Consilium Medicum

Peer-review medical journal

Editor-in-chief

Publisher

About

Professional medical multidisciplinary journal , based on the principles of evidence-based medicine. Consilium Medicum magazine has been issued since 1999.

The journal publishes national and international recommendations, reviews, lectures, original works, and clinical cases dealing with the most actual problems of the modern medicine, as well as interviews with experts within the different fields of medicine and conferences, congresses and forums reviews.

The journal is practically-oriented and publishes articles by leading clinicians who are professional in the special field of medicine in Russia, Ukraine, Belarus, and includes the high level of scientific information.

Consilium Medicum journal is the most popular journal among medical practitioners. There are 12 thematic issues per year. The journal is designed for therapeutists, pediatricians, cardiologists, endocrinologists, gastroenterologists, pulmonologists, dermatologists, obstetrician-gynecologists, urologists, nephrologists, neurologists, rheumatologists and physicians in other specialties, as well as for resident physicians, post-graduate students and senior students at medical universities.

Types of accepted articles

  • reviews, systematic reviews and meta-analysis
  • original research
  • clinical case reports and series of clinical cases
  • letters to the editor
  • hystorical articles in medicine

Research fields

  • Internal medicine
  • Endocrinology
  • Otorhinolaryngology
  • Cardiology
  • Neurology
  • Phthisiology
  • Surgery
  • Rheumatology
  • Urology
  • Pulmonology
  • Gastroenterology
  • Gerontology and geriatrics

Publication, distribution and indexation

  • Russian and English full-text articles;
  • issues publish monthly, 12 times per year;
  • no APC, Platinum Open Access
  • articles distributr under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0).

Indexation

  • Russian Science Citation Index (elibrary.ru)
  • DOAJ
  • CrossRef
  • Google Scholar
  • WorldCat
  • Ulrich's Periodicals Directory
  • CyberLeninka

Announcements More Announcements...

 
No announcements have been published.

Current Issue

Vol 27, No 4 (2025): Эндокринология

Full Issue

Articles

Hypothyroidism: from diagnosis to therapy success. A review
Biryukova E.V., Abramova A.D.
Abstract

Hypothyroidism is one of the most common thyroid gland disorders. The article addresses the epidemiology and classification of hypothyroidism. Hypothyroidism can have different etiologies. Deficiency of thyroid hormones leads to dysfunction of many organs and systems, manifested by numerous symptoms that can be nonspecific and mimic other diseases. Undiagnosed hypothyroidism is a risk factor for the progression of pre-existing cardiovascular diseases. The prevalence of hypothyroidism is related to the sex and age of patients. The article discusses the main causes of primary and secondary hypothyroidism. The most common cause of primary hypothyroidism is autoimmune thyroiditis, which can develop both independently or associated with other autoimmune conditions as part of the polyglandular syndrome. The causes of hypothyroidism include thyroid surgery and ablation. Transient hypothyroidism may develop in patients with destructive thyroiditis (postpartum, etc.). Thyroid insufficiency as an adverse reaction related to some drugs is discussed. The article describes the clinical symptoms of hypothyroidism. The severity of thyroid hormone deficiency determines the severity of clinical manifestations. Primary hypothyroidism is classified by severity into subclinical and manifest hypothyroidism. There are no significant clinical differences between severe primary and secondary hypothyroidism. Secondary hypothyroidism may be associated with other manifestations of hypothalamic-pituitary disorders. The challenges of diagnosing hypothyroidism, which can simulate another disease, are discussed. The final diagnosis is confirmed by several laboratory and instrumental tests. Subclinical hypothyroidism is characterized by an increase in thyroid-stimulating hormone (TSH) concentration with a normal level of free thyroxine (fT4). Manifest hypothyroidism presents with an increase in the TSH and a decrease in fT4. In secondary hypothyroidism, TSH and fT4 levels decrease. Levothyroxine sodium (L-T4) replacement therapy is used to treat hypothyroidism of any etiology.

Consilium Medicum. 2025;27(4):210-217
pages 210-217 views
A clinical case of late diagnosis of a chronic type I tyrosinemia
Chebotareva N.V., Stafeeva E.D., Li O.А., Kuchieva A.M., Polyakova S.I., Abdurakhmanov J.T., Moiseev S.V.
Abstract

Tyrosinemia type 1 is a genetic disease mainly of the first months and years of life caused by a violation of normal tyrosine catabolism with the formation of final toxic metabolites that have a direct damaging effect on the liver and kidneys with the development of a characteristic clinical picture, represented mainly by functional and morphological disorders on a part of the liver that forms a cirrhosis clinic with a high probability of the latter's degeneration into hepatocellular carcinoma. In the article below, we present a clinical case of the first described late onset of a chronic variant of tyrosinemia type 1 with leading manifestations by type of renal dysfunction with the development of de Toni–Debre–Fanconi syndrome, followed by the formation of phosphopenic osteomalacia and the late appearance of diagnostic criteria corresponding to the initial stage of cirrhosis of the liver.

Consilium Medicum. 2025;27(4):218-221
pages 218-221 views
Modern possibilities of the diagnosing of primary hyperparathyroidism
Boriskova M.E., Pankova P.A., Khamid L.A., Bykov M.A., Zuykevich D.V., Valiakhmedova K.V., Ulimbasheva Z.M., Pogosy0an K.A., Karonova T.L., Ryzhkova D.V.
Abstract

Background. Currently, the most common method of preoperative imaging of affected parathyroid glands (PTG) is a combination of scintigraphy with technetium [99mTc] sestamibi and neck ultrasound (with a sensitivity of 81–95%). In some cases, such as multiple PTG lesions, their ectopic location, multiple nodular thyroid lesions, and their hyperfunction or inflammation, standard imaging methods may show negative or contradictory results, which requires the use of 2nd-line diagnostic studies. One is positron emission tomography combined with computed tomography (PET/CT) with 11C-choline.

Aim. To determine the role of PET/CT with 11C-choline in the topical diagnosis of primary hyperparathyroidism.

Materials and methods. Retrospective analysis of data from 33 patients with primary hyperparathyroidism who underwent parathyroidectomy at the Department of Surgical Endocrinology of Pavlov First Saint Petersburg State Medical University from 2022 to 2024. Due to the ineffectiveness of standard imaging and/or the persistence of primary hyperparathyroidism after the first surgery, all patients included in the study underwent PET/CT with 11C-choline (Almazov National Medical Research Centre). The accuracy, sensitivity, specificity, and positive and negative predictive values were calculated considering the pathological postoperative verification of adenoma/hyperplasia and/or achievement of the reference range of parathyroid hormone and calcium plasma levels.

Results. A total of 41 masses were removed in 33 patients (8 patients had 2 masses removed each). Thirty-seven areas were positive according to PET/CT with 11C-choline. Its diagnostic accuracy was 95.5%, sensitivity 90.2%, specificity 97.8%, positive predictive value 94.9%, and negative predictive value 95.7%.

Conclusion. PET/CT with 11C-choline demonstrated high efficacy in preoperative localization assessment of PTG adenomas, even in cases where the results of first-line imaging methods were ambiguous. We use this method in complex cases, although it can be considered an alternative to first-line imaging. This question remains open and requires further studies comparing economic feasibility.

Consilium Medicum. 2025;27(4):223-228
pages 223-228 views
Hypopituitarism: features of the debut and differential diagnosis (clinical case)
Ledneva V.S., Bavykina I.A., Ivannikova A.S., Ovsyannikova K.O., Remezov M.B.
Abstract

Hypopituitarism is an endocrine disorder characterized by the absence or decreased production of hypothalamic neurohormones and one or more pituitary hormones. The disease most often manifests itself as a deficiency of somatotropic hormone, the main clinical symptom of which is short stature in patients. In the absence of growth retardation in children, hypopituitarism can only be suspected if abnormalities in the patient's hormonal profile are detected and magnetic resonance imaging of the hypothalamic-pituitary region is performed, which complicates diagnosis and prevents timely administration of hormone replacement therapy. The article presents a clinical case of a 4-year-old patient with the onset of hypopituitarism in the form of progressive obesity in the first year of life without growth retardation. According to objective examination data, no other symptoms of endocrine pathology were detected except for excessive development of subcutaneous fat. The girl was observed for a long time by a pediatric endocrinologist and pediatrician for obesity, subclinical hypothyroidism and received hormone replacement therapy with sodium levothyroxine. The diagnosis of hypopituitarism was established only at the age of 3 years after a comprehensive inpatient examination with determination of the hormonal profile, magnetic resonance imaging (MRI) of the brain, which revealed changes in the structure of the neurohypophysis, diabetes insipidus, secondary hypothyroidism and indirect signs of secondary hypocorticism (low cortisol levels) in the child. Hypopituitarism is a disease that is quite difficult to diagnose, so it is necessary to pay more attention to patients not only with growth retardation, but also to patients with obesity resistant to standard therapy.

Consilium Medicum. 2025;27(4):229-232
pages 229-232 views
The role of proinflammatory cytokines in the comprehensive treatment of patients with diabetic foot syndrome complicated by osteomyelitis
Lutsenko Y.G., Karabak I.S., Andrienko I.B., Karabak K.S.
Abstract

Background. Diabetic foot syndrome (DFS) complicated by osteomyelitis is a severe consequence of diabetes mellitus, often leading to amputations. Chronic inflammation and cytokine imbalance (interleukin – IL-1β, 6, tumor necrosis factor – TNF-α) play a key role in pathogenesis, making the search for immunomodulatory therapies, such as ozone therapy (OT), highly relevant.

Aim. To study the role of proinflammatory cytokines in the complex treatment of patients with DFS complicated by osteomyelitis.

Materials and methods. The study included 62 patients with DFS complicated by osteomyelitis, divided into two groups: the main group (n = 31) received standard treatment supplemented with OT (intravenous infusions of ozonated saline) and ultrasonic cavitation (USC) of osteomyelitic lesions, while the control group (n = 31) received only standard treatment. Levels of IL-1β, TNF-α, and IL-6 were measured using Enzyme-Linked Immunosorbent Assay before treatment and on days 14–15.

Results. In the main group, levels of IL-1β, TNF-α and IL-6 decreased by 4.4, 10.24 and 3.2 times respectively (p < 0.001). The frequency of postoperative complications (phlegmons) was lower in the main group (9.7% vs 22.6%; p = 0.04). The average hospitalization duration decreased from 20.3 ± 4.84 to 14.9 ± 2.08 days.

Conclusion. OT and USC demonstrated significant immunomodulatory effects, reducing pro-inflammatory cytokine levels and improving clinical outcomes. The inclusion of OT and USC in the comprehensive treatment of diabetic foot syndrome complicated by osteomyelitis is advisable to reduce healing time and complications.

Consilium Medicum. 2025;27(4):233-236
pages 233-236 views
Monocyte chemoattractant protein-1 in patients with different types of diabetes mellitus: clinical and practical significance
Golodnikov I.I., Samsonova M.D., Kononenko I.V., Nikonova T.V., Podshivalova E.S., Markelova E.K., Bondarenko E.V., Loginova M.Y., Shestakova M.V.
Abstract

Background. Monocyte chemoattractant protein-1 (MCP-1) plays a crucial role in inflammatory processes by recruiting monocytes and macrophages to sites of inflammation. Inflammation is closely linked to poor control of diabetes mellitus (DM), characterized by significant glycemic fluctuations and prolonged hyperglycemia, as well as subclinical, low-grade inflammation of adipose tissue in type 2 DM. Elevated levels of MCP-1 have been associated with both type 1 and type 2 DM; however, data on its role in the pathogenesis of latent autoimmune diabetes in adults (LADA) are extremely limited.

Aim. To evaluate MCP-1 levels and their association with glycemic control parameters in patients with different types of DM (type 1 DM, type 2 DM, and LADA).

Materials and methods. Between February and November 2023, 80 individuals participated in the study, divided into four groups: patients with type 1 DM (n = 22), type 2 DM (n = 22), LADA (n = 14), and healthy volunteers (n = 22). The median ages were 26 years [21; 32] for type 1 DM, 41 years [33; 51] for type 2 DM, 41 years [33; 46] for LADA, and 33 years [26; 40] for healthy controls. Inclusion criteria were age between 18 and 55 years, body mass index up to 35 kg/m², and a diagnosis of one of the specified forms of DM. Exclusion criteria included other systemic autoimmune diseases, pancreatic diseases, and the use of immunosuppressive therapy.

Results. MCP-1 levels were significantly higher in patients with type 1 DM (213 [162; 263] pg/ml) and type 2 DM (228 [168; 294] pg/ml) compared to healthy volunteers (174 [151; 207] pg/ml; p < 0.05). Patients with LADA showed a non-significant trend toward elevated MCP-1 levels (218.51 [160; 268] pg/ml; p > 0.05). ROC analysis indicated that MCP-1 is not suitable as an additional marker for the differential diagnosis of LADA.

Conclusion. Elevated MCP-1 levels in patients with type 1 and type 2 DM suggest its possible involvement in the pathogenesis of these diabetes types. The lack of significant MCP-1 elevation in patients with LADA limits its utility as a diagnostic marker for this condition.

Consilium Medicum. 2025;27(4):239-244
pages 239-244 views
The role of bioimpedance status in the diagnosis of presarcopenia in elderly and elderly patients with type 2 diabetes mellitus
Obyedkov R.N., Dedov E.I., Pshennikova I.G.
Abstract

Background. Determination of skeletal muscle mass (SMM) for the diagnosis of sarcopenia using bioimpedance analysis of body composition (BIAST) is a well-recognised method. However, as data are accumulating, alternative possibilities for its diagnosis are occurring, particularly the determination of phase angle (PA) and other BIAST parameters.

Aim. Тo determine BIAST parameters, which can be used to predict presarcopenia in elderly and senile individuals with type 2 diabetes mellitus (2 DM).

Materials and methods. A one-stage single-centre cross-sectional study of patients over 60 years old hospitalized in the endocrinological department of Buyanov City Clinical Hospital due to decompensation of 2 DM was carried out. During hospitalisation, the Sarcopenia Fast questionnaire was used to detect sarcopenia syndrome, patients with more than 4 points were included in the main stage of the study to detect sarcopenia according to the European Working Group on Sarcopenia in Older People 2 Consensus. Statistical processing was performed using the SPSS Statistics 23 software package.

Results. Patients with presarcopenia had higher mean values of fat mass (FM) (p = 0.037), whereas levels of specific basal metabolic rate (SBM) (p = 0.0001), active cell mass (ACM) (p = 0.002), PA (p = 0.0001), SMM (p = 0.003) and SMM fraction (fSMM) (p = 0.002) were significantly lower in patients with presarcopenia than in patients without presarcopenia. The diagnostic significance of the derived risk factors by binary logistic regression was assessed by ROC analysis. The area under the ROC curve corresponding to the relationship between the combined BIAST parameters: PA, SMM, fSMM, ACM, and probability of outcome p was 0.772 ± 0.04. The threshold probability p-value at the cut-off point was 0.54. P-values equal to or greater than these values were consistent with predicting the presence of presarcopenia. Sensitivity and specificity were 78.2 and 66.7 respectively with 95% confidence interval 0.694–0.85.

Conclusion. The study has identified universal boundaries for both men and women, FU, SMM, dSMM, ACM, which are included in the prognostic model for the diagnosis of presarcopenia in patients with 2 DM. The availability of information on the threshold values of the main bioimpedance indicators of body composition in patients with presarcopenia and 2 DM significantly expands research and diagnostic opportunities in aging medicine. Interpretation of these data is promising for further studies.

Consilium Medicum. 2025;27(4):246-251
pages 246-251 views
Allopurinol in the complex therapy of acute decompensation of heart failure
Sarieva L.H., Muksinova M.D., Nasonova S.N., Zhirov I.V., Tereshchenko S.N.
Abstract

Background. Acute decompensation of heart failure (ADHF) is a period of chronic HF, which is characterized by a rapid aggravation/onset of HF symptoms, requiring urgent hospitalization for intensive care and worsening the patient’s prognosis.

Aim. To evaluate the efficacy of allopurinol in patients with ADHF, hyperuricemia, and reduced glomerular filtration rate compared with standard of care for 6 months.

Materials and methods. We present the results of a 6-month follow-up for 72 patients with ADHF, hyperuricemia, and reduced filtration function of the kidneys, calculated using the CKD-EPI formula, divided equally into two groups: group 1 received standard of care for HF combined with a xanthine oxidase inhibitor – allopurinol, and group 2 received standard of care only. Allopurinol was administered to group 1 patients at an initial dose of 50 mg, on average, 24-48 hours after admission to the hospital, in addition to standard of care. The study included 72 patients, with an average age of 71.67 years in group 1 and 70.28 years in group 2. The indicators at the time of enrollment in the study, when HF compensation was achieved, and after 6 months were analyzed.

Results. The median length of hospital stay in the allopurinol group was 13 [12; 18] days vs. 14 [10; 15] days in the standard of care group (p = 0.283). At 6 months of follow-up, repeated hospitalizations due to ADHF were reported in both groups at a similar rate. During the entire follow-up period, one death was reported in the allopurinol group. Statistically significant decreases in the levels of N-terminal precursor of brain natriuretic peptide were observed in both groups (p < 0.001). Significant changes in C-reactive protein levels were found in both groups at discharge. The analysis of echocardiographic parameters revealed a significantly increased left ventricular ejection fraction, a reduction in inferior vena cava size, and a decrease in systolic pressure in the pulmonary artery in both groups. During the therapy, there was a significant increase in the walking test distance in both groups (p < 0.001), with no significant difference between the groups.

Conclusion. The results of the study indicate a positive effect of allopurinol on uric acid levels, with no additional benefits and effects on endpoints.

Consilium Medicum. 2025;27(4):252-257
pages 252-257 views
Persistent Itsenko-Cushing’s disease with no remission after two surgical treatments: a clinical case
Osipova E.V., Smirnova P.A., Soldatova V.D., Dzyuba A.S., Pavlova M.G.
Abstract

Itsenko-Cushing’s disease (ICD) is a rare neuroendocrine disease caused by hyperproduction of adrenocorticotropic hormone (ACTH) by pituitary adenoma, leading to a persistent increase in cortisol levels and the development of endogenous hypercorticism. Without treatment, ICD leads to severe complications and significantly reduces life expectancy. Transsphenoidal adenomectomy remains the “gold standard” of treatment, but a significant proportion of patients experience persistence or recurrence of the disease, requiring the use of alternative treatments. This paper presents a clinical case of a patient H., 62 years old, with confirmed ACTH-dependent hypercorticism. The diagnosis was made in 2023 based on the following tests: cortisol level in a nocturnal suppression test with 1 mg of dexamethasone – 458 nmol/L, salivary cortisol at 23:00 – 10.37 nmol/L, daily urinary cortisol excretion – > 200 μg/day, ACTH – 14.7 pmol/L. Magnetic resonance imaging showed a pituitary microadenoma. A transsphenoidal adenomectomy was performed; however, remission was not achieved. Ketoconazole therapy was administered, with clinical improvement, but the patient subsequently discontinued the drug on her own. Upon follow-up examination a year later, the persistence of ICD was confirmed (salivary cortisol at 23:00 – 10.5 nmol/L, daily urinary cortisol excretion – 475.2 μg/day, ACTH – 49.8 pg/mL), magnetic resonance imaging showed signs of a residual pituitary tumor. Repeated transsphenoidal adenomectomy was performed, but remission was not achieved again. At follow-up, clinical and laboratory signs of hypercorticism and the patient’s severe condition persisted. Due to the ineffectiveness of surgical treatment, the patient was referred for stereotactic radiosurgery. The management of patients with a persistent or recurrent ICD remains clinically challenging due to the lack of a universal, highly effective, and safe therapeutic approach. The treatment strategy is determined individually, considering the severity of hypercorticism, the presence of complications, the disease prognosis, and the availability of therapies.

Consilium Medicum. 2025;27(4):258-262
pages 258-262 views