The study was designed to search efficiency and safety of the 3-rd generation glucocorticosteroid (GCS) budesonide (Benacort) as 0.05 % nebulized solution in patients with exacerbation of moderate bronchial asthma (BA). The study involved 18 males and 12 females aged 42 to 65 yrs suffering from BA for 3 months to 30 yrs, 27 of them completed the investigation. Three patients broke off the study because of unpleasant taste, sour throat, cough attacks during the inhalations. Before the study 22 patients had not received any basic therapy, 8 ones had been treated with inhaled GSC 600 to 1 200 meg daily or cromones. Starting the study all the patients had moderate exacerbations of BA. The budesonide solution was inhaled via a nebulizer 1 000 to 2 000 meg daily. All the patients also received inhaled β 2 -agonists. The efficacy of budesonide was evaluated with clinical picture, lung function parameters, need in β 2 -agonists. The therapy with nebulized budesonide lasted 7 to 10 days. The full control of BA was reached in 5 (18 % ) of the patients, sufficient control was in 10 (37 % ) and partial control was obtained in 13 (48 % ) of them. There were not significant shifts in endogenous cortisol and glucose levels, arterial blood pres­ sure and heart beat rate parameters for the treatment period. So, this study demonstrated that the nebulized Benacort is highly effective and safe when used in patients with BA exacerbations. Combined administration of nebulized β 2 -agonists and GCS is thought to be the alternative for systemic GCS and xanthines.

Normalization of the growth hormone and IGF-1 levels during somatostatin analogs treatment usually is a predictor of somatotropinoma volume reduction. However, dissociation of biochemical and tumor-supressive effects of somatostatin analogs was also noted. We represent the female patient who showed reduction of the GH levels from 34.3 to 3.1 ng/ml and IGF-1 levels from 796 to 415 ng/ml (the gender and age upper normal limit 262 ng/ml) within 36 months treatment with maximum doses of somatostatin analogs (octreotide LAR 40 mg). Despite the lack of biochemical control of acromegaly, progressive decrease of tumor volume by 44 – 64 – 73% from initial volume (during 12 – 24 – 36 months of treatment) was noted. This case shows that it is possible to expect considerable reduction of somatotropinoma volume during treatment with somatostatin analogs even without achievement of complete control over GH and IGF-1 secretion.

Early carbohydrate metabolism disorders (ECMDs) and diabetes mellitus (DM) are frequently associated with acromegaly. We aimed to assess the prevalence of ECMDs in patients with acromegaly and to compare the results with those in adults without acromegaly using two population-based epidemiologic surveys. We evaluated 97 patients with acromegaly in several phases of their disease (mean age, 56 years and estimated duration of acromegaly, 12.5 years). An oral glucose tolerance test was done in those not yet diagnosed with DM to reveal asymptomatic DM or ECMDs (impaired glucose tolerance+impaired fasting glucose). Comparisons were made between patients with acromegaly and participants from the general adult population (n=435) and an adult population with multiple type 2 diabetes risk factors (n=314), matched for gender, age and BMI. DM was diagnosed in 51 patients with acromegaly (52.5%) and 14.3% of the general population (P<0.001). The prevalence of ECMDs was also higher in patients with acromegaly than in the general population and in the high-risk group; only 22% of patients with acromegaly were normoglycaemic. The prevalence of newly diagnosed ECMDs or DM was 1.3-1.5 times higher in patients with acromegaly compared with the high-risk group. Patients with acromegaly having ECMDs or DM were older, more obese and had longer disease duration and higher IGF1 levels (Z-score). Logistic regression showed that the severity of glucose derangement was predicted by age, BMI and IGF1 levels. In patients with acromegaly, the prevalence of DM and ECMDs considerably exceeds that of the general population and of a high-risk group, and development of DM depends on age, BMI and IGF1 levels.

According to foreign data somatotropinoma volume reduction was noted more than at a half of the patients receiving somatostatin analogs within 12 months as the first line of acromegaly treatment, however there is no data about tumor-supp ressive effect of Octreotid-depot. We assessed somatotropinoma volume during Octreotid-depot treatment in patients with an active acromegaly, and also tried to indentify possible predictors of tumor volume reduction during somastatin analogs treatment. Open prospective study include 18 patients with acromegaly (16 women, 2 men, age from 22 till 76 years old); after non-radical adenomectomy (n=5) and as first line of treatment (n=13). Patients received Octreotid-depot continuously within 12 months. Brain MRI was carried out before and after 12 months of Octreotid-depot therapy. Change of tumor volume for ≥20% from initial was interpreted as "significant". The GH level ≤2,5 ng/ml and the normal IGF-1 level were noted in 7 (38,9%) patients; GH ≤;2,5 ng/ml either the normal IGF-1 level, or simultaneous decrease in the GH and IGF-1 levels more than 50% from initial - in 8 (44,4%) patients, absence of effect from treatment - in other 3 cases. Significant tumor volume reduction was found in 12 (66,7%) of 18 cases, and degree of reduction varied from 23 to 97% (median 42% [38; 74%]); stabilization of the a tumor volume - in 5 (28%) patients; insignificant change of the sizes of a tumor (-7% and +12,5%) in other 2 patients. It wasn't revealed essential correlations between degree of tumor volume reduction and the GH and IGF-1 levels before and after somatostatin analog treatment, and also initial tumor volume.

Subclinical hypercorticism is characterized by increased cortisol secretion in the absence of the specific clinical manifestations of the disease. The prevalence of subclinical hypercorticism has been estimated at 8 cases per 10,000 population even though the frequency of subclinical hypercorticism may be higher among certain groups of the patients. We observed 111 patients presenting with type 2 diabetes mellitus and 40 ones with alimentary obesity. As a result, subclinical hypercorticism was diagnosed in 4 (10%) patients with obesity and in 12 (12%) ones with diabetes mellitus. In two of these cases, the diagnosis was later changed to clinically manifested hypercorticism. The imaging studies revealed pathological changes in pituitary and adrenal glands in six of the 16 patients presenting with subclinical hypercorticism. An algorithm for the examination of the patients with type 2 diabetes mellitus and alimentary obesity for the purpose of diagnostics of subclinical hypercorticism is proposed.

This paper reports the results of the year-long treatment of 46 patients presenting with active phase of acromegalia (39 (85%) women and 7 (15%) men, at the age varying from 22 to 76 years) using the long-acting somatostatin analog octreotide-depo. The treatment was started using a dose of 20 mg with the measurement of GH and IGF-1 levels each 3 months; the dose was titrated as appropriate. The maximum dose of octreotide-depo amounted to 40 mg. The effectiveness of therapy was evaluated from the severity and frequency of the principle symptoms of acromegalia, viz. facial, hand, and leg soft tissue oedema, fatigue, excessive sweating, headache, arthralgia, elevated blood GH and IGF-1 levels. The target GH levels were considered to be below 2.5 ng/ml and those of IGF-1 within the normal age-specific concentration range. The most well-apparent regression of clinical symptoms was observed within the first 3 months after the onset of the treatment, concurrently with the maximum reduction of blood GH and IGF-1 levels. The values reached during the first 3 months remained unaltered up to the end of the study. Simultaneous normalization of the blood GH and IGF-1 levels was documented in 55% of the patients. The clinical symptoms most frequently disappeared in the patients with normal IGF-1 levels. The adverse reactions of octreotide-depo therapy included short-term diarrhea (45.6%), meteorism (25.1%), abdominal pain (26%), nausea (13.4%), constipation (10.8%). These conditions were not serious and did not require the withdrawal of the preparation.

Aim of this study was to investigate efficiency and safety of OctreotidLong FS in patients with acromegaly. Materials and methods. 41 patients with acromegaly (8 – de novo and 33 patients after different somato statin analogs treatment) was treated OctreotidLong FS one injection in 28 days. Growth hormone (GH), Insulin like Growth Factor 1 (IFG1), fasting glucose (FG) and HbA1c were assess after 3, 6 and 12 month of therapy. Results. We found out the decreasing of GH and IGF1 from 12,8 (8,0–82,7) mU/ml to 3,8 (1,6–13,8) mU/ml ( p 0,05) and %IGF1 increasing (% IGF1) from 231 (150–286)% to 9,5 (−26–111)% ( p 0,05) in 8 de novo acromegalic patients. We also revealed that IGF1 didn’t change and GH decreased after 3 month (33 patients), 6 month (22 patients) and 12 month (8 patients) of OctreotidLong FS treatment. We didn’t observed negative effect of OctreotidLong FS treatment to carbohydrate metabolism in patients with acromegaly. Conclusion. The therapy of OctreotidLong FS leads to induce successful control of GH and IGFI in 50% de novo patients and didn’t change the number of patients with control of acromegaly after another somato statin analogs treatment. Carbohydrate metabolism also didn’t change after OctreotidLong FS treatment.

Aim of the study was to investigate the features of glucose metabolism in patients with acromegaly depending on treatment. Materials and methods: 63 patients with acromegaly: 29 patients with newly diagnosed acromegaly, 25 patients receiving somatostatin analogs (SSA) therapy and 9 patients underwent surgical treatment. Patients with earlier revealed diabetes mellitus (DM) were not included. The characterization of glucose metabolism was carried out by means of an assessment of fasting insulin plasma levels (FIP) and indexes of an insulinresistance (IR) HOMA-R and an insulinsensivity (IS) MATSUDA. Results: In patients receiving SSA therapy the carbohydrate metabolism disorders (CMD) were revealed in 92%, among newly diagnosed acromegalic patients – in 62% and in patients after surgical treatment in 33% of cases. In newly diagnosed acromegalic patients index MATSUDA was 3,5 times lower than in patients receiving SSA therapy, and 4 times lower than in patients after surgical treatment ((р=0,001). НОМА-R in newly diagnosed acromegalic patients was 3,7 times higher than in other groups, p=0,003 and the level of FIP was 4,3 times higher than in patients receiving SSA therapy and 2,9 times higher than in patients after surgical treatment (р=0,001). The index MATSUDA in newly diagnosed acromegalic patients with early CMD was 2,9 times lower, р=0,006, НОМА-R – 2,5 times higher, р=0,025 and FIP 2,4 times higher, р=0,039 than in patients with early CMDs without acromegaly. Conclusions: In patients with newly diagnosed acromegaly in the absence of CMDs increase in IR is compensated by hyperinsulinemia. In patients, receiving SSA therapy the IR decreases, however suppression of secretion of insulin leads to increase in percentage of DM in this group. After surgical treatment IR decreases against higher level of fasting plasma insulin that leads to normalization of carbohydrate metabolism. Keywords: Acromegaly, secondary diabetes mellitus, insulinresistance, MATSUDA, HOMA-R.

Aim of this study was to investigate efficiency and safety of OctreotidLong FS in patients with acromegaly. Materials and methods. 41 patients with acromegaly (8 – de novo and 33 patients after different somato statin analogs treatment) was treated OctreotidLong FS one injection in 28 days. Growth hormone (GH), Insulin like Growth Factor 1 (IFG1), fasting glucose (FG) and HbA1c were assess after 3, 6 and 12 month of therapy. Results. We found out the decreasing of GH and IGF1 from 12,8 (8,0–82,7) mU/ml to 3,8 (1,6–13,8) mU/ml ( p

This paper describes the strategy for pregnancy and labour management in women with the history of myocardial infarction after multiple stenting of coronary arteries using stents with cytostatic coating. The authors discuss a broad range of diseases underlying coronary lesions in young pregnant women receiving antiaggregation therapy. Neither multiple stenting nor intake of aspirin and ticlopid provoked teratogenic effect.

This paper summarizes the original clinical experience of the authors concerning differential diagnostics of ACTH-dependent hypercortisolism. A total of 8 patients were available for the estimation of the potential of such diagnostics with the use of the high-dose dexamethasone suppression test, pituitary MRI, and selective blood sampling from the inferior petrosal sinuses for the determination of the ACTH concentration gradient between central and peripheral compartments. It turned out that neither the high-dose dexamethasone suppression test nor pituitary MRI provided unambiguous information about the source of ACTH hypersecretion whereas the use of selective blood sampling allowed to confirm the primary diagnosis of Cushing's disease in 4 patients and revise it in 2 others. In all the patients having the diagnosis established based on the results of selective blood sampling, it was confirmed after transsphenoidal adenomectomy. At the same time, the diagnosis of ACTH-ectopic syndrome was confirmed by an immunohistochemical method only in 1 of the 2 patients. Thus, the results of the present study indicate that selective blood sampling from the inferior petrosal sinuses is a valuable diagnostic tool which should be recommended for a wider application in endocrinological practice. However, this method failed to reveal lateralization of the tumours in all the examined patients.

Aim of this study was to investigate the effect metformin to carbohydrate, lipids metabolism and leptin level in impaired glucose tolerance (IGT)patients.Methods. 16 patients with IGT were studied. Age of participant was 55.1?8.2 yrs. All patients was divide into two groups: treatment group (bagomet1700 a day and diet) and control group (only diet). Effect of therapy was access in HbA1c, fasting glucose (FG), HOMA, lipids, liver glucose production(LGP) and leptin, which investigate in intravenous glucose tolerance test (IVGTT). Results. Normalization of carbohydrate metabolism was discover in 37.5% in treatment group and in 12.5% in control group. HbA1c was decreasefrom 6.4 to 5.9 % (р

Although the minimal dose of 17β-estradiol in hormone replacement regimens was originally considered to be 2 mg/day, it is now increasingly accepted that a lower dose of 1 mg/day is effective in protecting women from the detrimental effects of the menopause and has a better safety profile. The aim of this study was to investigate effectiveness and tolerability of minimal dose of hormone replacement therapy (HRT) - femoston 1/5 in postmenopausal women with spine osteopenia. Study comprised 26 postmenopausal women aged 45-65 years with T-score L2-L4 2.5 SD. Treated group consisted of 16 women (average age 54.8+5.59 years and postmenopausal age 6.81+4.59 years) received femoston 1/5 (17β-estradiol 1 mg/ daily continuously combined with dydrogesterone 5 mg/daily) for 12 months. Control group included 10 subjects (average age 56.7+4.11 years and postmenopausal age 11.5+8.09 years). BMD and biochemical parameters were measured at baseline and in 6 and 12 months and climacteric symptoms were assessed at baseline and in 1, 3, 6 and 12 months. The increase in BMD were seen in lumbar spine +5.2%, total proximal femur +2.1% and trochanter +3.1% (р