Adrenocortical cancer: late diagnosis of the disease on the example of a clinical case. Case report

Adrenocortical carcinoma (ACC) is a rare malignant tumor originating in the adrenal cortex and characterized by poor 5-year survival. It occurs with a frequency of 2–4 cases per 2 million in the population. Women are more frequently affected than men and it is mostly detected in the fourth and fifth decades. In the most of cases, the cancerogenesis occurs sporadically because of gene driver mutations in somatic adrenocortical cells, in other cases it can be found as part of a genetically determined syndrome such as Li–Fraumeni syndrome or Wermer's syndrome (multiple endocrine adenomatosis type I). ACC most frequently happens occurs without symptoms in the initial stages leading to poor diagnoses. Because of this lack of early detection, the tumor is not considered malignant reducing the benefits of further treatment. Sometimes the fact that the resected tumor is indeed adrenocortical carcinoma becomes clear only after recurrence, or after the appearance of metastases. We present a case of adrenocortical carcinoma in a 46-year-old woman who went to the doctor in 1.5 year after symptoms were manfested. This clinical case illustrates the consequences of late diagnosis of a malignant tumor. We would like to emphasize the importance of timely detection of a neoplasm, using all of the potential of laboratory-instrumental and genomic analysis. Due to low oncological awareness, our patient was slow to seek medical help, which in turn led not only to metastases, but also to complications in the cardiovascular system

The autoimmune IgG4 -associated endocrine pathology

Immunoglobulin G4-associated diseases (IgG4-AD) arethe group of chronic progressive autoimmune fibro-inflammatory pathology of various organs and tissues, characterized by their enlargement and abundant infiltration of immunoglobulin G4-positive plasma cells, as well as an increase in the level of serum immunoglobulin G4 (IgG4).In most patients, the disease is characterized by a mild course.However, there is evidence of a high incidence of malignancies in patients with IgG4-AD.Among endocrine IgG4-associated pathologies, pancreatitis with outcome in diabetes mellitus, hypophysitis and thyroiditis are described. Laboratory examination usually reveals an increased level of IgG4. However, the concentration of IgG4 could not be used as the only diagnostic criterion.The possibility of plasmablastsdetermining as a marker of the disease is discussed.Among the imaging techniques CT, MRI and 18F-FDG-PET/CT are used.However, the most informative method of diagnosis is biopsy. Randomized clinical trials to determine clear recommendations for the treatment of IgG4-AD were not conducted.In most cases, glucocorticoids are prescribed, and immunosuppressive therapy is sometimes used.According to the results of recent studies, the genetically engineered drug rituximab is relatively effective in inducing remission of the disease.Given the high recurrence rate and the risk of malignancy, patients with IgG4-AD require careful long-term follow-up. Thus, the review describes the clinical manifestations of IgG4-AD, examines the possibilities of their diagnosis and presents the existing methods of treatment.However, given the fact that IgG4-AD became a separate group of autoimmune pathology less than 20 years ago, there are insufficient data on these diseases. Researches related to epidemiology, pathophysiology, diagnosis and effective treatment of IgG4-AD are actual

Influence of excessive iodine intake on the thyroid function and spectrum of thyroid abnormalities in population of Turinsk, Sverdlovsk Region, of Russia

Background. Previous surveys showed chronic iodine excess - median urinary iodine concentration (UIC) over 500 mcg/l supposedly due to water contamination in population of Turinsk, a town in Sverdlovsk Region of Russia. Aim. Conduct an assessment of the effects of chronic iodine excess on thyroid function and spectrum of thyroid abnormalities in schoolchildren and adults. Materials and methods. Assessment was conducted in 100 schoolchildren and 100 adults residing in Turinsk and 97 schoolchildren and 100 adults in the control site (city of Pervouralsk) with optimal UIC. Assessment included thyroid ultrasonogrpahy, urinary iodine and dry spot TSH in schoolchildren and TSH and TPO-ab in adults. Iodine was also measured in random water samples from 10 households in Turinsk. Results. Median UIC in schoolchildren in Turinsk (719 mcg/l) was significantly higher (129 mcg/l) than in Pervouralsk resulting in higher prevalence of thyroid enlargement and TSH level. In adults TSH level as well as prevalence of sub-clinical hypothyroidism and autoimmune thyroiditis were higher in residents of Turinsk compared to control group from Pervouralsk. Conclusions. Iodine excess alters thyroid function in schoolchildren and adults increasing prevalence of thyroid enlargement in children and autoimmune thyroidis in adults

“Pattern approach” or search for new templates. Respond to the article “Evaluating of significance of thyroglobulin (Tg) level in blood as a biomarker of iodine deficiency disorders severity in Uzbekistan”

Science will never stop in its search for new solutions. The process of investigating and predicting by scientific theories is the process of identifying and managing patterns (sets of repetitive models, stable combinations and sequences). Over the years, the problem of iodine deficiency remains important for global health. Despite all the measures have been taken to eliminate this disease, now it is not possible to optimize iodine deficiency diagnosis and treatment all over the world. So, previously published in Clinical and experimental thyroidology journal article Evaluating of significance of thyroglobulin (Tg) level in blood as a biomarker of iodine deficiency disorders severity in Uzbekistan is incredibly relevant and undoubtedly requires detailed analysis. The analysis and comments to provided research is the subject of current article

The awareness of Russians about iodine deficiency diseases and methods of it’s prevention

Background. The average consumption of iodine by a resident of Russia is 3 times smaller than the established norm. Insufficient iodine intake poses a serious threat to the health of 100 million Russians, including the threat of impaired physical and mental development of 32.8 million children, living in the Russian Federation. The current situation requires a systematic iodine prophylaxis. Aims: to assess the awareness of Russians about the iodine deficiency diseases, their effects and prevention measures, as well as the formation of citizen’s conscious of the necessity for a balanced use of iodized salt and foods, rich in iodine. Methods. A survey of Russians of different age categories in the nationwide campaign for prevention of iodine deficiency disorders and the counting of the results. Results. In the survey participated 34968 Russians. 54.4% of respondents consumed iodized salt. Public awareness of iodine deficiency diseases in average is about 62.6%. 66.4% of Russian respondents supported the law on universal salt iodization at the production facilities in Russia were made by 66.4% of Russians. Conclusions. Based on the evaluation of the obtained data, even among persons, well-informed on the issue of iodine deficiency disorders, not all understand the importance of using iodized salt and the impact of this factor on the overall incidence. With the aim of preventing the spread of iodine deficiency and reduce the risk of its severe consequences in Russia is necessary to organize a system of mass prevention and improving health literacy of the population on this issue

Adrenal vein sampling in differential diagnosis of primary aldosteronism on the example of a clinical case

Primary aldosteronism is the most common cause of endocrine hypertension, occurring in 5–10% of patients with hypertension. Convincing evidence has been obtained indicating that primary aldosteronism increases the risk of cardiovascular complications, respectively, early diagnosis and treatment of patients with the definition of further tactics is a key step to prevent the progression of cardiovascular complications. The choice of the most appropriate treatment method for patients with primary aldosteronism depends on the diagnosis of nosological subtypes – bilateral adrenal hyperplasia (also known as idiopathic aldosteronism), which recommends a conservative treatment or unilateral aldosteronism due to aldosterone-producing adenoma, in which surgical treatment (adrenalectomy) is the tactic of choice. In addition, the "obvious" adrenal adenomas may in fact turn out to be areas of focal hyperplasia – a diagnostic error in this case leads to the unreasonable implementation of adrenalectomy. In order to clarify the lateralization of aldosterone hyperproduction, adrenal venous sampling is used. However, this method requires constant radiography, qualified endovascular surgery and is carried out in centralized medical hospitals. In this clinical case, we want to demonstrate the importance of a diagnosis of primary aldosteronism step by step

Diagnosis and differential diagnosis of adrenal incidentalomas

This lecture focuses on the diagnosis and differential diagnosis of adrenal incidentalomas with special reference to diagnostic steps, major pharmacological tests, and instrumental studies. Strategies of management of patients with this pathology are described

The Incidence of West Nile Disease in Russia in Relation to Climatic and Environmental Factors

Since 1999, human cases of West Nile fever/neuroinvasive disease (WND) have been reported annually in Russia. The highest incidence has been recorded in three provinces of southern European Russia (Volgograd, Astrakhan and Rostov Provinces), yet in 2010–2012 the distribution of human cases expanded northwards considerably. From year to year, the number of WND cases varied widely, with major WND outbreaks in 1999, 2007, 2010, and 2012. The present study was aimed at identifying the most important climatic and environmental factors potentially affecting WND incidence in the three above-mentioned provinces and at building simple prognostic models, using those factors, by the decision trees method. The effects of 96 variables, including mean monthly temperature, relative humidity, precipitation, Normalized Difference Vegetation Index, etc. were taken into account. The findings of this analysis show that an increase of human WND incidence, compared to the previous year, was mostly driven by higher temperatures in May and/or in June, as well as (to a lesser extent) by high August-September temperatures. Declining incidence was associated with cold winters (December and/or January, depending on the region and type of model). WND incidence also tended to decrease during year following major WND outbreaks. Combining this information, the future trend of WND may be, to some extent, predicted, in accordance with the climatic conditions observed before the summer peak of WND incidence

Russian Association of Endocrinologists clinical practice guideline for adrenal incidentalomas differential diagnosis

This article discusses the management guidelines for serendipitously diagnosed adrenal masses cases, assessment of their hormonal activity and malignancy potential, pro- and contra indications for surgical treatment and follow-up algorithm for hormonally inactive tumors. Hypercathecholaminemya, endogenous hypercortisolism, primary hyperaldosteronism should be considered as variants of specific hormonal activity of tumor. The midnight suppression test with dexametasone 1 mg is recommended in all cases. Evaluation of basal ACTH in case of negative result of the test with dexametasone 1 mg (absence of morning cortisol level suppression) should be considered as confirmation test. For primary diagnosis of pheohromocytoma/paraganglioma (PPGL) a free plasma or fractionated urine methanephrines concentrations evaluation should be recommended. If test is positive, comprehensive examination to exclude or confirm PPGL is necessity. The aldosterone/rennin ratio exposure should be considered for patients with arterial hypertension to exclude primary hyperaldosteronism. To evaluate malignant pattern of a tumor in all unclear cases should be provide assessment of computed tomography quantitative indices. Adrenal incidentalomas treatment guidelines isnt considered in the field of this recommendations and reported in relevant guidelines

Supra-regional correlations of the most ancient paleosols and Paleolithic layers of Kostenki-Borschevo region (Russian Plain)

International audienceThe archaeological site Kostenki12, located on the Middle Don River, provides a key stratigraphic profile for regional paleopedological, paleoenvironmental, geological and cultural sequences, containing the oldest known cultural layers of the region (layer V - Paleolithic, layer IV - Upper Paleolithic, layer III - Kostenki-Strelets culture early phase) dating to the early part of MIS3, or, in chronometric terms, to 54-42 ka. Kostenki12 complements Kostenki14 (Markina Gora), which is a key profile for the interval 42-27 ka. The new data from Kostenki12 show that the East European Upper Paleolithic began similar to 45 ka. The stratigraphy exhibits similarities to that of Borschevo5. The Kostenki12 pollen diagramis correlated with: 1) other pollen diagrams from Kostenki-Borschevo region; 2) the most detailed climatostratigraphical scale of the Russian Plain Late Pleistocene; 3) O-16/O-18 Greenland GISP2 scale; 4) C-13/C-14 record from stalagmite at Villars Cave (France), as well as with pollen records (5-7) from: 5) Lake Monticchio (Italy), 6) southern Black Sea (M72/5-25-GC1) and 7) Glinde and Moershoofd (northern Germany). The results of the supra-regional paleoenvironmental correlations demonstrate that the lowest Paleolithic layer V and paleosol D, characterized by elm dominance, correlate to the second half of the optimum of the Glinde interstadial at 51-48 ka, corresponding to DO 14. The earliest Upper Paleolithic layer IV and paleosol B, characterized by coexistence of elm forests and wet meadows, began to form during the second part of the Moershoofd interstadial optimum at 46-44 ka, correlating with DO 12. Paleosol A and layer III (Kostenki-Strelets culture) began to form after the abrupt end of the Moershoofd interstadial similar to 43.5 ka, during unstable conditions, according to pollen and paleozoological data (steppe with horse dominance and later spruce forest tundra with reindeer dominance in paleozoological complex). These correlations provide more accurate dating of the Paleolithic layers and paleosols at Kostenki-Borschevo, suggesting that previously reported radiocarbon dates on units below CI tephra layer are too young, but that the OSL chronology is generally accurate. (C) 2014 Elsevier Ltd and INQUA. All rights reserved