Miznarodnij Endokrinologicnij Zurnal最新文献

{"title":"The problem of timely diagnosis of primary hyperaldosteronism. Clinical case","authors":"V.M. Zhdan, H.V. Volchenko, M.Yu. Babanina, M.V. Tkachenko, O.A. Kiryan, Ye.M. Kitura, I.V. Ivanitsky","doi":"10.22141/2224-0721.19.6.2023.1318","DOIUrl":"https://doi.org/10.22141/2224-0721.19.6.2023.1318","url":null,"abstract":"A clinical case is presented of delayed diagnosis of primary hyperaldosteronism (PHA) due to aldosterone-producing adenoma. Suspicion of PHA arises in case of persistent combination of hypertension with hypokalemia of various severity, a specific neuromuscular syndrome, as well as a high risk of cardiomyopathy, heart failure, and deterioration of kidney function, which are not typical for banal hypertension. Unsatisfactory blood pressure control with a standard combination of pharmacotherapy, an unexpected positive effect of mineralocorticoid receptor antagonists, high blood pressure in young people, as well as a family history of early high blood pressure or stroke at a young age, paroxysmal course of hypertension itself increases the risk of PHA. For a long time, a disease in our patient was considered a banal hypertension, although the diagnostic hypothesis of PHA should appear immediately after severe neuromuscular syndrome, rapid progression of cardiomyopathy and clinically significant heart failure began to dominate in the clinical picture. A 44-year-old female patient came to the attention of rheumatologists with suspicion of inflammatory myopathy due to frequent episodes of muscle weakness whose origin remained unclear. Key complaints of pronounced paroxysmal generalized muscle weakness, especially in the limbs, numbness and paresthesias in the extremities, calf muscle cramps against the background of hypertension were regarded as a neuromuscular syndrome specific to PHA. The PHA hypothesis was supported by the presence of cardiomyopathy, heart failure, clinically significant hypokalemia, and elevated aldosterone level. Computed tomography of the retroperitoneal space confirmed the presence of adrenal adenoma. Unfortunately, with a delay, after 13 years of hypertension, the diagnosis of PHA against the background of aldosterone-producing adenoma was confirmed. Consultation with a surgeon endocrinologist was suggested, as well as administration of eplerenone 50 mg daily in combination with lercanidipine 20 mg daily. Already after 6 weeks of pharmacotherapy, a positive therapeutic effect was obtained regarding the control of hypertension, heart failure, and the severity of neuromuscular syndrome. The differential diagnosis of secondary endocrine hypertension can be successful only with the possession of skills for early clinical detection of endocrine pathology, even in subclinical disease presentation. The diagnosis of PHA makes it possible to offer a patient radical surgical treatment, as well as to choose optimal approaches to pharmacotherapy.","PeriodicalId":31740,"journal":{"name":"Miznarodnij Endokrinologicnij Zurnal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135808848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of stress on the thyroid morphofunctional status (literature review)","authors":"I.V. Chernyavska, V.M. Dubovik, O.A. Goncharova, E.M. Ashurov","doi":"10.22141/2224-0721.19.6.2023.1314","DOIUrl":"https://doi.org/10.22141/2224-0721.19.6.2023.1314","url":null,"abstract":"The article is a literature review on the effect of stress on the thyroid morphofunctional status. The article provides the results of research regarding the effect of various stressors on the thyroid functional state. It also discusses the mechanisms of immune system dysfunction under the influence of stressors that cause autoimmune disorders. The pathophysiological connection between the action of stress hormones and thyroid hormones is described, which consists in changes in the functional state of the thyroid gland depending on the stage of stress. The article also analyzes recent multifactorial population studies on the association of elevated cortisol levels, hyperinsulinemia, hyperleptinemia, and increased neoplastic proliferative activity. The dyshormonal etiology of insulin resistance is based on hypersensitivity due to various factors, which is based on catecholaminergic and serotonergic dysregulatory pathology. As a result, hypercortisolemia occurs. Also, in response to a chronic increase in cortisol level, the expression of leptin increases. Hyperinsulinemia and hyperleptinemia develop under the influence of hypercortisolemia. Patients with obesity, dyslipidemia, hyperleptinemia, hyperinsulinemia have increased level of insulin-like growth factor-1 and other growth factors that participate in the vascular wall remodeling and in the mechanisms of stimulation of the division of various types of cells. There are isolated studies indicating an increased incidence of nodular goiter in people with a negative metabolic phenotype. The presence of hyperinsulinemia and hyperleptinemia can be a crucial marker of the boundary between physiological cell division and neoplastic proliferative activity. Insulin-like growth factor-1 plays a significant role in the regulation of cell proliferation and apoptosis in terms of energy metabolism and depends on the type of eating behavior. Chronic stress changes eating behavior. Therefore, in this difficult historical period for Ukraine, it is important to study both clinical and pathogenetic aspects of hormonal, immunological, metabolic changes that occur in the body under the influence of chronic stress and contribute to the development of thyroid pathology.","PeriodicalId":31740,"journal":{"name":"Miznarodnij Endokrinologicnij Zurnal","volume":"5 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135808846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes mellitus and COVID-19: living with double risk","authors":"O.V. Muravlova, Z.O. Shaienko, I.L. Dvornyk, L.M. Sizova, V.I. Ilchenko, T.I. Purdenko, O.A. Shpetnyi","doi":"10.22141/2224-0721.19.6.2023.1315","DOIUrl":"https://doi.org/10.22141/2224-0721.19.6.2023.1315","url":null,"abstract":"Background. The purpose is to analyze and summarize the studies conducted to determine the impact of COVID-19 on the course of diabetes mellitus and the manifestations of chronic complications of this disease. Materials and methods. We did the search in PubMed and ScienceDirect databases using the following line: “SARS-CoV-2 or COVID-19 and diabetes or hyperglycemia”. Results. It was found that in patients with diabetes, the severity of COVID-19 is increased. In particular, the number of those who needed intensive care or artificial ventilation has elevated. The same negative trend is noted for the overall mortality rate in patients with diabetes. It has been found that COVID-19 contributes to an increase in the development of diabetes, including diabetic ketoacidosis, hyperosmolar syndrome, brain stroke and mental health disorders, which can potentiate the effect of COVID-19 in enhancing the manifestations of diabetes and double risk for these patients. Along with this, the common pathways of the pathogenesis of diabetes and COVID-19 determine the bidirectionality of the interaction in their comorbidity. Conclusions. We have demonstrated numerous links between COVID-19 pathogenetic mechanisms and diabetes. Despite this, current research shows only modest evidence of an increased risk of metabolic, neurological, and psychiatric complications in patients with diabetes who had COVID-19. However, along with the direct impact of patients’ infection, the conditions of pandemic are also affected, which complicate access to the necessary care and should be taken into account when studying the clinical consequences of COVID-19 in patients with diabetes.","PeriodicalId":31740,"journal":{"name":"Miznarodnij Endokrinologicnij Zurnal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135808852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil gelatinase-associated lipocalin: function, specificity, role in the diagnosis of renal dysfunction in hypertensive patients with concomitant type 2 diabetes and obesity","authors":"I.P. Dunaeva","doi":"10.22141/2224-0721.19.5.2023.1294","DOIUrl":"https://doi.org/10.22141/2224-0721.19.5.2023.1294","url":null,"abstract":"Background. Neutrophil gelatinase-associated lipocalin (NGAL) belongs to the superfamily of lipocalins whose main function is the binding and transportation of hydrophobic molecules, si­derophores, as the most important ligands of NGAL. The diagnostic significance of NGAL as a marker of renal dysfunction, as well as its prognostic value in terms of the further prognosis of the course of renal pathology has now been confirmed. The purpose of the study: to determine the role of NGAL in the development of renal dysfunction in hypertensive patients with comorbid type 2 diabetes (T2D) and obesity. Materials and methods. One hundred and eleven patients with hypertension (50 men, 61 women) aged 54.37 ± 1.18 years and 20 controls were examined. During the examination, they were divi­ded into 4 groups depending on the presence of comorbid pathology: hypertension — the first group (n = 22); hypertension combined with obesity — the second group (n = 30); hypertension combined with T2D — the third group (n = 31); hypertension, T2D and obesity — the fourth group (n = 28). In all patients, body weight and height were measured, body mass index was calculated, levels of glycated hemoglobin, lipid metabolism, systolic and diastolic blood pressure were measured. The content of NGAL in blood serum was evaluated by the enzyme-linked immunosorbent assay. Results. The level of NGAL in all patients included in the study was significantly higher compared to the control group (p < 0.01). However, it was highest in comorbidity of hypertension, T2D and obesity, which, in turn, indicates a high risk of interstitial fibrosis in these patients. A significant correlation was found between the level of NGAL and the concentration of cardiotrophin (p < 0.032), catestatin (p < 0.001), β2-microglobulin (p < 0.001), cystatin (p < 0.021), atherogenic coefficient (p < 0.011), NT-proBNP (p < 0.014), vitamin D (p < 0.004). The obtained data demonstrate the significant role of NGAL in the development of early cardiovascular and renal complications in our patients. Conclusions. A significant increase in the level of NGAL was found in patients with hypertension, hypertension with T2D, hypertension with obesity, hypertension with T2DM and obesity compared to healthy individuals (p < 0.01). A significant correlation of the NGAL level with the serum concentration of cardiotrophin, catestatin, cystatin C, β2-microglobulin, atherogenic coefficient, NT-proBNP, and vitamin D in the exami­ned patients was proved.","PeriodicalId":31740,"journal":{"name":"Miznarodnij Endokrinologicnij Zurnal","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135499253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of cortisol on achieving target blood pressure levels in patients with resistant hypertension and chronic kidney disease","authors":"Yu.M. Sirenko, O.L. Rekovets","doi":"10.22141/2224-0721.19.3.2023.1268","DOIUrl":"https://doi.org/10.22141/2224-0721.19.3.2023.1268","url":null,"abstract":"Background. Resistant hypertension is defined as failure to achieve the target blood pressure (BP), despite treatment with at least three antihypertensive drugs that include a diuretic, and is associated with a poor prognosis. This is caused by organ damage from long-term exposure to high blood pressure, and is also linked to diabetes mellitus, chronic kidney disease and obesity. The purpose of the work is to evaluate biological markers associated with failure to achieve the target level of blood pressure in patients taking 3 or more antihypertensive drugs, depending on the presence of chronic kidney disease. Materials and methods. The study included 1146 patients with resistant hypertension who took 3 or more antihypertensive drugs. They were examined using both instrumental and laboratory methods with the measurement of office blood pressure upon admission to the hospital and upon discharge, evaluation of biochemical blood parameters, levels of creatinine, blood lipids, renin, blood aldosterone, cortisol. Results. The average age of the patients was 57.90±0.37 years. There were more women than men— 62.7 versus 36.7%. The body mass index was 31.00±0.19kg/m2. The average office systolic/diastolic BP upon admission to the hospital was 174.60±0.64/100.50±0.38 mmHg. 22.4% of patients had glomerular filtration rate (GFR) <60ml/min/1.73m2. In the subgroup with GFR ≥60ml/min/1.73m2, the achievement of the target BP was 44.76%, which is significantly higher than in patients with GFR <60ml/min/1.73m2 (12.56%, p<0.05). Blood cortisol level in the subgroups with failure to reach the target level of office blood pressure was 127.72±4.20 μg/dl (with GFR<60 ml/min/1.73m2) and 163.71±15.20 μg/dl (GFR ≥60ml/min/1.73m2), which was significantly higher compared to the patients with the target BP level: 6.02±0.90 μg/dl (with GFR <60ml/min/1.73m2; p<0.05) and 47.84±4.40 μg/dl (in the subgroup with GFR ≥60ml/min/1.73m2; p<0.05). Conclusions. In patients with resistant hypertension, elevated blood cortisol content, regardless of GFR, was associated with failure to achieve the target level of office blood pressure.","PeriodicalId":31740,"journal":{"name":"Miznarodnij Endokrinologicnij Zurnal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135777162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peculiarities of ionoregulatory renal function of rats in the dynamics of experimental diabetes mellitus development","authors":"О.А. Olenovych","doi":"10.22141/2224-0721.19.2.2023.1256","DOIUrl":"https://doi.org/10.22141/2224-0721.19.2.2023.1256","url":null,"abstract":"Background. The purpose of the research was to study the peculiarities of ionoregulatory renal function in the dynamics of alloxan-induced experimental diabetes mellitus. Materials and methods. The experiments were carried out on 63 white non-linear mature male rats, 53 with experimental diabetes mellitus of varying duration induced by intraperitoneal administration of alloxan in a dose of 160 mg/kg of body weight, and 10 intact rats (control group). Ten, 20, 25, 30, 40 and 45 days after administration of the diabetogenic substance, the animals were withdrawn from the experiment. Ionoregulatory function of the kidneys was studied by means of the clearance method under condition of water induced 2-hour diuresis to determine the clearance of endogenous creatinine, glomerular filtration rate, sodium and potassium content in the urine and blood plasma. It was followed by calculation of the electrolyte excretion, intensity of their filtration, absolute and relative reabsorption, their proximal and distal tubular transport (including standardized by glomerular filtrate volume). Results. The ionoregulatory function of the kidneys in rats with alloxan-induced experimental diabetes is characterized by the intensification of natriuresis and kaliuresis at all stages of the experiment. An increase in the urinary sodium loss in the early stages of alloxan-induced experimental diabetes is primarily stipulated by glomerular hyperfiltration, followed by an enhancement of filtration sodium load to the nephron. The loss of proportionality between the filtered amount of sodium and its proximal reabsorption causes a decrease in the total reabsorption potential of the tubular segment of the nephron in the dynamics of alloxan-induced experimental diabetes. It is reflected primarily on the proximal tubules, and subsequently induces a functional weakening of the tubule-tubular connection and relative dysfunction of the distal segment of the nephron with subsequent inhibition of aldosterone-dependent regulatory mechanisms. Conclusions. The kaliuric reaction of the diabetic kidney may serve as one of the signs of decompensation of the renal blood flow autoregulation by tubuloglomerular feedback, which is an initiating factor for the dysfunction of the tubular apparatus of diabetic kidney.","PeriodicalId":31740,"journal":{"name":"Miznarodnij Endokrinologicnij Zurnal","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135847015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}