Obesity is a complex multifactorial pathology associated with a complex of metabolic, cellular, cardiovascular factors leading to extremely negative health consequences, which determines the high social significance of this nosology. Telemedicine technologies are being widely implemented in practical healthcare, including can be used for many obese patients. Currently, the true prevalence of obesity is not reflected in the forms of statistical registration of diseases and, often, is not considered by doctors as the main cause of the development of cardiovascular diseases, carbohydrate metabolism disorders and diseases of the musculoskeletal system. The underestimation of the problem of obesity is also reflected in the structure of telemedicine consultations with a specialized endocrinological research center

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

The prevalence of obesity and type 2 diabetes continues to grow, which determines the need to develop new methods of prevention in order to reduce the population risks of developing these diseases. The current direction is to limit the consumption of easily digestible carbohydrates and use low-calorie or non-calorie sweeteners instead. Currently, there is an increase in the use of non-calorie sweeteners in the manufacture of food. In this regard, the study of their possible effects on metabolic processes is of great importance.This review presents studies that have shown different effects of non-calorie sweeteners on carbohydrate and fat metabolism, body weight, the composition of intestinal microbiota, as well as the regulation of eating behavior. Some studies show that low-calorie sugar substitutes can be used in obese people as part of a comprehensive weight loss program, as well as in patients with type 2 diabetes mellitus with the aim of reducing postprandial hyperglycemia. Other studies demonstrate the negative effect of a number of low-calorie sweeteners on carbohydrate metabolism.The main search for materials was carried out in Pubmed databases, eLIBRARY.ru, Google Scholar. Temporary search criteria 2012–2023 The relevant additional literature was included after a manual search in the literature lists of the included articles.

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.

Hyperandrogenism is the most prevalent cause of menstrual cycle abnormalities and infertility in women. Here, we present a case of a 32-year-old woman with a 7-year history of menstrual irregularity and infertility. Laboratory test results revealed elevated 17-hydroxyprogesterone, progesterone 21-deoxycortisol. Abdominal computed tomography found a 3,9х2,9х2,6 cm left adrenal tumor. Non-classic congenital adrenal hyperplasia was diagnosed initially, however, treatment with supraphysiological doses of dexamethasone proved ineffective and progesterone and 17-hydroxyprogesterone levels remained high. Genetic testing revealed no 21-hydroxylase deficiency. Laparoscopic adrenalectomy was performed with subsequent pathological report being compatible with an adrenal cortical adenoma. 17-hydroxyprogesterone, progesterone 21-deoxycortisol levels returned to the normal range postoperatively and the patient’s menstrual cycle normalized without additional medication. Steroid metabolites producing adenomas are also extremely rare with only a few cases found in patients without previous CAH diagnosis. When a patient with clinically and biochemically diagnosed NCCAH demonstrate no typical features and shows poor response to steroid therapy, the patient should receive multisteroid LC–MS/MS assay for glucocorticoids and androgens, adrenal and ovarian imaging and undergo CYP21A2 gene mutation analysis.

On September 29, 2023, a meeting of the interdisciplinary expert council “Cognitive health of a comorbid patient” was held in Vladikavkaz. To reduce the social and economic burden of cognitive impairment, which is increasingly being detected in comorbid patients in the Russian Federation, it is necessary to introduce socially significant initiatives for the timely diagnosis and prevention of these diseases, as well as update modern approaches to treatment, taking into account their multifactorial pathogenesis and the risk of complications. Based on the results of scientific reports and discussions held during the expert council, experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

Parathyroid carcinoma (PC) accounts for 0.005% of all malignant neoplasms and is usually associated with an unfavourable prognosis. The greatest diagnostic difficulties arise from the atypical location of thyroid neoplasms. The prevalence of ectopic location of parathyroid gland (PG) ranges from 2 to 43%, while the incidence of this anomaly in patients with primary hyperparathyroidism is 16-30%. This article analyses the difficulties in diagnosing PC with atypical location of the thyroid gland, using two clinical cases as examples, and suggests additional methods for a personalised approach.

Non-alcoholic fatty liver disease (NAFLD) is a liver disease with a characteristic accumulation of fatty inclusions in hepatocytes and includes a spectrum of liver lesions from steatosis to cirrhosis. In view of the increasing incidence of obesity and associated NAFLD, a search is underway for optimal treatments. The authors analyzed published clinical studies on the effect of bariatric surgery on morphological changes in the liver. The literature was searched for the keywords «non-alcoholic fatty liver disease», «obesity», «bariatric surgery» in Pubmed databases and еLibrary.ru for the period from 1990 to 2022 . Both the positive effects of surgical treatment of obesity in the form of a decrease in steatosis, steatohepatitis of the liver, and adverse effects in the form of aggravation of cirrhosis in patients after surgery are considered. Despite the obvious effectiveness of bariatric surgery in relation to the components of the metabolic syndrome associated with obesity, there is still no unambiguous opinion about their effectiveness in relation to NAFLD.

Surgical treatment in the scope of laparoscopic gastric bypass for morbid obesity and type 2 diabetes mellitus (DM 2) with careful preoperative preparation, a gradual expansion of the diet with the obligatory observance of the recommendations of a nutritionist on the balance of micro- and macronutrients, a gradual increase in the amount of available physical activity in the postoperative period allows not only significantly reduce body weight, but also achieve compensation for obesity-related diseases. The expected development of micro- and macronutrient deficiencies requires an active search for and compensation for these conditions both at the pre- and postoperative stages. The development of postbariatric hypoglycemia confirms the need to comply with dietary recommendations not only at the stage of conservative treatment of obesity and DM 2, but also, no less important, after bariatric surgery.

The study of the genetic aspects of endocrine diseases is based on the aspiration to develop the methods of early diagnosis, treatment and observation of patients. Von Hippel-Lindau syndrome is genetically determined disease characterized by damage of various organs and systems. The article presents a clinical case of treatment of a patient with retinal detachment who was first admitted to the surgical department of the Federal State Budgetary Institution «NMIC of Endocrinology» of the Ministry of Health of Russia with complaints of dry mouth, general weakness. Further examination, revealed pathological changes in the adrenal glands, kidneys, brain, pancreas, spleen, spinal cord. The presented clinical case demonstrates the need for a multidisciplinary approach to the management of patients with von Hippel-Lindau syndrome.

Дифференциальная диагностика узловых образований щитовидной железы (ЩЖ) и интратиреоидных образований околощитовидных желез (ОЩЖ) представляет определенную сложность: эхографически они могут не отличаться друг от друга; цитологическое исследование биопсийного материала не позволяет достоверно отличить клетки ОЩЖ от фолликулярных клеток ЩЖ, в ряде случаев в образованиях ОЩЖ выявляется коллоид. В то же время около 1/3 ОЩЖ могут располагаться интратиреоидно. Предоперационная диагностика злокачественных новообразований ОЩЖ еще более ограничена, к тому же до 5% от всех случаев рака ОЩЖ могут протекать бессимптомно. Хирургическое лечение пациентов с образованиями ЩЖ, как правило, проводится без дополнительной предоперационной оценки состояния фосфорно-кальциевого обмена, что в ряде случаев приводит к несвоевременной диагностике патологии ОЩЖ. МАТЕРИАЛЫ И МЕТОДЫ: описание клинических случаев нетипичного течения карцином ОЩЖ. Клинический случай 1: пациентка М., 59 лет, обратилась в ФГБУ «НМИЦ эндокринологии» Минздрава России (НМИЦЭ) в 2021 г. по поводу левостороннего узлового зоба (образование с кистозной дегенерацией, р. 5,9х3,8х3,2 см, EU-TIRADS 4), в анамнезе – в 2008 г. склеротерапия узла. По результатам биопсии: фолликулярное новообразование ЩЖ (Bethesda IV). Лабораторно: эутиреоз; умеренная гиперкальцитонинемия неопухолевого генеза (кальцитонин крови 14,2 пг/мл, в ходе пробы с глюконатом кальция на 2 мин. 38,7 пг/мл, 5 мин. 36,5 пг/мл, 10 мин. 33,4 пг/мл, в смыве из узла – менее 1 пг/мл). В НМИЦЭ выполнена экстрафасциальная тиреоидэктомия. По данным морфологического исследования: в левой доле ЩЖ опухоль из мелких клеток с гиперхромными ядрами и светлой цитоплазмой, инвазией прилежащих тканей и врастанием в ткань доли ЩЖ, участками сосудистой инвазии. В ткани образования определены обширные участки фиброза, кровоизлияния различной давности; ткань ЩЖ микро-нормофолликулярного строения с лимфоцитарной инфильтрацией и формированием немногочисленных лимфоидных фолликулов. Прилежащие лимфатические узлы без патологических изменений. При иммуногистохимическом исследовании (ИГХ) определена диффузная экспрессия ПТГ. Совокупные данные позволили диагностировать карциному ОЩЖ pT2NxR0 (ВОЗ, 2017 г.). В анализах крови после операции: ПТГ 13,2 пмоль/л (1,7-6,4) при снижении кальция, скорректированного на альбумин, до 2,06 ммоль/л и дефиците витамина D (14 нг/мл). С учетом последующей нормализации уровней витамина D (43,4 нг/мл) и ПТГ (55,9 пг/мл (15-65)) на фоне приема колекальциферола указанные изменения соответствовали вторичному гиперпаратиреозу (ВГПТ). При скрининге осложнений гиперпаратиреоза не выявлено. Пациентке было рекомендовано проведение генетического исследования (к настоящему моменту не выполнила), регулярное наблюдение эндокринолога и онколога. Клинический случай 2: пациентка Ш., 49 лет, обратилась в НМИЦЭ в 2022 г. по поводу левостороннего узлового зоба (жидкостное образование, с перегородками, р. 5,9х3,8х3,2 см, EU-TIRADS 2). По результатам биопсии: коллоидный зоб (Bethesda II). Лабораторно: эутиреоз, кальцитонин 1,49 пг/мл, ПТГ крови 706,5 пг/мл (15-65), кальций, скорректированный на альбумин, 3,21 ммоль/л, креатинин 79,3 мкмоль/л, витамин 25(ОН)D 16,3 нг/мл, ПТГ в смыве с иглы из узла >5000 пг/мл – диагностирован первичный гиперпаратиреоз (ПГПТ). При скрининге осложнений заболевания не выявлено. В НМИЦЭ выполнена экстрафасциальная гемитиреоидэктомия слева. На 2-е сутки после операции: ПТГ 79,65 пг/мл, кальций общий снижен до 2 ммоль/л. По данным морфологического исследования: карцинома ОЩЖ pT1 (AJCC 8th). Опухоль состояла преимущественно из клеток с оптически пустой цитоплазмой, окружённой неравномерной фиброзной капсулой с признаками её инвазии и врастанием в прилежащую жировую клетчатку, отмечались участки подозрительные в отношении инвазии сосудов. Капсула левой доли ЩЖ была «спаяна» с опухолью за счет участков выраженного фиброза с фокусами подозрительными в отношения инвазии. По данным ИГХ наблюдалась диффузная экспрессия ПТГ с наличием фокуса сосудистой инвазии в одном из срезов (при проведении исследования с эндотелиальным маркером CD31 описанный участок на срезе не визуализировался). Через 2,5 месяца после операции: ПТГ 109,3 пг/мл (15-65) при уровне кальция, скорректированного на альбумин, 2,36 ммоль/л, гипокальциурии (1,3 ммоль/л) и недостаточности витамина D (28 нг/мл) – данные расценены как проявление ВГПТ. При генетическом исследовании в 7 экзоне гена SDHA (NM 004168.4) выявлен вариант (HG38, chr5:230886C>T, c.781C>T) в гетерозиготном состоянии – рекомендовано дообследование в рамках исключения феохромоцитомы/параганглиомы. Пациентка продолжает наблюдение в НМИЦЭ, рекомендовано наблюдение онколога. Истинная распространенность интратиреоидных образований ОЩЖ у пациентов с узловым зобом неизвестна: в рутинной практике оценка кальциемии пациентам с узловыми образованиями в ЩЖ, как правило, не проводится. В представленных клинических случаях оценка кальция и ПТГ на дооперационном этапе была проведена только пациентке Ш. В то же время выявление ПГПТ необходимо для планирования хирургического лечения и снижения риска интраоперационных осложнений. Дооперационная диагностика карциномы ОЩЖ крайне затруднительна, однако диагноз может быть заподозрен при выраженной гиперкальциемии (> 3 ммоль/л) и крупном размере образования (> 3 см в диаметре). В соответствии с классификацией ВОЗ диагноз рака ОЩЖ устанавливается только на основании данных морфологического исследования (в том числе с дополнительным проведением ИГХ при необходимости) и/или при наличии метастазов. ВЫВОДЫ: ввиду крайне низкой информативности УЗ и цитологического исследований в верификации интратиреоидных образований ОЩЖ целесообразным является оценка уровня кальция у всех пациентов с узловым зобом с последующим решением вопроса о необходимости исследования ПТГ крови и в смыве с пункционной иглы во время биопсии.

ВЛИЯНИЕ ЛАПАРОСКОПИЧЕСКОГО МИНИ-ШУНТИРОВАНИЯ НА КОМПЕНСАЦИЮ УГЛЕВОДНОГО ОБМЕНА У БОЛЬНЫХ С МОРБИДНЫМ ОЖИРЕНИЕМ И САХАРНЫМ ДИАБЕТОМ 2 ТИПАКим Е .И

Aim: present clinical guidelines, aimed at general practitioners, gastroenterologists, cardiologists, endocrinologists, comprise up-to-date methods of diagnosis and treatment of non-alcoholic fatty liver disease.Key points. Nonalcoholic fatty liver disease, the most wide-spread chronic liver disease, is characterized by accumulation of fat by more than 5 % of hepatocytes and presented by two histological forms: steatosis and nonalcoholic steatohepatitis. Clinical guidelines provide current views on pathogenesis of nonalcoholic fatty liver disease as a multisystem disease, methods of invasive and noninvasive diagnosis of steatosis and liver fibrosis, principles of nondrug treatment and pharmacotherapy of nonalcoholic fatty liver disease and associated conditions. Complications of nonalcoholic fatty liver disease include aggravation of cardiometabolic risks, development of hepatocellular cancer, progression of liver fibrosis to cirrhotic stage.Conclusion. Progression of liver disease can be avoided, cardiometabolic risks can be reduced and patients' prognosis — improved by the timely recognition of diagnosis of nonalcoholic fatty liver disease and associated comorbidities and competent multidisciplinary management of these patients.

The obesity epidemic has led to the growing number of bariatric operations and the expansion of indications for this operation as the most effective method of treatment, that’s why endocrinologists are increasingly faced the challenge of late complications, including postbariatric hypoglycemia. Postbariatric hypoglycemia is a rare but severe metabolic disorder that occurs months or years after upper gastrointestinal surgery. Postbariatric hypoglycemia can be accompanied by severe clinical symptoms and lead to disability and decreasing of the life’s quality. It is difficult to assess the prevalence of hypoglycemia after bariatric surgery due to the lack of clear diagnostic criteria, often a hidden clinical picture and ignorance of doctors and patients about this complication. Hypoglycemia in this case has postprandial and hyperinsulinemic nature. The mechanisms of development of this complication have recently been actively discussed. The exchange of incretins and dysregulation of insulin secretion are the subject of constant research in this area. Understanding the mechanisms of development of this condition makes it possible to develop optimal methods of diagnosis and treatment. The issues of pathophysiology, basic principles of diagnosis and treatment of post-bariatric hypoglycemia will be considered in this review.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года БАРИАТРИЧЕСКИЙ ПАЦИЕНТ: ПОСЛЕОПЕРАЦИОННЫЙ МОНИТОРИНГ Ершова Е .В ., Комшилова К

Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal.

65 patients with nonalcoholic fatty liver disease (NAFLD) were included in open-label observative prospective cohort study. Mean age was 54.8 ± 10.5 y. o. All patients were treated with metformin before and during the study. All patients were treated by GLP-1 receptor agonist dulaglutide subcutaneously weekly 26 weeks. Patients of group with type 2 diabetes were treated with dulaglutide 0.75 mg weekly 2 weeks, than 1.5 weekly 24 weeks. Patients of group without diabetes were treated by dulaglutide 0.75 mg weekly 4 weeks, than 1.5 weekly 22 weeks. Both groups of patients were demonstrated significant reduce of body weight, BMI, waist circumference, glucose, HbA1c, insulin resistance indexes, transaminases and gamma-glutamyltranspeptidase activity. Fatty liver index and liver stiff ness also decreased after treatment. We can conclude that dulaglutide treatment in NAFLD patients decreases body wieight, improves glucose and lipid metabolism and decreases inflammatory activity of steatohepatitis.

Nonalcoholic fatty liver disease (NAFLD) – a common chronic disease of the liver, the main feature of which is the accumulation of fat in hepatocytes, is not related to alcohol abuse. NAFLD is associated with obesity, especially abdominal, metabolic syndrome and various metabolic markers of risk for cardiovascular disease and type 2 diabetes, which affects the incidence, prognosis and life expectancy of patients with obesity. This lecture describes the main causes of the disease, its pathogenesis, clinical presentation, diagnosis and treatment.

Obesity is a chronic disease associated with cardiometabolic risk factors, primarily cardiovascular diseases and type 2 diabetes mellitus. In 2016,Russiaregistered a new drug for treating obese patients liraglutide 3.0 mg, which is an analogue of human glucagon-like peptide-1. Given the urgency of the problem, we present a clinical case that shows the efficacy of therapy with liraglutide 3.0 mg daily in a patient with obesity, and its effect on metabolic risk factors.