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The prevalence of T2D is steadily increasing annually, which resulted in an active search for a way to control the disease. The last decade has seen a rise in the number of new groups of glucose-lowering drugs, which not only proved effective in the management of hyperglycemia and safe against hypoglycemia, but also joined the ranks of the drugs of the first-line therapy. Among them is incretin-active agents - type 4 dipeptidyl peptidases inhibitors (IDPP-4, glyptines). Sitagliptin was the world's first approved IDPP-4, and began to be used successfully in Russia since 2007. The review presents data on the efficacy, safety (including cardiac safety) of sitagliptin use and accumulated experience of its use in the treatment of patients with type 2 diabetes.

Diabetes mellitus (DM) and heart failure (HF) are frequent comorbidities with a bidirectional relationship. Patients with HF have increased risk of developing DM, and those with DM are at greater risk of developing HF. HF does not fit clearly into the microangiopathy and macroangiopathy groups. It is known that coronary artery disease and arterial hypertension are the major causes of HF; however, it has been shown that DM can trigger functional and structural abnormalities in the myocardium via diabetic cardiomyopathy, a condition with either restrictive or dilated phenotype. While HF treatment is equally effective and safe in patients with and without DM, this statement is not applicable for antidiabetic treatment. Several antidiabetic drugs, such as rosiglitazone, pioglitazone and saxagliptin increase the risk of hospitalisation for HF, therefore these antidiabetic drugs are contraindicated in patients with DM and HF or patients at risk of developing HF. Despite a large number of clinical evidence, uncertainty about the safety of antidiabetic drugs in patients with HF always exists. In this review, the issues of DM treatment in patients with HF are addressed in detail.

Central hypothyroidism is a rare cause of hypothyroidism, consequence of various disorders affecting pituitary (secondary) or hypothalamus (tertiary hypothyroidism). Difficulties in the diagnosis and management of patients are due to the nontypical clinical picture, frequent combination with impaired function of other pituitary hormones, difficulties in laboratory assessment in high TSH levels or low - normal T4 free levels. Diagnosis is based on a confirmed decrease in the level of free T4 with a low or normal level of TSH. The standard treatment for hypothyroidism of any etiology remains monotherapy with levothyroxine, which allows to restore the euthyroid state in most patients. The criterion for the effectiveness of therapy is to maintain the level of T4 free in the upper half of the reference norm interval. The article presents a modern understanding of epidemiology, pathogenesis and strategies for managing patients with central hypothyroidism.Центральный гипотиреоз является редкой формой гипотиреоза, обусловленной поражением гипофиза (вторичный гипотиреоз) или гипоталамуса (третичный гипотиреоз). Затруднения в диагностике и ведении больных обусловлены стертой клинической картиной, частым сочетанием с нарушениями функции других тропных гормонов гипофиза, трудностями лабораторной верификации диагноза при высоком уровне тиреотропного гормона (ТТГ) и низком или нормальном уровне свободного Т4. Диагностика основывается на подтвержденном снижении уровня свободного Т4 при низком или нормальном уровне ТТГ. Стандартом лечения гипотиреоза любой этиологии при этом остается монотерапия левотироксином натрия, позволяющая восстановить эутиреоидное состояние у большинства пациентов. Критерием эффективности терапии является поддержание уровня свободного Т4 в верхней половине референсного интервала нормы. В статье приведены современные представления об эпидемиологии, патогенезе и стратегии ведения пациентов с центральным гипотиреозом.

Aim. To analyze the association between the polymorphic markers in CTLA4, TNF, IL10 and IL16 genes and the risk of manifestation of endocrine ophthalmopathy (EO) in patients with Graves’ disease (GD). Materials and methods. Case-control study included 248 patients with GD. Using polymerase chain reaction we studied the distribution of alleles and genotypes of polymorphic markers such as A60G (rs3087243) in CTLA4 gene, G(-308)A (rs1800629) in TNF gene, G(-1082)A (rs1800896) in IL10 gene, T3249C (rs4778641) in IL16 gene among 141 patients with Graves’ disease and EO and 107 patients with GD without EO. Results and discussion. The frequencies of A alleles and the AA genotypes were significantly increased and the frequencies of G alleles and the GG genotype polymorphic markers rs3087243 of CTLA4 gene and rs1800896 of IL10 gene, as well as the GG genotype polymorphic marker rs1800629 of TNF gene were reduced in patients with GD and EO. The polymorphism in CTLA4 gene was also associated with the activity and the severity of EO. The comparative analysis of the allele and genotype frequency distribution of polymorphic markers of IL16 gene did not show the significant difference. Conclusion. The risk of manifestation and the development of EO in patients with Graves’ disease can be caused by not only environmental, but also genetic risk factors.

We introduce the audience to the personal and professional life of M.I. Balabolkin ? a prominent Russian endocrinologist, scientist and a proliferous author. We highlight his contribution into the development of national endocrinology services, including the foundation of academic departments of endocrinology in 1977 (first in the nation) and in 1991 (in the Institute of Higher Professional Education, now part of the First Moscow Medical University). We also attempt to summarize professor Balabolkin?s educational and scientific heritage that encompasses studies on pathogenesis and clinical management of major endocrine disorders, as well as instruction of a multitude of successful clinicians and scientists.

For the past several years, a number of studies addressed glucagon and its role in glycemic homeostasis and the development of diabetes mellitus.Current review discusses basic developmental stages of pancreatic islets with special regard for the role of beta-cells and basic mechanisms of glucagonfunction. We also highlight promising approaches to diabetes compensation based on adjustment of glucagon secretion.

The issues pertaining to etiology, pathogenesis, clinical manifestations, and treatment of endocrine ophthalmopathy (EOP) are discussed. EOP is a heterogeneous autoimmune eye disease most frequently associated with Graves’ disease even though it is just as well encountered both in the patients presenting with chronic autoimmune thyroiditis and in the absence of thyroid dysfunction. Although pathogenesis of EOP remains to be elucidated its autoimmune nature with the involvement of sensitized T-lymphocytes and autoantibodies against orbital tissues leaves no doubt. The understanding of mechanisms underlying the development of EOP gave impetus to the creation of new groups of medicines selectively acting on various pathogenic processes associated with this disease. The management of EOP remains a challenging problem requiring a multi-disciplinary approach for its solution.

To analyze the associations of the rs3087243 CTLA4 polymorphism and the rs1800629 TNF polymorphism with endocrine ophthalmopathy (EOP) in ethnic Russian patients with Graves' disease (GD).The case-control study enrolled 205 patients with GD. The distribution of alleles and genotypes of the rs3087243 CTLA4 and rs1800629 TNF polymorphisms was studied in 141 patients with GD and EOP (a GD+EOP group) and 64 patients with GD without EOP (a GD-EOP group). The polymorphic alleles were identified by polymerase chain reaction-restriction fragment length analysis.The patients with GD in their history and EOP had significantly higher frequencies of A allele and AA genotype and a lower proportion of G allele and GG genotype of the rs3087243 CTLA4 polymorphism. Comparative analysis revealed no significant differences in the frequency of the alleles and genotypes of the rs1800629 TNF polymorphism.The rs3087243 CTLA4 polymorphism is associated with the risk of EOP in ethnic Russian patients with GD.Цель исследования. Анализ ассоциаций полиморфного маркера rs3087243 гена CTLA4 и полиморфного маркера rs1800629 гена TNF с эндокринной офтальмопатией (ЭОП) у пациентов русского происхождения с болезнью Грейвса (БГ). Материалы и методы. В исследовании случай-контроль включили 205 пациентов с БГ. Изучали распределение аллелей и генотипов полиморфных маркеров rs3087243 гена CTLA4 и rs1800629 гена TNF у 141 пациента с БГ и ЭОП (группа БГ+ЭОП) и 64 пациентов с БГ без ЭОП (БГ-ЭОП). Аллели полиморфных маркеров идентифицировали методом полимеразной цепной реакции с последующим анализом длин рестриктазных фрагментов. Результаты. У пациентов с БГ в анамнезе и ЭОП достоверно повышены частоты аллеля А и генотипа АА и снижена доля аллеля G и генотипа GG полиморфного маркера rs3087243 гена CTLA4. Сравнительный анализ частот аллелей и генотипов полиморфного маркера rs1800629 гена TNF достоверных различий не выявил. Заключение. Полиморфный маркер rs3087243 гена CTLA4 ассоциирован с риском развития ЭОП у пациентов с БГ русского происхождения.

Objective: to assess hormonal and metabolic parameters and psychological status of young men with obesity. Methods: The study included 60 men with obesity (BMI>30 kg/m2) divided in two groups. Patients in the first group (n=30) received orlistat for 12 weeks (120 mg 3 times daily with meal). Patients in second group (n=30) followed hypocaloric diet and aerobic exercise. All patients were examined before treatment and after 12 weeks. Evaluation included hormonal and biochemical analyses, 48 patients were examined by psychological questionnaires (Beck Depression Inventory, Beck Anxiety Inventory, Liebowitz Social Anxiety Scale, Dutch Eating Behavior Questionnaire). Results: Patients that received orlistat treatment showed significant decrease of body mass: 50% of patients had decrease more than 5%, 30% of patients - more than 10% (p

The review presents data from the literature on the physiological and pathophysiological role of hormones of adipose tissue (adiponectin, tumor necrosis factorƒ, interleukin-6, leptin, resistin, plasminogen activator inhibitor-1). The article considers the contribution of adipocytokines to the development of reproductive impairment. The results of studies on the relationship of the obesity and dysfunction of the reproductive system in women are presented.The review provides data from the literature about drug therapy of polycystic ovary syndrome.

End of XX - beginning of XXI century. were characterized by a rapid increase in the incidence of type 2 diabetes mellitus, which is caused by overeating, an increase in the number of refined products, obesity, a decrease in physical activity, and an increase in life expectancy. Worldwide, the number of people with diabetes is over 100 million. In Europe, the cost of treating diabetes and its complications, according to experts, is 5.8% of the total medical budget

The review presents a recent data from the literature on the physiologic and pathophysiologic role of adipose tissue hormones (adiponectin, resistin, leptin). The article details the role of adipocytokines in atherogenesis. It also presents the results of studies depicting the relationship between subclinical hypothyroidism, lipid metabolism and insulin resistance as well as the impact of thyroid dysfunction upon the secretion of adipocytokines.

Background. Graves' ophthalmopathy (GO) is an autoimmune inflammatory disorder affecting the retroorbital tissues. Although the role of TRAb in GO is now accepted by many researchers and clinicians, their use in the disease management of GO is less well studied than the role of TRAb for the diagnosis and therapy monitoring of Graves’ disease. Aim : to evaluate the relation between TRAb level and the activity of GO, the course of GO and the effectiveness of the treatment. Materials and methods. We have studied 26 patients with GO and Grave’s Disease. Activity of GO was measured with the clinical activity score (CAS), we defined active GO as a CAS≥3. TSH, FT4 and TRAb were evaluated. All patients had received intravenous methylprednisolone (ivMP) pulse therapy in cumulative dose 6000 mg. We observed patients for 1 year after pulse therapy. TRAb level was evaluated before, 3, 6 and 12 months after pulse therapy. Results: At the time of initial treatment all patients had active GO, 60% with CAS 3-4 and 40% with CAS 5-7. On year after the pulse therapy of GO, all patients were classified into responders (69,2%) and non-responders (30,8%) according to their clinical manifestations. Pulse therapy considered as effective if GO activity decreased with CAS ≤ 2. Serum TRAb level was significantly higher in patients who non-responded to therapy – 34,8 U/L vs 17,5 U/L (p≤0,01). This level was significantly decreased in patients responded to treatment – 1,6 U/L vs 12,4 U/L (p≤0,01). TRAb level above 28,8 U/L before treatment (p≤0,01), 10,1 U/L after 3 months of treatment (p≤0,01), 5,1 U/L after 6 months of treatment (p≤0,01) and 8,2 U/L after 3 months of treatment (p≤0.01) was associated with higher risk of non-responding. Conclusion: We conclude, that TRAb level may serve not only as predictor of GO activity and severity, but changes in the level of antibodies could be of additional help for the disease management with ivMP.

This article describes the case of a young woman with autoimmune polyglandular syndrome type 2, presented by the primary adrenal insufficiency and thyroid dysfunction. In the course of the disease there was a change of the thyroid functional activity from hypothyroidism to hyperthyroidism, which led to adrenal insufficiency decompensation.