальнейшем обследовании обнаружены патологические изменения надпочечников, почек, головного мозга, поджелудочной железы, селезенки, спинного мозга. Представленный клинический случай демонстрирует необходимость мультидисциплинарного подхода к ведению пациентов с синдромом фон Гиппеля–Линдау

INTERDISCIPLINARY CLINICAL PRACTICE GUIDELINES "MANAGEMENT OF OBESITY AND ITS COMORBIDITIES"

Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical  practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal

Clinical Practice Guidelines of the Russian Scientific Liver Society, Russian Gastroenterological Association, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians and National Society for Preventive Cardiology on Diagnosis and Treatment of Non-Alcoholic Liver Disease

Aim: present clinical guidelines, aimed at general practitioners, gastroenterologists, cardiologists, endocrinologists, comprise up-to-date methods of diagnosis and treatment of non-alcoholic fatty liver disease.Key points. Nonalcoholic fatty liver disease, the most wide-spread chronic liver disease, is characterized by accumulation of fat by more than 5 % of hepatocytes and presented by two histological forms: steatosis and nonalcoholic steatohepatitis. Clinical guidelines provide current views on pathogenesis of nonalcoholic fatty liver disease as a multisystem disease, methods of invasive and noninvasive diagnosis of steatosis and liver fibrosis, principles of nondrug treatment and pharmacotherapy of nonalcoholic fatty liver disease and associated conditions. Complications of nonalcoholic fatty liver disease include aggravation of cardiometabolic risks, development of hepatocellular cancer, progression of liver fibrosis to cirrhotic stage.Conclusion. Progression of liver disease can be avoided, cardiometabolic risks can be reduced and patients' prognosis — improved by the timely recognition of diagnosis of nonalcoholic fatty liver disease and associated comorbidities and competent multidisciplinary management of these patients

Obesity and non-alcoholic fatty liver disease personalized approaches to metabolic risks correction

Nonalcoholic fatty liver disease (NAFLD) – a common chronic disease of the liver, the main feature of which is the accumulation of fat in hepatocytes, is not related to alcohol abuse. NAFLD is associated with obesity, especially abdominal, metabolic syndrome and various metabolic markers of risk for cardiovascular disease and type 2 diabetes, which affects the incidence, prognosis and life expectancy of patients with obesity. This lecture describes the main causes of the disease, its pathogenesis, clinical presentation, diagnosis and treatment

Efficacy of liraglutide 3 mig therapy in obesity and associated diseases

Obesity is a chronic disease associated with cardiometabolic risk factors, primarily cardiovascular diseases and type 2 diabetes mellitus. In 2016,Russiaregistered a new drug for treating obese patients liraglutide 3.0 mg, which is an analogue of human glucagon-like peptide-1. Given the urgency of the problem, we present a clinical case that shows the efficacy of therapy with liraglutide 3.0 mg daily in a patient with obesity, and its effect on metabolic risk factors

EARLY EXPERIENCE OF GPP-1 LIRAGLUTIDE 3.0 MG ANALOGUE IN RUSSIA AND ITS EFFECT ON METABOLIC RISK FACTORS IN OBESITY PATIENTS

Obesity is a chronic disease associated with cardiometabolic risk factors of cardiovascular diseases and type 2 diabetes. In 2016, in Russia a new drug was registered for the treatment of patients with adiposity - liraglutide 3.0 mg, which is an analog of human glucagonoma peptide-1. The study purpose: to study the efficacy of liraglutide 3.0 mg/day and its impact on cardiometabolic risk factors in patients with obesity. We examined 30 patients aged 25-59 with obesity without diabetes. Patients received therapy with liraglutide 3.0 mg/day for 3 months. The examination included measurement of anthropometric parameters, blood sampling with the estimation of the parameters of lipid and carbohydrate metabolism.Results: after 3 months of treatment with liraglutide 3.0 mg a significant improvement of anthropometric parameters was observed: reduction of weight, BMI and waist circumference and a significant improvement in parameters of metabolic comorbidities.Conclusions: complex therapy with use of liraglutide 3.0 mg per day for 3 months is effective for therapy of obesity and correction of obesity-associated cardiometabolic disturbances