Vol 19, No 4 (2017)


Diagnosis and treatment of primary adrenal insufficiency in adult: a Russian Association of Endocrinology Clinical Practice Guideline (project)

Melnichenko G.A., Troshina E.A., Yukina M.Y., Platonova N.M., Beltsevicha D.G.


In the project of clinical recommendations Russian Association of Endocrinology focused on diagnosis and differential diagnosis of primary adrenal insufficiency with special reference to diagnostic steps, major pharmacological tests, instrumental studies. Strategies of management of patients with this pathology are described.
Consilium Medicum. 2017;19(4):8-19
pages 8-19 views

Algorithms of specialized medical care for diabetes mellitus patients, 8th Edition: what innovations?

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Интервью с академиком РАН, профессором, доктором медицинских наук, зам. директора по научной работе ФГБУ «Эндокринологический научный центр» Минздрава России, директором Института диабета Мариной Владимировной Шестаковой.
Consilium Medicum. 2017;19(4):20-22
pages 20-22 views

Pathogenetic background of dipeptidyl peptidase-4 inhibitors application in the management of diabetes mellitus type 2

Demidova T.Y., Kulenok S.G., Gasanzade P.A.


Management of type 2 diabetes mellitus (DM) suggests the earliest therapy appointment. It is noted that in patients with DM type 2 the β-cell mass is reduced by more than 50%, and this reduction begins at the stage of pre-diabetes. The reducing of incretin effect can be observed at the stage of impaired glucose tolerance in the incensement of insulin concentration in response to oral intake of glucose and nutritional stimulus. Insulin secretion induced by glucagon-like peptide-1 in patients with type 2 DM is reduced in comparison with healthy people as a result of reduced functioning of β-cells mass. Thus, β-cell dysfunction is not only the step to developing type 2 DM, but also determines the continuing progressive course of the disease. This study indicates the possibility of improving incretin effect against the background of improved functional status of β-cells, for example, as a result of a removal of glucotoxicity. Drug preference is given to agents, simultaneously affecting several parts of pathogenesis and with the high level of safety. Dipeptidyl peptidase-4 inhibitors significantly restore β-cell mass and morphology of pancreatic islets, thus such function as insulin secretion has been persisting. This article describes the benefits of early application of dipeptidyl peptidase-4 inhibitors to correct the pathogenetic defects, as well as the development of new approaches to affect the incretin system.
Consilium Medicum. 2017;19(4):23-28
pages 23-28 views

Treatment goals and objectives of diabetes mellitus: interviews with experts

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В Новосибирске 3 апреля 2017 г. состоялась международная конференция «Современный взгляд на цели и задачи терапии сахарного диабета 2-го типа», в которой приняли участие российские и зарубежные эксперты. Предлагаем вашему вниманию интервью с профессором кафедры неотложной терапии с эндокринологией и профпатологией факультета повышения квалификации и профессиональной переподготовки врачей Новосибирского государственного медицинского университета, доктором медицинских наук, профессором, врачом высшей категории Людмилой Александровной Руяткиной; эндокринологом, профессором кафедры эндокринологии и метаболизма Университета Пизы (Италия) Стефано Дель Прато; кардиологом, сотрудником лаборатории катетеризации сердца Техасского научного центра здоровья (США), профессором Робертом Чилтоном.
Consilium Medicum. 2017;19(4):29-31
pages 29-31 views

Motivation for improving glycemia self-monitoring efficiency in patients with diabetes mellitus: problems and solutions

Marchenkova L.A., Makarova E.V.


Blood glucose self-monitoring has always been an important aspect of diabetes mellitus (DM) treatment. Despite the fact that glycemic control principles are simple and transparent, only a small percentage of patients follow the recommendations accordingly endocrinologist prescriptions. This review presents actual information on self-monitoring principles, clinical and psychological barriers that interferes regular effective measurement of blood glucose and role of positive attitude towards glycemic control in DM patients. Full awareness of the disease, knowledge of self-monitoring technique and ability to correct unsatisfactory state - gives the DM patient confidence and helps to achieve good treatment outcomes. The important factor to facilitate patient's motivation for regular and effective self-monitoring is to use modern, accurate and comfortable in everyday usage glucometers.
Consilium Medicum. 2017;19(4):32-35
pages 32-35 views

Pathogenetic substantiation inclusion of taurine in the treatment of patients with diabetes mellitus type 2

Statsenko M.E., Turkina S.V., Tyshchenko I.A., Gorbacheva E.E.


The review is devoted to the validity of taurine in patients with diabetes mellitus type 2. The data of numerous experimental and clinical studies have shown the positive effect of taurine on both the course of diabetes mellitus type 2 and on the comorbid pathology (heart disease, kidney disease).
Consilium Medicum. 2017;19(4):36-42
pages 36-42 views

Pathogenetic approaches to prevention and treatment of diabetic retinopathy

Kolchik O.V., Nemirova S.V., Petrova K.S.


The number of patients with complications is growing with the increase of diabetes mellitus (DM) prevalence worldwide. 25-33% of patients have diabetic retinopathy (DR). DR is a leading cause of blindness and low vision among people of working age and it is a serious problem. Standard treatment methods for DR are mainly used in patients with advanced-stage of disease and are not always safe and successful. This makes us search new approaches to solve this problem and pay attention to prevent late DR complications. This article discusses the pathogenetic mechanisms of DR development and the possibility of reducing the risk of its progression. Special attention is paid to the application of drug calcium dobesilate possessing a wide range of effects on DR pathogenesis.
Consilium Medicum. 2017;19(4):43-49
pages 43-49 views

Non-alcoholic fatty liver disease and diabetes mellitus: targets of metabolic tandem

Zvenigorodskaya L.A., Shinkin M.V.


The prognosis of the World Health Organization indicates that by 2020 non-alcoholic fatty liver disease (NAFLD) will occupy the first position within liver diseases. Liver transplantation in NAFLD patients with cirrhosis occupies second position after viral cirrhosis, nowadays. Mortality in NAFLD patients 1 month after surgery is significantly higher than mortality rate in patients with cirrhosis of different etiology. We also indicate the increased risk of other complications of liver transplantation, such as sepsis, transplant rejection and the development of cardiovascular pathology. According to modern point of view NAFLD is a liver damage, including fatty degeneration, fatty degeneration and inflammatory cell infiltration and injury of hepatocytes (non-alcoholic steatohepatitis/metabolic liver disease) and fibrosis (results in cirrhosis). Cause-effect relation of NAFLD and diabetes mellitus (DM) is the subject of numerous discussions. The connecting pathogenetic link between NAFLD and DM is insulin resistance. The realization of insulin resistance is primarily carried out in hepatocytes. Specific diagnostic criteria for NAFLD practically do not exist; the most likely NAFLD diagnosis is an "exclusion diagnosis". There is no standard therapy for patients with NAFLD, nowadays. None of the drugs used in the treatment of NAFLD has high evidential base. Correction of body-mass index, food addiction and physical activity is the most effective actions to prevent the development of NAFLD and diabetes mellitus.
Consilium Medicum. 2017;19(4):50-57
pages 50-57 views

The application of metformin provokes disturbance in vitamin B12 homeostasis

Gromova O.A., Stakhovskaya L.V., Torshin I.Y., Tomilova I.K.


Metformin is one of the most widely used oral hypoglycemic agents. Adverse side effect of metformin and other biguanides is disturbance in vitamin B12 metabolism, associated with low serum vitamin B12 level, especially against the backdrop of calcium deficiency. This application is associated with vitamin B12 hypovitaminosis and is accompanied with peripheral neuropathy, asthenia. The long-term application can cause megaloblastic anemia and increase the risk of depression, cerebrovascular and neurodegenerative diseases. Clinical studies and meta-analyses have constantly confirmed the association between metformin application and vitamin B12 hypovitaminosis. It was shown, that every 25 pmol/l increase in cobalamin was associated with a 6% risk reduction in neuropathy. The application of cyanocobalamin would help compensate the disturbance in vitamin B12 metabolism caused by metformin.
Consilium Medicum. 2017;19(4):58-64
pages 58-64 views

Assessment of iodine profhylaxis effectiveness in adult population of Saint Petersburg

Soboleva D.E., Dora S.V., Karonova T.L., Volkova A.R., Ostroukhova E.N., Bystrova A.A., Shlyakhto E.V.


Purpose - to assess the effectiveness of iodine deficiency prophylaxis in adult population of St. Petersburg. Materials and methods. We examined 542 residents of St. Petersburg aged 18-77 years. All participants were divided into 3 groups according to age (18-24, 25-44, 45 years and older). Pregnant women were evaluated separately. All participants were questioned, the values of urinary iodine concentration (UIC) were analyzed. Results. Median UIC of all participants was 91.2 mg/l and corresponded to mild iodine deficiency. Persons younger 25 years and older 44 years had iodine sufficiency, participants aged 25-44 were diagnosed with mild iodine deficiency. Median UIC in pregnant women was 112.4 mg/l and corresponded to insufficient iodine intake. Iodized salt was used by 41.1% of all surveyed persons and 52.2% of pregnant women. Iodine supplements were taken by half of pregnant women. The type of nutrition, education, family and financial situation as well as living conditions did not affect adherence to methods of prevention. Conclusions. The adult population of St. Petersburg had a different iodine status. Persons of reproductive age including pregnant women had mild iodine deficiency. Prophylaxis of iodine deficiency held in St. Petersburg in 2013-2015 was not effective enough. No social factors influencing adherence to iodine deficiency prevention methods were revealed.
Consilium Medicum. 2017;19(4):65-69
pages 65-69 views

Congenital adrenal hyperplasia (21-hydroxylase deficiency) in adulthood patients: diagnosis and treatment

Molashenko N.V., Sazonova A.I., Troshina E.A.


In the article presents the main approaches to the diagnosis and treatment of patients with classical and nonclassical forms 21-hydroxylase deficiency. The techniques of diagnostic tests and parameters of hormonal indicators to assess the adequacy of replacement therapy glucocorticoids and mineralocorticoids are considered.
Consilium Medicum. 2017;19(4):70-74
pages 70-74 views

Primary hyperaldosteronism: diagnosis and treatment. A new look at the problem. According to the materials of the Russian Association of Endocrinologists clinical guidelines for primary hyperaldosteronism diagnosis and treatment

Melnichenko G.A., Platonova N.M., Beltsevich D.G., Yukina M.Y., Molashenko N.V., Troshina E.A.


The article presents the project of the Russian Association of Endocrinologists clinical guidelines for primary hyperaldosteronism (PH) diagnosis and treatment, which provides the modern algorithm for examining patients with PH and also is considered the basic principles of laboratory, instrumental diagnosis and pathogenetic treatment approaches.
Consilium Medicum. 2017;19(4):75-85
pages 75-85 views

Clinical case patient with hemorrhagic fever with renal syndrome, complicatedby the pituitary apoplexy

Kotova M.E., Salukhov V.V., Dobrovolskaya L.M.


A case of panhypopituitarism in the patient associated with acute infectious disease in the form of hemorrhagic fever with renal syndrome is presented. Severityof disease resulted in multiple complications, including acquired panhypopituitarism related to pituitary hemorrhage. As result of medical and diagnostic proceduresusing high-tech methods of investigation, complications revealed (including abnormal functions of the pituitary gland) were resolved, and the patientwas discharged in satisfactory condition. This case shows the need of the substitution treatment to maintain missing tropic function of pituitary gland, followedby serial observation and long-term (possibly lifelong) observation by the endocrinologist.
Consilium Medicum. 2017;19(4):86-90
pages 86-90 views

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