Complete visualization of parathyroid glands in the preoperative period is the key to successful surgical treatment of secondary hyperparathyroidism. At the present time various imaging techniques such as neck ultrasound, scintigraphy, computed tomography of the neck and upper mediastinum, magnetic resonance imaging are used, but clear diagnostic algorithm is not developed yet.

Background. Secondary hyperparathyroidism (sHPT) is one of the serious complications in chronic kidney disease and is associated with progressive bone disease and vascular calcification.The objective of the study was to determine the impact of Mimpara (Cinacalcet HCl) on mineral disorder, bone turnover and bone mineral density (BMD) versus parathyroidectomy (PTx) in haemodialysis patients’ refractory to alfacalcidol. Materials and methods. 62 haemodialysis patients with sHPT were enrolled in this 6=months prospective study. All of them had surgical indications for PTx. Surgical indications was established according to clinical or biological assessment. 40 patients underwent Mimpara treatment. Dose of Mimpara was titrated every 4 weeks. Sequential doses included 30–180 (mean 59.1 ± 34.2) mg/day. 22 patients underwent PTx. The surgical technique was depended on quantity of hyperplastic parathyroid glands.Results. In 6 months mean iPTH, Ca, Са×Р, CTx and OC levels significantly decreased by 55.7%, 13.8%,34.3%, 21.4 and 1.4% in the Mimpara group vs. 90.7%, 14%, 55.5%, 58.7% and 26.9% in the PTx group. Median serum iPTH level decreased by 30% after initiation of Mimpara in 94.3% patients, from them by 50%in 74.3%. Achieved the KDOQI treatment targets for PTH in 28.6% patients.In 6 months after PTx median serum iPTH level was 100 pg/ml in 50% patients, achieved the KDOQI treatment targets in 27.3%, 300 pg/ml in 18.2%. Median serum 25(ОН)D after PTx significantly increase by 127.3% vs 6.72% in the Mimpara group. In 6 months active restoration of BMD was found in the PTx patients, and patients treated with Cinacalcet showed stabilization of BMD.Mimpara therapy led to a reduction in glandular volume during the course of the study: in both glands with a baseline volume 500 mm3 and with a baseline volume ≥500 mm3. Conclusions. PTx and Cinacalcet therapy improves phosphorus=calcium homeostasis, bone turnover, but bone resorption and formation markers decreased better in the PTx group compared to Cinacalcet group. The effectiveness and safety of Mimpara for secondary hyperparathyroidism were evaluated in dialysis patients’ refractory to alfacalcidol, which reduced the need for parathyroidectomy in patient without severe osteodystrophy.

Aim. To study the prevalence of androgen deficiency in men with type 1 diabetes mellitus (DM1) undergoing programmed hemodialysis (PHD) andto develop methods for the treatment of metabolic disorders. Materials and methods. The study included 43 men with DM1 on PHD. Group 1 comprised 20 patients below 40 years of age, group 2 included23 older patients. Patients of group 1 were allocated to subgroup A (treated with testosterone and ether mixture (TEM)); and control subgroup B(n=14 and 6 respectively). Patients of group 2 were divided into subgroup C (treated with TEM) and control subgroup D (n=14 and 9 respectively).Patients in the study and control subgroups were matched for age, duration of DM1, hemodialysis (years), total testosterone (TT, nmol/l), hemoglobin(Hb, g/l) and glycated hemoglobin (HbA1c, %) levels. All the patients were treated with epoetin-beta (EPO-b) on an individual basis depending onHb level; TEM was given thrice weekly. Results. Group 1: age 34.0?3.9 yr, HbA1c 9.3?1.4%, Hb 118.1?9.6 g/l, TT 21.2?6.6 nmol/l. Group 1: age 47.3?3.5 yr, HbA1c 9.5?1.8%,Hb 94.9?5.7 g/l, TT 9.8?3.9 nmol/l. Androgen deficiency was diagnosed in 48.8% (total group), 5.0% (group 1) and 86.9% (group 2) of the patients.Reduction of TT level was not accompanied by a significant rise in LH concentration to above normal values (p>0.05). HbA1c level in eithergroup did not significantly change within 6 months after the onset of the study. Combined treatment with EPO-b and TEM resulted in a Hb concentrationof 118.2?6.7 g/l in subgroup A (p=0.79). Hb level in subgroup C increased to 113.5?6.3 g/l (p=0.009). Hb changes in control groups wereinsignificant. Requirement for EPO-b in subgroups A and C decreased by 32.1% (p=0.007) and 41.1% (p=0.001) respectively but remained unalteredin both control subgroups. Conclusion. Reduction of the TT level in men with DM1 on PHD is a function of age and constitutes an independent risk factor of anemia. Androgendeficiency and its correction have no effect on carbohydrate metabolism. Combined treatment with EPO-b and TEM increases blood Hb level in oldermen and reduces requirement for EPO-b regardless of the age.

Цель. Изучение влияния андрогенного дефицита на эритропоэз и коррекция его с помощью комбинированной терапии препаратами эритропоэтина и тестостерона. Материалы и методы. В исследование включено 43 мужчины с сахарным диабетом 1 типа, получающих терапию ПГД. Пациенты были разделены на 2 группы в соответствии с возрастным критерием: группа 1 ? моложе 40 лет; группа 2 ? старше 40 лет. Всем пациентам проводилось определение антропометрических показателей (рост, вес, индекс массы тела). Выполнена оценка состояния углеводного обмена, гемопоэза. Для оценки андрогенного дефицита выполнено исследование уровней: лютеинизирующего гормона (ЛГ), ОТ, секс-стероид, связывающего глобулина (СССГ). Дополнительно мужчинам у которых выявлялось снижение уровня тестостерона, проводилось исследование уровня пролактина в крови . Результаты. При распределении мужчин по возрастным группам получены данные, демонстрирующие, что прогрессивное снижение концентрации Т с возрастом не сопровождается повышением уровня ЛГ выше нормы ? это свидетельствует о вторичности процесса или о нарушении механизма отрицательной обратной связи. Полученные в исследовании данные позволили установить, что андрогенный дефицит и его коррекция не влияли на компенсацию сахарного диабета. Получено значимое увеличение уровня гемоглобина на 16,2% у мужчин, которые получали комбинированную терапию. Заключение. андрогенный дефицит у мужчин, получающих лечение ПГД, является широко распространенным состоянием. Более выраженное влияние терапии препаратом Т получено в старшей возрастной группе с лабораторно подтвержденным андрогенным дефицитом.