Endocrine disorders represent a serious public health problem and frequently can be caused by genetic factors or their combination with environmental and lifestyle factors. Assessment of relevant genetic factors is important to estimate the risk of endocrine pathologies in an individual before their manifestation. Identification of genetic variations in proteins of the major histocompatibility complex is important with regard to the autoimmune nature of many endocrine pathologies, including type 1 diabetes. In this study, we investigated the relationship between human leukocyte antigen (HLA) genes and 13 endocrine disorders by using experimental whole-exome sequencing profiles obtained for 895 patients from the National Medical Research Center for Endocrinology, Moscow. In addition, the linkage disequilibrium of the identified alleles in the context of the respective diagnoses was assessed. We identified totally 45 statistically significant associations between HLA alleles and specific diagnoses of endocrine pathologies. Among them, 33 were described for the first time and 12 have been previously reported for type 1 diabetes. Overall, 17 alleles were associated with type 1 diabetes and four alleles – with other forms of diabetes. Furthermore, three alleles were associated with obesity, five – with adrenogenital diseases, three – with hypoglycemia, and three – with precocious puberty. Single alleles were found to be associated with congenital hypothyroidism without goiter, hyperfunction of pituitary gland, adrenomedullary hyperfunction, and short stature due to endocrine disorder. The study shows that early HLA typing can help in detecting genetic risk factors of endocrine disorders. In addition, identification of disease associations with specific HLA alleles can broaden our understanding of the mechanisms involved in the pathogenesis of relevant endocrine disorders.

Morbid obesity is a pathology associated with a complex of metabolic disorders, type 2 diabetes mellitus, and cardiovascular diseases, leading to extremely negative health consequences, which necessitates a multidisciplinary approach. The presented clinical case is an example of a combination of primary (exogenous-constitutional) obesity with two other endocrine diseases, and it demonstrates the importance of determining the optimal treatment tactic for a patient with morbid obesity, taking into account his concomitant diseases. Step-by-step patient treatment was carried out by a team of therapeutic and surgical specialists

Background: Insulinoma is a neuroendocrine tumor (NET), with its main clinical manifestation being the hypoglycemic syndrome. The symptoms of hypoglycemia are nonspecific, and therefore, in most cases, the diagnosis is made untimely. The Russian clinical guidelines for the diagnosis and treatment of NET suggest as a diagnostic test that the universal circulating marker of all NET, chromogranin A (CgA) be determined. However, the literature data on the sensitivity of CgA in the diagnosis of insulinoma are contradictory. Aim: To evaluate the diagnostic effectiveness of the CgA test in the diagnosis of insulinoma. Materials and methods: This was a hospital-based single-center, cross-sectional comparative (first step) and prospective non-comparative (second step) study conducted from 2016 to 2022. During the first part of the study, we determined serum CgA in 120 patients with suspected non-diabetic hypoglycemia and compared its levels in the patients with and without confirmed insulinoma (n = 87 and n = 33, respectively). During the second study step, CgA was measured in the insulinoma patients at 6 [4.0; 7.0] months after surgery. The CgA levels at baseline and post-surgery were analyzed in 74 patients (those with recurring non-diabetic hypoglycemia were excluded from the analysis). Results: In the study subjects without insulinoma, the median CgA level was 0.7 [0.5; 1.1] (range, 0.1 to 2.0) nmol/l and the difference (with Bonferroni adjustment) from its levels in the patients with insulinoma before surgery was non-significant (1.0 [0.7; 1.4], range, 0.1 to 8.5 nmol/l, р = 0.045). The CgA concentration in the insulinoma patients after surgery was 0.9 [0.7; 1.2], range, 0 to 1.9 nmol/l and significantly differed from that at baseline (1.0 [0.7; 1.4], range, 0.1 to 8.5 nmol/l, p = 0.012, Wilcoxon test). In the patients with insulinoma before surgery the CgA levels exceeding the generally accepted reference range ( 2 nmol/l) was found in 11.5% (n = 10), with its median level of 2.5 [2.3; 4.1], range 2.3 to 8.5 nmol/l. There were no significant associations between the CgA levels and localization, tumor numbers, their size and malignization grade, insulin and proinsulin values, and duration of fasting. The sensitivity and specificity of the CgA test were 12% [95% confidence interval [CI]: 6%–20%] and 100% [95% CI: 97%–100%], respectively. The prognostic value of a positive result (PVPR) was 100% [95% CI: 69%–100%] and the prognostic value of a negative result (PVNR) 30% [95% CI: 28%–32%]. Conclusion: As a diagnostic test, CgA has high specificity and prognostic value of a positive result. However, the uncertainty of the prognostic value of a negative result is unacceptably high. A special study is required to clarify the operational characteristics of CgA in insulinoma.

BACKGROUND: Thyroid nodules are a prevalent issue, with an estimated incidence of 19% to 35% based on ultrasound examination and 8% to 65% based on autopsy findings [1]. In some cases, Plummer’s disease is observed, and nodular masses may be observed in 10% to 35% of Graves’ disease cases, with iodine accumulation of a different nature [2, 3]. One of the principal treatments for Graves’ and Plummer’s diseases is radioiodine therapy, which serves to exclude the possibility of malignancy in nodules. Furthermore, the pharmacokinetics of iodine is investigated, which represents the most time-consuming and labor-intensive stage of preparation for radioiodine therapy. In clinical practice, ultrasound is performed in accordance with the TI-RADS system, followed (if necessary) by fine-needle aspiration puncture biopsy, stratified according to the Bethesda system. However, the interpretation of ultrasound examinations is inherently subjective, whereas the use of decision support systems can reduce the number of fine-needle aspiration puncture biopsies by 27% and the number of missed malignant neoplasms by 1.9%. Furthermore, the quantitative characterization of nodal ultrasound may enhance the investigation of the pharmacokinetics of I-131 [4, 5]. AIM: The study aimed to develop a method for quantitatively characterizing ultrasound images of thyroid nodular masses for predicting malignancy and I-131 accumulation by nodular masses. MATERIALS AND METHODS: The study included 125 nodules with pathomorphologic findings (65 benign, 60 malignant) and 25 benign nodules (established by cytologic examination) of patients who underwent radioiodotherapy as part of the Russian Science Foundation grant project No. 22-15-00135. Longitudinal and transverse projections of thyroid nodules were obtained using GE Voluson E8 (36% of all benign nodules and 27% of malignant nodules) and GE Logiq E (64% of benign and 73% of malignant nodules). A pharmacokinetics study was conducted on 25 nodes obtained on a GE Logiq V2 device. The accumulation index of I-131 was determined after 24 hours. A spatial adjacency matrix, gray level line length matrix, gray level zone size matrix, and histogram were employed to investigate features based on ultrasound images. RESULTS: The malignancy prediction model, developed on the basis of the most significant features and after KNN correlation analysis, exhibited a diagnostic accuracy value of 72±3%, a sensitivity of 73±5%, and a specificity of 73±5%. An investigation of I-131 pharmacokinetics revealed that the maximum histogram intensity gradient (r=–0.48, p=0.08) and intensity entropy (r=–0.51, p=0.06) exhibited the highest Spearman correlation coefficient modulus with I-131 accumulation after 24 hours. CONCLUSIONS: The present study demonstrates the feasibility of using quantitative characterization of ultrasound images of nodal masses as a tool to monitor nodules before radioiodotherapy. This is with a view to subsequent adjunctive fine-needle aspiration puncture biopsy and prediction of I-131 accumulation after 24 hours.

Increasing life expectancy and, as a consequence, a large number of comorbidities lead to a multitude of medications prescribed by physicians of different specialties. Patients with obesity and carbohydrate metabolism disorders, especially with type 2 diabetes mellitus (DM2), are at particular risk of polypragmasy, which is associated with the use of potentially nonrecommended medications. Prescribing errors can cause significant harm to the patient’s health and increase the risk of rehospitalization and healthcare costs. Identification of probably not recommended drugs in this category of patients will improve understanding of prevalence and risk factors of their use, develop strategies to prevent and limit the burden of taking inappropriate drugs and promote development of personalized and patient-oriented treatment options. Tools exist to assess potentially inappropriate therapy (PIT) in the elderly and new tools and criteria are often created. However, they are not specifically aimed at people with obesity and carbohydrate metabolism disorders. Thus, these criteria usually include only a few items related to DM2. Consequently, there is a clear need for a modern tool that can be used to address PIT specifically in older adults with obesity and carbohydrate metabolism disorders.

Currently, increasing evidence shows the mutual influence of aldosterone and adipose tissue. Aldosterone excess has been reported in patients with obesity and metabolic syndrome. Aldosterone has a direct effect on adipose tissue increasing anabolic activity and expression of mineralocorticoid receptors. In turn, excessive activation of MCR leads to stimulation of adipogenesis and an increase in the volume of adipose tissue. Aldosterone excess can be considered an independent cardiovascular risk factor that affects such processes as cardiac fibrosis, nephrosclerosis, and arteriosclerosis. There is convincing evidence of higher prevalence and severity of impaired glucose homeostasis and lipid metabolism disorders among patients with primary hyperaldosteronism. Similar pathological changes are also observed in patients with obesity and metabolic syndrome. This review presents scientific data on the metabolic effects of aldosterone, in particular its effect on adipose tissue function, glucose and lipid metabolism. Treatment with mineralocorticoid receptor antagonists may provide substantial benefit in the management of metabolic syndrome, contribute to the stabilisation of glucose and lipid metabolism, improve clinical status of patients with cardiovascular diseases and reduce the risk of complications. However, available evidence from the conducted studies is not sufficient to justify introduction of such therapy into clinical practice.

The question of effective ways to treat obesity in people of different ages inevitably affects nutritional principles. Currently, intermittent fasting is of particular interest. There are several variants of intermittent fasting, the common feature of which is periodic temporary breaks in food intake. This review assessed the results of studies on the effectiveness of such a restrictive diet in patients with various pathologies.

The lack of systemic mass iodine prophylaxis in the Russian Federation is the main reason for the annual increase in the inci dence of thyroid pathologies throughout the country. Despite the set of measures aimed at implementing the Strategy for Improving the Quality of Food Products in the Russian Federation (RF) until 2030, approved by the RF Government Decree of 29.06.2016 No. 1364, including providing for the supply of iodized salt to retail organizations, food units of healthcare institu tions, kindergartens, schools and other institutions, the prevalence of thyroid pathologies in the regions remains high. The arti cle presents the results of the study assessing the severity of iodine deficiency and the prevalence of thyroid pathology among the population of the Tula region, conducted by specialists of the “Endocrinology research center” of the Ministry of Health of Russia together with the Ministry of Health of the Tula Region.BACKGROUND: The relevance of research on the assessment of iodine status and the study of the structure of thyroid pathol ogy among residents of certain territories of the Russian Federation, which are characterized by natural iodine deficiency and past technogenic radiation contamination, is associated with the need to clarify the mechanisms of development of thyroid pathology, including comorbid conditions, and will allow the implementation of scientifically justified preventive measures. AIM: To conduct a comprehensive study to assess the current iodine sufficiency of the population of the Tula region — an area affected by the Chernobyl nuclear power plant accident in 1986, analyze the actual prevalence and structure of thyroid pathol ogy compared to official statistics, and formulate conclusions about necessary preventive measures.MATERIALS AND METHODS: During the study in the Tula region, 589 people were examined, including 303 school-age chil dren (7–11 years old) and 286 adults (18 years and older). The epidemiological part of the study was conducted among the child population using the cluster method in three districts of the region (Tula — 90 children, Arsenyevsky district — 118 children, Yasnogorsky district — 95 children) and included: collection of anamnesis and questionnaires, measurement of anthropomet ric indicators (height, weight), examination by an endocrinologist with palpation of the thyroid gland, thyroid ultrasound with volume calculation, determination of iodine concentration in urine, examination of samples of table salt from households for the presence of iodine in them. A cross-sectional cohort survey of the adult population was conducted from June 8 to 10, 2022, in three districts of the Tula region: Yasnogorsk (n=79), Arsenyevsky (n=70), Shchekinsky (n=137) and included: collection of anamnesis and questionnaires, examination by an endocrinologist, thyroid ultrasound, determination of thyroid-stimulating hormone (TSH) and thyroid peroxidase antibodies (TPO-AT) in the blood serum, as well as a study of samples of table salt from households for the presence of iodine. RESULTS: According to the results of the epidemiological study in the Tula region, mild iodine deficiency (ID) was established (median urinary iodine (mUI) — 69.1 μg/l, share of diffuse goiter in children according to ultrasound data — 8.5%), with the allocation of the Arsenyevsky district, in which the mUI of 41.5 μg/l indicates moderate ID and a large proportion of goiter in children was detected — 13.5%. The share of households in the Tula region using iodized salt is very low — 18.5%. The results of the examination of the adult population of the Tula region confirmed the high prevalence of thyroid pathology in the region (ultrasound signs of structural changes in the thyroid gland were detected in 52.8% of those examined), which is mostly rep resented by nodular forms of goiter (76.8%). The combination of ultrasound signs of autoimmune and nodular thyroid pathol ogies occurs in 11.3% of cases of the overall prevalence of structural changes in the thyroid gland. When comparing with the data from previously conducted expeditions, a negative dynamics has been noted in the form of an increase in the prevalence of diseases of the thyroid glands detected by ultrasound in the study areas, from 26% in 1995 to 65–85.7% in 2022.CONCLUSION: Monitoring of the epidemiological situation in the Tula region has demonstrated a persisting inadequate level of iodine sufficiency among the population, which is reflected in the increasing prevalence of thyroid diseases and indicates the inefficiency of episodic measures for preventing iodine deficiency disorders (IDD). Taking into account the ecological status of the region, from the standpoint of medical and social significance, it is extremely important for regional health authorities to take urgent measures, namely, the development and implementation of a regional target program for the prevention of IDD with an emphasis on mass prevention using iodized salt.

The syndrome of apparent mineralocorticoid excess (AME) is a rare genetic disease characterized by juvenile hypertension, hypokalemia, suppression of renin and aldosterone. AME syndrome is caused by a mutation in the HSD11B2 gene, which encodes 11ß-hydroxysteroid dehydrogenase type 2, that converts cortisol into cortisone.The purpose of the article is to describe a clinical case of genetically confirmed (mutation C.911A>G of the HSD11B2 gene) AME syndrome. The disease manifested in the first years of life; the patient was prescribed mineralocorticoid receptor antagonists, potassium preparations, potassium-sparing diuretics, and other antihypertensive therapy. Due to the absence of normotonia and normokalemia, dexamethasone has been prescribed since the age of 12. Due to uncontrolled arterial hypertension and hypokalemia, complications developed (medullary nephrocalcinosis, myocardial remodeling), and prolonged dexamethasone intake led to a slowdown in puberty and a decrease in bone mineral density.

Advances in the development and improvement of medical technologies and methods of processing medical images make it possible to highlight clinically significant characteristics that were not previously available to classical methods of medical imaging. Ultrasound diagnostics of thyroid gland nodules has a huge potential medical images processing. The article presents an overview of the existing ultrasound classification systems for thyroid nodules malignancy and the prospects for the development of intellectual tools TIRADS (Thyroid Imaging Reporting and Data System) classification system.

Obesity is a complex condition that is associated with various metabolic disorders and has a significant social impact. Weight loss is primarily achieved through dietary changes, such as reducing calorie intake. Therefore, it is essential to provide patients with effective weight loss programs and recommend a low-calorie diet as soon as possible. In addition to drug therapy for metabolic disorders, it is crucial to educate patients about the importance of a healthy diet and encourage them to adopt a low-calorie approach. Numerous studies have demonstrated the effectiveness of low-calorie and very low-calorie diets for treating obesity. However, compliance with these diets can be challenging, as they require careful attention to nutritional value and the balance of macronutrients and micronutrients. Prolonged adherence to reduced dietary regimens can lead to hypovitaminosis, lack of dietary fiber, or decreased protein intake. In 2024, a new product for balanced low-calorie nutrition, OPTIFAST, was introduced on the Russian market by the Nestlé Health Science company in Germany. This product provides patients with all essential nutrients and allows them to manage their daily calorie intake. It also provides a feeling of fullness that is essential for maintaining adherence to a low-calorie diet and ensuring effective and safe weight loss, primarily through adipose tissue reduction.

Rationale: Immune-related adverse events (irAEs) are a specific type of drug toxicity that can occur in cancer patients undergoing immunotherapy with immune checkpoint inhibitors (ICIs). Endocrine irAEs rank the 3rd after the skin and gastrointestinal ones. Clinical course of endocrine irAEs usually results in irreversible damage of the glands function. Prevailing thyroid disorders among endocrine irAEs, their reactivity compared to that of autoimmune thyroiditis, the risk of potential temporary or complete withdrawal of the immunotherapy would make it necessary to search for markers able to identify the most susceptible patient groups. Aim: To evaluate an association between baseline laboratory parameters (hormonal, biochemical, and serological) in patients with malignant solid neoplasms before the first course of anti-tumor immunotherapy with ICIs in monotherapy and the subsequent development of thyroid irAEs. Methods: In this retrospective cohort we analyzed medical files from 102 adult patients (50 (49%) men, median age 60 years) with confirmed solid malignant tumors who were treated in two specialized in-patient departments from January 2020 to February 2022. Their baseline blood samples for subsequent evaluation of thyroid function, carbohydrate and calcium metabolism, as well as to exclude adrenal insufficiency were taken before the initiation of the first course of specific immunotherapy with ICIs. Thereafter, the patients were monitored for any registered irAE for up to 34 months from the beginning of the antitumor immunotherapy with ICIs. Results: Thyroid irAEs were registered in 13/102 (12.7%) patients. Only two markers were significantly associated with the development of thyroid disorders under immunotherapy with ICIs: baseline levels of anti-thyroperoxidase antibodies (TPOAb) ≥ 7.54 IU/mL (reference range (RR) 0–5.6) and anti-thyroglobulin antibodies (TgAb) ≥ 16.45 IU/mL (RR 0–115) (p 0.001). For TPOAb ≥ 7.54 IU/mL and TgAb ≥ 16.45 IU/mL, the areas under the ROC curve (AUC) were 0.828 [95% confidence interval (CI) 0.678–0.979] and 0.875 [95% CI 0.742–1.000], diagnostic sensitivity was 75% [95% CI 48–92] and 92% [95% CI 64–100], diagnostic specificity 92% [95% CI 85–96] and 84% [95% CI 77–86], prognostic values of the positive result 69% [95% CI 44–85] and 58% [95% CI 40–63], and prognostic values of the negative results 94% [95% CI 87–98] and 98% [95% CI 90–100], respectively. Conclusion: Baseline levels of TPOAb and TgAb may serve as markers for the risk of thyroid irAEs in cancer patients with solid malignancies who are planned to receive anti-tumor immunotherapy with ICIs.

Androgen insensitivity syndrome is a genetic disorder characterized by complete or partial androgen insensitivity in individuals with a 46XY genotype. It is also the most common cause of disorders of sexual differentiation in patients with a 46XY karyotype. This condition is caused by a defect in the androgen receptor gene (AR), leading to abnormal development of male genitalia, impaired formation of male secondary sexual characteristics, and phenotypic features resembling the female sex.One of the important aspects related to the management of androgen insensitivity syndrome is the necessity of preventive gonadectomy. However, the rationale for prophylactic removal of gonads remains a subject of debate. This article presents a clinical case of a 37-year-old woman with complete androgen insensitivity syndrome who, despite recommendations for gonadectomy based on suspicious MRI characteristics of the gonads, made the decision to decline surgical intervention, justifying her choice by the positive impact of gonadal hormonal activity on her external appearance and physical characteristics. This clinical case highlights the complexity of decision-making in the management of androgen insensitivity syndrome, where patient preferences and needs may play a significant role, despite potential risks and concerns surrounding the preservation of gonads.

BACKGROUND: Overweight and obesity have a significant impact on the course and results of treatment of many diseases, including cancer. One of the modern types of antitumor therapy is immune checkpoint inhibitors. Taking into account the high effectiveness of immune checkpoint inhibitors for various types of tumors, it seems interesting to study the initial anthropometric data of patients and assess the possible influence of nutritional status on the development of endocrine immune-mediated adverse events.AIM: To compare groups of patients with different starting body mass index (BMI) before the first administration of the immune checkpoint inhibitors drug and analyze the risk of developing endocrine immune-mediated adverse events in the future.MATERIALS AND METHODS: The single-center study included 172 patients who were recommended antitumor therapy immune checkpoint inhibitors at the N.N. Blokhin National Medical Research Center of Oncology and Moscow City Oncology Hospital №62 in 2020–2022. Measurement of height and body weight with further calculation of BMI was carried out before the first administration of the drug immune checkpoint inhibitors.Depending on the subsequent occurrence of immune-mediated adverse events, patients were divided into groups: those with developed immune-mediated adverse events (any, cutaneous, thyroid) and those without immune-mediated adverse events (any, cutaneous, thyroid).RESULTS: According to the results of our study, in 38 patients (37.3%) out of 102, for whom data on the presence/absence of any immune-mediated adverse events were obtained, the following were recorded: thyropathies (n=13, 12.7%), skin lesions (n=13, 12.7%), gastrointestinal toxicity (n=7, 6.9%), hepatotoxicity (n=4, 3.9%), hypophysitis (n=2, 2%), nephritis (n=2, 2%), diabetes mellitus (DM) (n=1, 1%), hematological toxicity (n=1, 1%), pneumonitis (n=1, 1%), Guillain-Barré syndrome (n=1, 1%). At the same time, in most patients only one immune-mediated adverse event was encountered (n=31, 81.6%), two immune-mediated adverse events were detected significantly less frequently (n=7, 18.4%).When conducting a comparative analysis of groups of patients with developed immune-mediated adverse events, including dermatological ones, or their absence, a statistical trend in differences in BMI was obtained. Using ROC analysis, a BMI cut-off point was determined equal to 28.16 kg/m² for all immune-mediated adverse events and 25.39 kg/m² for skin immune-mediated adverse events, below which, contrary to the available data, the risk of developing immune-mediated adverse events increased, but the diagnostic sensitivity (DS) and diagnostic specificity (DS) turned out to be low.CONCLUSION: We identified a statistical trend in the risk of developing immune-mediated adverse events (primarily dermatological) with a lower BMI before the start of antitumor immunotherapy immune checkpoint inhibitors. More research is required to find a more reliable relationship.

BACKGROUND:Insulinoma is a neuroendocrine tumor, the main manifestation of which is hypoglycemia. However, the symptoms of hypoglycemia can be non-specific for a long time, especially outside provocative conditions, and quite often the tumor manifests from a life-threatening condition - hypoglycemic coma. In this regard, timely laboratory diagnosis of insulinoma and determination of its aggressive course is one of the priorities in modern researches. AIM:Search for new immunohistochemical (IHC) and circulating markers (CM) of insulinoma, including its aggressive course. MATERIALS AND METHODS:The patients examined at the Endocrinology Research Centre in the period 2017-2022 and operated on for an insulin-producing tumor were included. Before surgery and 2-12 months after it, blood sampling was performed with the determination of targeted marker proteins. Some patients underwent an extended IHC examination of the tumor, surrounding tissue and islets of Langerhans with primary antibodies to target marker proteins with an assessment of the degree of their expression. To determine the aggressive course of the tumor, the degree of malignancy (Grade), the number of tumors and signs of recurrence were characterized. RESULTS:Based on the analysis of literature and pathogenetic characteristics of insulinoma, the following candidates for targeted marker proteins were selected: cocaine and amphetamine-regulated transcript (CART), chromogranin B (CrB), neuroendocrine secretory protein 55 (NESP55), glucagon-like peptide 1 (GLP1), arylalkylamine-N-acetyltransferase (AA-NAT), melatonin, and, exclusively for IHC research, protein D52 (TPD52), as well as receptors for glucagon-like peptide-1 (rGLP1) and melatonin (MTNR1b). 41 patients were included in the study, of which 10 patients underwent an extended IHC study. In patients with both aggressive and non-aggressive insulinoma after surgical treatment, CM levels did not change significantly and in individual patients they could both increase and decrease, including those patients with the expression of the corresponding marker in tumor tissue. It was shown that CART was expressed only in the tumor (in 4/10 of cases), while MTNR1b and rGLP1 were expressed in the tumor (in 6/10 and 10/10, respectively) and the islets of Langerhans (in 5/9 and 9/9, respectively). The association of marker expression with the aggressiveness of the course of insulinoma has not been revealed. CONCLUSION:The markers CART, MTNR1b and rGLP1 are of primary interest for further study in a larger sample of patients with insulinoma. Other markers (TPD52, XgB, NESP55, melatonin, AA-NAT) have not been shown to be associated with an insulin-producing tumor, therefore they are not promising for future researches. At the same time, it is necessary to continue research aimed at finding new both circulating and IHC markers in order to early diagnose the manifestation of the disease and its recurrence, and more accurately determine the malignant and proliferative potential of the tumor.

Acromegaly is a chronic endocrine disease characterized by excessive secretion of growth hormone, which, in turn, leads to an increase in the secretion of insulin-like growth factor 1 in the liver. The targets for these hormones are most of the cells in our body. Excess growth hormone (in the vast majority of cases caused by hormone-producing pituitary adenoma – somatotropinoma), insulin-like growth factor leads to cellular, and tissue growth of almost all organs and systems, including the osteoarticular apparatus. Diagnosis of the disease in the early stages is often difficult and is established 5–10 years after the onset of symptoms, that leads to various complications and disability of patients. Often joint pain is the first manifestation of acromegaly. Damage to the musculoskeletal system causes a significant deterioration in the quality of life even when long-term stable remission of the underlying disease is achieved. In the article a clinical case with the peculiarities of diagnosing rheumatic disease in acromegaly is presented. A patient aged 56 years was diagnosed with acromegaly based on clinical and laboratory data, and a month later she underwent transnasal adenomectomy. However, Endocrinology Research Centre drew attention to the patient's complaints of pain in large joints, and therefore she was referred for a consultation to a rheumatologist at the Nasonova Research Institute of Rheumatology. As part of the examination, an increase in the titer of the antinuclear factor (1/2560) and the level of antibodies to ribonucleoprotein was revealed, which is most typical for mixed connective tissue disease. Treatment was prescribed and dynamic monitoring is being carried out.

AIM. To study the effect of the non-calorie sweetener erythritol and the combination of erythritol and sucrose on postprandial secretion of insulin and peptide-YY (PYY).MATERIALS AND METHODS. A comparative study was conducted to assess the effect of erythritol, sucrose and a combination of erythritol and sucrose on postprandial glucose, IRI and PYY levels. The participants were selected from among healthy volunteers, aged 18 to 35 years. If the participants met the selection criteria, further stages of the study were carried out. During the study, each participant took a solution of sucrose 75 g, erythritol 75 g or a mixture of sucrose and erythritol (75 g and 25 g, respectively). Further determination of glucose and insulin was carried out every 30 minutes, so glucose, insulin and PYY values were determined initially and at the 30th, 60th, 90th and 120th minutes.RESULTS. Data were obtained confirming the absence of the effect of erythritol on postprandial secretion of insulin and glucose. In our work, we also demonstrated a decrease in postprandial glycemia when taking sucrose and erythritol together. Sucrose and erythritol equally stimulated PYY secretion.CONCLUSION. Our data show that erythritol can be considered as an optimal sugar substitute in people with impaired carbohydrate metabolism and obesity.

Abstract Disclosure: A.A. Trukhin: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). A.V. Manaev: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). S.M. Zakharova: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). M.S. Sheremeta: None. E.A. Troshina: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). Background: Over 83 years radioiodine therapy (RIT) of autonomous thyroid nodules still have uncovered pages, according to its complexity and thyroid nodules variety. There are two main criteria to allow RIT – no malignancy and presence of iodine uptake, the last one could be checked by Tc-99m-pertachnetate or I-123, I-131 iodine scintigraphy. Case with thyroid nodules first undergo ultrasound (US) TI-RADS classification, then fine needle aspiration stratification according to the Bethesda system. Publications applied such algorithm shows 75-85% accuracy in malignancy determination, that in 15-25% can lead to improper RIT application. Aim: Method development for thyroid nodules ultrasound checkup before I-131 administration and I-131 24h uptake prognosis. Methods: Study includes 150 nodules (65 benign, 60 malignant, 25 autonomous benign thyroid nodules). Both US longitudinal and transversal thyroid nodule projections were obtained via GE Voluson E8 (36% benign cases / 27% malignant cases) and GE Logiq E (64% benign cases / 73% malignant cases) in cinematic loop regime. Autonomous thyroid nodules underwent I-131 pharmacokinetics examination with 24h uptake determination and RIT. Statistical textural features were obtained through spatial adjacency matrix. Results: Analysis of 16 statistical textural features shows weak correlation between 11 statistical textural features E (Energy), S (Entropy), LU (Local homogeneity), MP (Maximum probability), TR (Matrix trace), CORR (Correlation), IMC (information measure of correlation), DV (Difference variance), DE (Difference entropy), SE (Sum entropy), SA (Average value of the sum). ROC-analysis using 11 statistical textural features shows the best model for benign/malignance determination with AUC = 0.83, Se = 74%, Sp = 73%, PPV = 75%, NPV = 72%, Acc = 74%. I-131 pharmacokinetics examination shows strong correlation SA to I-131 24h uptake. Conclusions: The performed study demonstrates the possibility of using textural statistical features of ultrasound images as instrument for thyroid nodules ultrasound checkup before I-131 administration, for extra FNA prescription and prognosis the I-131 24h important in exact therapeutic I-131 activity calculation. Presentation: 6/2/2024