[The etiology and pathogenesis of primary chronic adrenal insufficiency: Current aspects].

Primary chronic adrenal insufficiency is a relatively rare disease. To date, according to various authors, the prevalence of Primary chronic adrenal insufficiency in the world varies significantly.

[Euthyroid Graves' disease (problems of diagnosis and treatment)]. / Eutireoidnaia bolezn' Grévsa (Problemy diagnostiki i lecheniia).

Twenty-six patients with endocrine ophthalmopathy without signs of thyroid disease (according to ultrasonic scanning, measurements of free thyroxin and thyrotropic hormone-TTH) were examined. Edematous exophthalmos in the compensated stage was diagnosed in 13 patients, subclinical stage of this condition in 10, and endocrine myopathy in 3 patients. Russian drug thyroliberin was used for accurate diagnosis of thyroid dysfunction; injection of this drugs to normal subjects leads to a drastic (3.5-5-fold) increase of TTH level. After measurement of TTH, the drug was infused intravenously by jet injection in a dose of 500 micrograms. Ten normal subjects were controls. 30 min after thyroliberin injection, TTH was measured. It was sharply increased in half of patients and in the control group. In one-third of cases (mainly with edematous exophthalmos) TTH level increased negligibly or even decreased after the test. After 1.5-2 years, signs of hyperthyrosis manifested in one-third of this group of patients. The authors consider that patients with the so-called Graves' disease are at a high risk of thyroid abnormalities and should be regularly consulted by both ophthalmologist and endocrinologist.

[Diffuse toxic goiter]. / Diffuznyi toksicheskii zob.

Diffuse toxic goiter is a common disease of the thyroid gland. As organospecific autoimmune condition the disease is not infrequently combined with endocrine ophthalmopathy and in this connection a more precise preparation of the patients to surgery is found to be mandatory. Elderly persons demonstrate atypical patterns of the disease course (insignificant enlargement of the gland, manifest depression, isolated cardial disorders without other symptoms of thyrotoxicosis, resistance to thyrostatic treatment). The patients need a life-long dispensary follow-up as diffuse toxic goiter is a condition of a relapsing type.

[Determination of autoantibodies to thyrotropin receptors in patients with diffuse toxic goiter]. / Opredelenie autoantitel k retseptoram tireotropnogo gormona u bol'nykh diffuznym toksicheskim zobom.

The blood level of antithyroid autoantibodies to TSH receptors was determined in patients with toxic goiter (TG) before and during antithyroid therapy using two biological methods (by the increment in the cAMP level in slices and primary monolayer culture of human thyroid cells) and a radioreceptor method (by inhibition of TSH binding with its receptors from the animal thyroid). Comparison of the results of these three methods has shown that all methods are almost equally valuable for diagnosis of new cases of TG. However the biological method was shown to be more sensitive and informative with regard to predicting the time of immunological remission during antithyroid therapy.

[The role of Coxsackie viruses in the pathogenesis of diffuse toxic goiter]. / Rol' virusov Koksaki v patogeneze diffuznogo toksicheskogo zoba.

Altogether 15 untreated patients aged 16 to 55 with diffuse toxic goiter had morphologically confirmed diagnosis of the presence of antibodies to Coxsackie virus (group B); titers of group A (1:128 and more) were revealed in 3 of them. It indicated recent (not more than 2 yrs.) Coxsackie virus infection. Such titers were absent in the control group (18 healthy persons). Difference in the study and control groups was statistically significant (p less than 0.05). The role of Coxsackie virus in the breakdown of natural tolerance to autologous thyroid tissue was discussed.

[Thyroid-stimulating autoantibodies in the blood of patients with diffuse toxic goiter]. / Tireostimuliruiushchie autoantitela v krovi bol'nykh diffuznym toksicheskim zobom.

The level of thyrostimulating autoantibodies (TSA) in IgG fraction isolated from the blood serum by precipitation of (NH4)2SO4 was determined in 36 patients with diffuse toxic goiter (DTG) and in 8 healthy donors. TCA which were assessed by a rise of the level of cAMP in human thyroid sections (obtained at operation from extranodal tissue of patients with nodal euthyroid goiter) after 2 h-incubation at 37 degrees C with IgG, were determined in 32 DTG patients (89%). The patients were divided into 2 groups with respect to their clinical and thyroid status: with a high and normal or subnormal content of the blood thyroid hormones. In the 1st group the frequency of detection (96%) and the level of TSA (570.64 +/- 109.63%) were much higher than in the 2nd group of patients (70 and 186.29 +/- 23.06%, respectively). The highest levels of TSA (1085.25 +/- 551.27%) were found in 4 of 26 patients (the 1st group) who had not received specific therapy.

[Characteristics of the clinical course of diffuse toxic goiter]. / Osobennosti klinicheskogo techeniia diffuznogo toksicheskogo zoba.

The authors describe rather rare clinical forms of diffuse toxic goiter with bradycardia, pretibial myxedema, the absence of ophthalmic sings and noticeable cachexy. All necessary investigations for more rational differential diagnosis are enlisted. A possibility of the development of the clinical picture of thyrotoxicosis in TTH producting hypophyseal adenomas, chorionepithelioma and hydatidiform mole is emphasized.

[Indicators of the T- and B-systems of immunity in patients with diffuse toxic goiter]. / Pokazateli T- i B-sistem immuniteta u bol'nykh diffuznym toksicheskim zobom.

Several indices of the function of T- and B-immune systems were determined in patients with diffuse toxic goiter before treatment and at thyrotoxicosis compensatory stage. Sensitization of lymphocytes to thyroglobulin was observed in the majority of patients with the decompensatory stage of the disease. The experimental results of the lymphocyte migration inhibition test were not dependent on patient's sex and/or age, endocrine ophthalmopathy occurrence and titers of antibody to thyroglobulin. The function of T- and B-immune systems tended to normal in the treatment process.