Incidentalomas are the most common neoplasms in the hypothalamic-pituitary region. Diagnostics, treatment strategy, and indications for the surgical intervention on the patients with these tumours pose a serious challenge for a wide circle of specialists. The diagnostic problems arise from the absence of the specific clinical signs and symptoms as well as the reliable biochemical markers of the disease. The modern laboratory methods do not allow to reveal the pathological hormonal secretion during the diagnostic study, predisposition of the neoplasm to the invasive and infiltrative growth, and signs of its «aggressiveness». This considerably complicates the choice of the optimal surgical strategy and the evaluation of the long-term results of the treatment. Bearing in mind the importance of the problem under consideration, the working group was set up for the development of federal recommendations on the treatment of pituitary incidentalomas based on the principles of evidence-based medicine. The experience accumulated by the domestic and international experts was summarized in the federal clinical guidelines on pituitary incidentalomas containing the available information about these neoplasms.

Реферат по материалам статьи Ittermann T, Markus MR, Schipf S, Derwahl KM, Meisinger C, Volzke H. Metformin Inhibits Goitrogenous Effects of Type 2 Diabetes. Eur J Endocrinol. 2013 May 17;169(1):9-15. doi: 10.1530/EJE-13-0101. Print 2013.

Granins are glycoproteins presented in granules of neuroendocrine cells, they regulate secretory pathway that is responsible for controlled delivery of peptides, hormones and neurotransmitters, and growth factors, organization of the granular matrix, and the mechanisms of administration after hormone secretion The highest accuracy has been observed in neuroendocrine tumors characterized by an intense secretory activity, but its specificity and sensitivity remain very high also in nonfunctioning tumors. The granins application as the markers of nonfunctioning pituitary adenomas would allow the early disease detection, assessment the secretory capacity of tumor, and differential diagnosis with autoimmune forms of pituitary lesions. Furthermore, granins can be used as markers of related metabolic disorders, especially of cardiovascular diseases.

He main issue in osteoporosis management is the duration of treatment with different drugs particularly in cases of severe osteoporosis with high fracture risks and indications of switching from one to other agents. Denosumab is a new class of osteoporosis treatment called a human monoclonal antibody that prevents RANKL-RANK interaction and thereby inhibits osteoclast formation, demonstrates significant efficacy for vertebral, nonvertebral and hip fracture risk reduction. This case demonstrates multifactorial reasons for osteoporosis development (postmenopausal osteoporosis, primary hyperparathyroidism), as well as the long-term applying of different osteoporosis drugs with various actions mechanisms and different effectiveness.

Реферат по материалам статьи Esteghamati A, Noshad S, Rabizadeh S, Ghavami M, Zandieh A, Nakhjavani M. Comparative effects of metformin and pioglitazone on omentin and leptin concentrations in patients with newly diagnosed diabetes: A randomized clinical trial. Regul Pept. 2013 Jan 14;182C:1-6.

He main issue in osteoporosis management is the duration of treatment with different drugs particularly in cases of severe osteoporosis with high fracture risks and indications of switching from one to other agents. Denosumab is a new class of osteoporosis treatment called a human monoclonal antibody that prevents RANKL-RANK interaction and thereby inhibits osteoclast formation, demonstrates significant efficacy for vertebral, nonvertebral and hip fracture risk reduction. This case demonstrates multifactorial reasons for osteoporosis development (postmenopausal osteoporosis, primary hyperparathyroidism), as well as the long-term applying of different osteoporosis drugs with various actions mechanisms and different effectiveness.

Multiple endocrine neoplasia syndrome type 1 (MEN1, Wermer syndrome) – group o а heterogeneous inherited deseases, caused by hyperlasia or neoplasia of several endocrine glands. The phenotype of MEN1 is broad, and over 20 different combinations of endocrine and non-endocrine metabolic manifestations have been described. This case demonstrates multiple formations of endocrine organs, starting non-classical with macroprolactonoma resistant to dopamine agonists therapy, other endocrine disorders developed gradually eventually: hyperparathyreoidism and hypoglycemia caused by pancreas lesions, produced proinsulin in high levels.