Prevalence of diabetes mellitus in patients with acromegaly

Early carbohydrate metabolism disorders (ECMDs) and diabetes mellitus (DM) are frequently associated with acromegaly. We aimed to assess the prevalence of ECMDs in patients with acromegaly and to compare the results with those in adults without acromegaly using two population-based epidemiologic surveys. We evaluated 97 patients with acromegaly in several phases of their disease (mean age, 56 years and estimated duration of acromegaly, 12.5 years). An oral glucose tolerance test was done in those not yet diagnosed with DM to reveal asymptomatic DM or ECMDs (impaired glucose tolerance+impaired fasting glucose). Comparisons were made between patients with acromegaly and participants from the general adult population (n=435) and an adult population with multiple type 2 diabetes risk factors (n=314), matched for gender, age and BMI. DM was diagnosed in 51 patients with acromegaly (52.5%) and 14.3% of the general population (P<0.001). The prevalence of ECMDs was also higher in patients with acromegaly than in the general population and in the high-risk group; only 22% of patients with acromegaly were normoglycaemic. The prevalence of newly diagnosed ECMDs or DM was 1.3-1.5 times higher in patients with acromegaly compared with the high-risk group. Patients with acromegaly having ECMDs or DM were older, more obese and had longer disease duration and higher IGF1 levels (Z-score). Logistic regression showed that the severity of glucose derangement was predicted by age, BMI and IGF1 levels. In patients with acromegaly, the prevalence of DM and ECMDs considerably exceeds that of the general population and of a high-risk group, and development of DM depends on age, BMI and IGF1 levels

Эффективность и безопасность Бенакорта (раствор будесонида) при купировании обострения бронхиальной астмы

The study was designed to search efficiency and safety of the 3-rd generation glucocorticosteroid (GCS) budesonide (Benacort) as 0.05 % nebulized solution in patients with exacerbation of moderate bronchial asthma (BA). The study involved 18 males and 12 females aged 42 to 65 yrs suffering from BA for 3 months to 30 yrs, 27 of them completed the investigation. Three patients broke off the study because of unpleasant taste, sour throat, cough attacks during the inhalations. Before the study 22 patients had not received any basic therapy, 8 ones had been treated with inhaled GSC 600 to 1 200 meg daily or cromones. Starting the study all the patients had moderate exacerbations of BA.The budesonide solution was inhaled via a nebulizer 1 000 to 2 000 meg daily. All the patients also received inhaled β2-agonists. The efficacy of budesonide was evaluated with clinical picture, lung function parameters, need in β2-agonists. The therapy with nebulized budesonide lasted 7 to 10 days. The full control of BA was reached in 5 (18 % ) of the patients, sufficient control was in 10 (37 % ) and partial control was obtained in 13 (48 % ) of them. There were not significant shifts in endogenous cortisol and glucose levels, arterial blood pres­ sure and heart beat rate parameters for the treatment period. So, this study demonstrated that the nebulized Benacort is highly effective and safe when used in patients with BA exacerbations. Combined administration of nebulized β2-agonists and GCS is thought to be the alternative for systemic GCS and xanthines.Цель исследования: изучить эффективность и безопасность глюкокортикостероида (ГКС) III поколения будесонида (Бенакорт) в виде 0,05%-ного раствора для ингаляции с помощью небулайзера у больных с обострением бронхиальной астмы (БА) средней тяжести.В исследование вошли 18 мужчин и 12 женщин в возрасте от 42 до 65 лет с верифицированным диагнозом БА и давностью заболевания от 3 мес. до 30 лет, из них закончили исследование 27 человек, 3 отказались от продолжения лечения раствором будесонида из-за неприятного привкуса, першения в горле, пароксизмального кашля во время ингаляции. Базовая терапия у 22 больных отсутствовала, у 8 была представлена ингаляционными ГКС в дозе 600-1 200 мкг в сутки (в пересчете на беклометазона дипропионат) или кромонами. На начало исследования у больных диагностировано обострение средней тяжести. Раствор Будесонида вводился через небулайзер в дозе от 1 000 до 2 000 мкг в сутки. Кроме того, больные получали ингаляционные β2-агонисты. Эффективность будесонида оценивалась по клинической картине, показателям ФВД , потребности в β2-агонистах. Длительность терапии раствором будесонида через небулайзер составила от 7 до 10 дней. К 10-му дню лечения полный контроль над течением БА установлен у 5 (18 % ), хороший — у 10 (37 % ), неполный контроль — у 13 (48 % ) больных. На фоне лечения не было отмечено достоверных изменений в показателях эндогенного кортизола и глюкозы крови, негативных изменений АД и ЧСС.Таким образом, проведенное клиническое исследование показало, что препарат бенакорт, применяемый с помощью небулайзера, обладает высокой эффективностью и безопасностью у больных БА в стадии обострения. Сочетанное использование β2-агонистов и глюкокортикостероидов с помощью небулайзера может быть альтернативой системным ГКС и метилксантинам при купировании обострения БА

Vliyanie metformina na uglevodnyy i lipidnyy obmen u bol'nykh sakharnym diabetom 2 tipa, ranee ne poluchavshikh medikamentoznuyu sakharosnizhayushchuyu terapiyu

Цель. Оценка влияния терапии метформином на углеводный и липидный обмен, оценив изменение параметров кинетики глюкозы в ходе ВТТГ и динамику уровня лептина у больных СД2, ранее не получавших медикаментозную сахароснижающую терапию. Материалы и методы. Проведено открытое рандомизированное исследование в параллельных группах. В исследовании приняли участие 34 больных СД 2. Больные были распределены на две группы методом простой рандомизации: 17 больным были назначены диета 9 и глюкофаж, второй группе ? только диета 9. Титрация дозы препарата проводилась 1 раз в неделю во время 2 и 3 визитов по результатам измерения глюкозы цельной капиллярной крови натощак, измеренной на глюкометре Accu Сhec. Эффективность терапии оценивалась по динамике уровня гликированного гемоглобина (HbA1с), ГПН, гликемической кривой во время ВТТГ, уровня С-пептида, показателей липидного обмена (уровень общего холестерина (ОХ), липопротеидов высокой плотности (ЛПВП), липопротеидов низкой плотности (ЛПНП), триглицеридов (ТГ). Уровень HbA1с определялся исходно, через 12 и 24 недели лечения. Результаты. Уровень HbA1c через 3 месяца снизился в группе лечения глюкофажем на 1,2% (

Efficiency and safety of OctreotidLong FS therapy in acromegaly patients

Aim of this study was to investigate efficiency and safety of OctreotidLong FS in patients with acromegaly. Materials and methods. 41 patients with acromegaly (8 – de novo and 33 patients after different somato statin analogs treatment) was treated OctreotidLong FS one injection in 28 days. Growth hormone (GH), Insulin like Growth Factor 1 (IFG1), fasting glucose (FG) and HbA1c were assess after 3, 6 and 12 month of therapy. Results. We found out the decreasing of GH and IGF1 from 12,8 (8,0–82,7) mU/ml to 3,8 (1,6–13,8) mU/ml ( p 0,05) and %IGF1 increasing (% IGF1) from 231 (150–286)% to 9,5 (−26–111)% ( p 0,05) in 8 de novo acromegalic patients. We also revealed that IGF1 didn’t change and GH decreased after 3 month (33 patients), 6 month (22 patients) and 12 month (8 patients) of OctreotidLong FS treatment. We didn’t observed negative effect of OctreotidLong FS treatment to carbohydrate metabolism in patients with acromegaly. Conclusion. The therapy of OctreotidLong FS leads to induce successful control of GH and IGFI in 50% de novo patients and didn’t change the number of patients with control of acromegaly after another somato statin analogs treatment. Carbohydrate metabolism also didn’t change after OctreotidLong FS treatment

DISSOCIATION OF BIOCHEMICAL AND TUMOR-SUPRESSIVE EFFECTS OF SOMATOSTATIN ANALOGS

Normalization of the growth hormone and IGF-1 levels during somatostatin analogs treatment usually is a predictor of somatotropinoma volume reduction. However, dissociation of biochemical and tumor-supressive effects of somatostatin analogs was also noted. We represent the female patient who showed reduction of the GH levels from 34.3 to 3.1 ng/ml and IGF-1 levels from 796 to 415 ng/ml (the gender and age upper normal limit 262 ng/ml) within 36 months treatment with maximum doses of somatostatin analogs (octreotide LAR 40 mg). Despite the lack of biochemical control of acromegaly, progressive decrease of tumor volume by 44 – 64 – 73% from initial volume (during 12 – 24 – 36 months of treatment) was noted. This case shows that it is possible to expect considerable reduction of somatotropinoma volume during treatment with somatostatin analogs even without achievement of complete control over GH and IGF-1 secretion

EFFEKTIVNOST', PERENOSIMOST'I KOMPLAENTNOST' ALENDRONATA NATRIYa(70 MG 1 RAZ V NEDELYu)PRI LEChENII POSTMENOPAUZAL'NOGO OSTEOPOROZA

The aim of this study was to assess effectiveness ant tolerability of alendronate in women suffered of postmenopausal osteoporosis. 15 postmenopausal women with primary osteoporosis (age 61.0±4.8 (M±σ) years) was administered alendronate in dosage 70 mg weekly with calcium supplementation (1000 mg daily) for 12 months. Control group consisted of 19 women also suffered from postmenopausal osteoporosis (age 61.7±5.2 years) received only calcium salts for study period. There was a significant increase vs baseline in BMD in lumbar spine (in 2.1% in 6 months and in 2.7% in 12 months), in femoral neck from (in 2.1% and 3.3% accordingly), in trochanter (in 5.5% and 6.3% accordingly) and in total proximal femur (in 2.9% and 1.9% accordingly) in treated patients. We also found in treated group a marked decrease in serum ionized calcium from 1.24±0.03 to 1.21±0.03 mmol/l in 6 months and to 1.2±0.04 mmol/l in 12 months (

ISSLEDOVANIE EFFEKTIVNOSTI MIKRODOZI-ROVANNOY ESTROGEN-GESTAGENNOY TERAPIIV PROFILAKTIKE POSTMENOPAUZAL'NOGO OSTEOPOROZA I KORREKTsII KLIMAKTERIChESKIKh NARUShENIY

Although the minimal dose of 17β-estradiol in hormone replacement regimens was originally considered to be 2 mg/day, it is now increasingly accepted that a lower dose of 1 mg/day is effective in protecting women from the detrimental effects of the menopause and has a better safety profile. The aim of this study was to investigate effectiveness and tolerability of minimal dose of hormone replacement therapy (HRT) - femoston 1/5 in postmenopausal women with spine osteopenia. Study comprised 26 postmenopausal women aged 45-65 years with T-score L2-L4 2.5 SD. Treated group consisted of 16 women (average age 54.8+5.59 years and postmenopausal age 6.81+4.59 years) received femoston 1/5 (17β-estradiol 1 mg/ daily continuously combined with dydrogesterone 5 mg/daily) for 12 months. Control group included 10 subjects (average age 56.7+4.11 years and postmenopausal age 11.5+8.09 years). BMD and biochemical parameters were measured at baseline and in 6 and 12 months and climacteric symptoms were assessed at baseline and in 1, 3, 6 and 12 months. The increase in BMD were seen in lumbar spine +5.2%, total proximal femur +2.1% and trochanter +3.1% (

EFFEKTIVNOST' PRIMENENIYaKOMBINIROVANNOY TERAPII KAL'TsIEMS VYSOKIMI I SREDNIMI DOZAMI VITAMINA D3dlya profilaktiki postmenopauzal'nogo osteoporoza

The aim of this study was to assess the effectiveness of the combined treatment with calcium and middle (400 mg daily) or high doses (800 mg daily) of vitamin D for prevention of osteoporosis in postmenopausal women with osteopenia in spine. Thirty patients, 45-70 years old, were divided into 3 equal groups: the women in the group 1 were treated with vitamin D3 400 IU. and calcium 1000 mg daily; the women in the group 2 received vitamin D3 800 IU and calcium 1000 mg daily; the patients from the group 3 did not receive any supplementation - the control 1 group. A significant increase in BMD was found at lumbar spine (+1.9 % after 6 months,

SOSTOYaNIE KOSTNOY TKANI I RISK RAZVITIYa OSTEOPOROZA U ZhENShchIN V STADII POLNOY REMISSIIBOLEZNI ITsENKO-KUShINGA NA FONE FIZIOLOGIChESKOYMENOPAUZY

It is well known that clinical signs of endogenous hypercorticism including secondary osteoporosis rapidly reverse on the base of hormonal remission after radiosurgical treatment of Cushing's disease (CD). The aim of the study was to assess BMD and bone turnover biochemical markers in postmenopausal women with complete CD-remission. We examined 43 women aged 38-67 years in physiological postmenopause who had a complete long-term hormonal CD-remission for at least 2 years (11±6,8 years in average) after combine treatment with hemiadrenalectomy and radiosurgery. Control group comprised 98 healthy postmenopausal women at the same age and postmenopausal age. Our main findings were BMD in postmenopausal CD-patients was higher vs. controls in lumbar spine (1,233±0,17 vs. 1,146±0,20 g/cm2,