[Adrenal cortical steroidogenesis and adrenal androgen secretion in Cushing disease].

The daily time course of changes In the secretion of dehydroepiandrosterone, its sulfate, and Cortisol, as well as their precursors (17-α-hydroxypregnenolone, 17-α-hydroxyprogesterone, and 11-deoxycortisol) was studied in patients with Itsenko-Cushing syndrome and disease. The mean daily blood concentrations were calculated for each hormone. The activity of the enzymatic systems of steroidogenesis was estimated from the ratio of the mean daily concentrations of the precursor of an enzymatic reaction to those of its product. The findings suggest that production of elevated concentrations of corticosteroids (both Cortisol and androgens) through the Δ5-pathway with the enhanced activity of 11ß-hydroxylase and sulfatase is characteristic of patients with Itsenko-Cushing disease. In patients with Itsenko-Cushing syndrome, the generation of higher Cortisol levels is accomplished through the Δ4-pathway whereas the synthesis of androgens through the Δ5-pathway is minimal due to the decreased activity of 17,20-desmolase.

[Comparative study of prolactin-secreting and hormonally inactive pituitary adenomas in patients with moderate hyperprolactinemia].

The present paper deals with the differential prolactin diagnosis of pituitary adenomas with moderate prolactin hyperproduction and hormonally inactive pituitary adenomas. Sixty patients with gross pituitary adenomas were examined. Morphological analysis of in-traoperative samples included histological, immunohistochemical studies with antibodies to hormones of the adenohypophysis. There was a probable frequency of prolactin-secreting tumors among gross pituitary adenomas proceeding with moderate hyperprolactinemia (25%) and that of hormonally inactive pituitary adenomas among the tumors regarded as prolactinomas (16%) in the preoperative period.

[Early and late results of neurosurgical treatment with Itsenko-Cushing disease].

То study the efficiency of neurosurgical treatment of the Itsenko-Cushing disease (1CD), the authors analyzed the early and late results of adenomectomy in 99 patients (90 females and 9 males) with ICD. The diagnosis of ICD was verified on the basis of hormonal studies, functional tests, and the results of topic diagnosis. All the patients had an active stage of the disease and a pituitary tumor, as evidenced by magnetic resonance Imaging (MRI). Out of the 99 patients, 75% had a microadenoma of the pituitary and 25% had its macroadenoma. No correlation was found between the sizes of a tumor, the duration of the disease, and the severity of hy-percorticism. The Indication for surgery was a well-defined localized pituitary tumor as verified by MRI. The patients tolerated a neurosurgery well and complications as incoming diabetes insipidus were observed only in 12%, which is in agreement with the data available in the literature. Algorithms were developed for postoperative management of these patients. The findings have indicated that the development of the hormonal and clinical signs of hypocorticism serves as a good predictive marker of a radically performed operation. Six months after surgery, 82% of the patients were at remission. At an average 8.6-year follow-up, remission continued to be in 69(85.2%) of 81 patients. After surgery, patients with ICD should be, however, followed up since 14% developed a recurrence in the late postoperative period.

[The clinical features of acromegaly and its treatment policy according to age at the onset of disease].

The hormonal activity and the duration of an active phase of the disease are important factors that are involved in the pathogenesis of organ and system complications decreasing lifespan in patients with acromegaly. A hundred and forty patients with active acromegaly were examined to determine the age-related features of the course of the disease. According to the age by the moment of the examination, all the patients were divided into 3 groups: 1) 14 patients aged 20-39 years; 2) 72 patients aged 40-59 years; and 3) 54 patients aged 60 years or more. The mean age at the onset of disease was 27.5±1.9, 37.5±1.0, and 51.2±1.2 years in Groups 1, 2, and3, respectively (p - 0.000); the duration of a latent period being 3.8±0.7, 6.2±0 6, and 9.3±0 8years (p.

[Drug treatment for acromegaly: results of long-term use of Sandostatin LAR].

То evaluate the effectiveness and safety of drug treatment for acromegaly, the authors conducted an open-labeled prospective study of the impact of treatment with long-acting octreotide Sandostatm LAR) on the content of growth hormone (GH) and IRF-1 and on the size of a pituitary tumor. The study covered 40 patients (28 females and 12 males) aged 21 to 65 years (median 45 years) who had active acromegaly; 4 (10%) patients were diagnosed as having pituitary microadenoma; 36 (90%) had pituitary macroadenoma. Twenty-four patients received no therapy; 16 patients had tumors after their ineffective removal. All the patients took Sandostatin LAR, 20 mg intramuscularly, once every 28 days. The mean duration of treatment was 8.25 months (range: 3 to 12 months). Clinical and hormonal parameters were estimated 3, 6, and 12 months of treatment. A treatment-induced decrease in GH and/or insulin-like growth factor 1 (ILGF-1) by at least 30% of their baseline values considered effective. The state of a tumor was evaluated by brain magnetic resonance imaging in 26 patients. Three month following Sandostatin LAR treatment, the median concentration of GH significantly decreased from 33.5 to 5.55 ng/ ml (p < 0.001) and later on it remained nearly at this level (5.1 ng/ml and 5.35 ng/ml after 6 and 12 months, respectively). The concentrations of ILGF -1 similarly changed: its median was 779 ng/ml at baseline, 390 (p < 0.001), 390, and 330 ng/ml after 3, 6, and 12 months, respectively. Following 12 months of treatment, there were reductions in GH levels in 52.2% of the patients (including a < 2.5-ng/ml reduction in 33.3% of the patients) in the concentration of ILGF-1 by more than 50% of the baseline values in 49.9% (including a complete ILGF-1 concentration normalization in 33.3%). Twelve months after treatment, there was a reduction in the size of a tumor in 38.4% of the patients (by an average of41.25±7.22% of the baseline volume) and its growth stabilization in 59.1%. The findings suggest that treatment with Sandostatin LAR in a dose of 20 mg Is an effective and safe treatment, leads to a significant reduction in the values of GH and IL GF-1 just 3 months after treatment, and controls hormonal secretion and tumor growth in most patients with acromegaly.

[The specific features of the course of acromegaly in old age and possibilities of somatulin treatment].

Acromegaly is a severe neuroendocrine disease caused by chronic excessive production of growth hormone. There are 50-70 cases of this disease per 1 million people. In the vast majority of cases, the cause of the disease is a pituitary adenoma from somatotrophic cells. With the advent in clinical practice of prolonged analogues of somatostatin, endocrinologists have new therapeutic options. In the article we present a clinical case of the patient with the diagnosis: acromegaly, active form; Endosuprasellar pituitary adenoma (somatotropinoma); Hypopituitarism (secondary adrenal insufficiency, secondary hypothyroidism); Chronic pyelonephritis in the acute phase; Hypertension of the II stage, ischemic heart disease, angina pectoris II functional class; Common atherosclerosis with a primary lesion of the aorta, coronary vessels and cerebral vessels.