The aim of the study: to study the influence of cardiovascular autonomic neuropathy (CAN) on the blood pressure (BP) profile in patients with a combination of diabetes mellitus type 2 and hypertension.

Material and methods. 36 patients with a combination of diabetes mellitus type 2 and hypertension were examined. Ambulatory BP monitoring (ABPM), 5 standard cardiovascular tests (CVT) according to Ewing, and analysis of heart rate variability were performed. Based on the results of the CVT, the patients were divided into 2 groups: CAN (+) and CAN (-). Glycated hemoglobin and the time in the target range (TIR) were used to analyze glycemic control.

Results. CAN (+) group had higher level of glycated hemoglobin and decreased TIR. Statistically significant differences in heart rate variability were revealed: SDNN, total spectrum power (TP) and “cloud” area of scatterplot were lower in the CAN (+) group. Patients with CAN had higher mean values and systolic pressure (SP) load during the day and mean values and SP and diastolic pressure (DP) load at night, increased BP variability during the day and at night and an increase in the pulse pressure. The CAN (+) group was dominated by night-peakers for SP: 71 vs. 16% (p=0.002) and non-dippers for DP: 47 vs. 16% (p=0.05).

Conclusion. The study allows us to conclude about the relationship of the cardiovascular relationship of CAN with the worst indicators of glycemic control. The presence of autonomic dysfunction is associated with the absence of a normal decrease or increase BP at night, higher mean values of SP, indicators of BP variability, increased pulse pressure.

Diabetic foot syndrome (DFS) is a significant medical and social problem. Despite modern prevention and treatment options, as well as patient routing, DFS remains one of the dominant causes of lower limb amputation and leads to disability in patients with both type 1 (DM1) and type 2 (DM2) diabetes mellitus.

The aim. To compare the clinical and laboratory characteristics of patients with DM1 (n = 30) and DM2 (n = 729) hospitalized at the Limb Rescue Center of the V.P. Demikhov State Clinical Hospital in the period from 2019 to 2020.

Materials and methods. Anamnestic and clinical laboratory data from 759 electronic medical records of patients of the limb rescue center, patients with DM1 or DM2, were analyzed.

Results. The majority of patients with DM1 were 45–60 years old – 56.67% (n = 17), with DM2 – elderly (50.75%, n = 370). The median fasting plasma glucose upon admission in patients with DM1 was 11.5 [6.2; 14.7] mmol/L, in patients with DM2 – 9.9 [7.2; 13.8] mmol/L. The average HbA1c in group 1 was 8.71 ± 0.26 (95% CI: 8.18 – 9.25 in patients with DM2 – 7.8 [6.7; 9.1]%. The mean GFR was 65.92 ± 3.43 (95% CI: 58.88 – 60.57) ml/min/1.73 m² and 63.38 ± 0.90 (95% CI: 61.62 – 65.15) ml/min/1.73 m², respectively, in groups 1 and 2. The structure of ulcerative necrotic lesions in patients with DM1 was dominated by ulcer (33.33%, n = 10) and purulent/purulent-destructive arthritis (26.6%, n = 8), and in patients with DM2 - gangrene (33.47%, n = 244) and ulcer (25.1%, n = 183). Amputation occurred in 36.67% (n = 11) of patients with DM1 and in 24.3% (n = 372) of patients with DM2.

Conclusions. The identified features of patients with DFS and DM1 and DM2, along with the data obtained on the relatively high frequency of amputations in both groups, indicate the need to optimize patient routing algorithms and increase the attention of patients with both DM1 and DM2 to the importance of foot care and regular visits to the diabetic foot office.

Background. Diabetic peripheral neuropathy (DPN) is recognized as the most prevalent microvascular complication of diabetes leading to the development of pain syndrome, sensory impairment, and motor function disturbance. The role of DPN as an independent factor influencing mortality in patients with type 2 diabetes mellitus (T2DM) remains insufficiently studied.

Aim. To assess the impact of DPN on the frequency of death in patients with T2DM over a period of five years.

Material and methods. A single-center uncontrolled study was conducted involving 496 patients with T2DM who were hospitalized in the endocrinology department. The evaluated outcome was all-cause mortality. The average follow-up period was 1701 ± 338 days. Clinical and anamnestic data were collected from the patients, laboratory studies of biochemical blood parameters were performed, and the severity of clinical symptoms and neurological deficits were assessed using special scales and questionnaires.

Results. During the five-year observation period, 81 patients (16.3%) died. Age over 70 years old, decrease in vibration perception threshold (VPT) by more than 2 points, and history of acute myocardial infarction (AMI) were associated with adverse outcomes. For patients aged over 70 years and those with previous AMI, there was a 2.5-fold increased risk of death. VPT scores exceeding 2 points were associated with an 1.8-fold increase in unfavorable outcomes. A scoring system for predictors of fatal outcomes was introduced. An ROC analysis was conducted for the predictive scoring model. The area under the ROC curve was 0.696 (95% CI: 0.629–0.760, p < 0.001).

Conclusion. Assessment of VPT is a simple test available in clinical practice that not only allows diagnosing DPN and predicting the risk of developing diabetic foot syndrome but also evaluating long-term prognosis in patients with T2DM. Based on measuring VPT, a point-based system for predicting the risk of death within 5 years has been proposed.

This review analyzes the role of dipeptidyl peptidase-4 (DPP-4) inhibitors in the modern treatment strategy for type 2 diabetes mellitus, focusing on their use in combination therapy and their place in clinical algorithms. The issues of efficacy and safety of DPP-4 inhibitors in combination with other sugar-lowering drugs are considered, with special emphasis on their favorable tolerance profile and low risk of hypoglycemia. The priority of using DPP-4 inhibitors in elderly patients with type 2 diabetes mellitus is emphasized, taking into account comorbidity and the need to maintain quality of life. The analysis of recent studies on the potential neuroprotective effects of DPP-4 inhibitors, including their effect on cognitive functions and the risk of dementia, is carried out.

Growth hormone- and prolactin-secreting pituitary adenomas are characterized by high variability of clinical course and response to therapy. In recent years, molecular biomarkers associated with the growth pattern and hormonal secretion of pituitary adenomas have been actively studied for their possible use as prognostic factors determining patient management tactics. Some of the promising molecules are β-arrestins and E-cadherin. β-arrestins are multifunctional adapter proteins that modulate proliferation, migration of a number of tumor cells and their sensitivity to antiproliferative therapy. E-cadherin is a key transmembrane protein of cell adhesion, which in addition to its structural role, is also regulates proliferation, differentiation and protection of cells from apoptosis. This review presents the results of studies included in the PubMed database concerning the role of β-arrestins and E-cadherin in the pathophysiology of growth hormone- or prolactin-secreting pituitary adenomas, with an emphasis on the potential to identify these proteins as biomarkers for predicting the effectiveness of drug therapy with somatostatin analogues in acromegaly and dopamine receptor agonists in prolactinomas.

Obesity has become one of the most serious health problems in the 21st century, affecting millions of people worldwide (approximately 42–43% of the adult population). However, there is a tendency to increase life expectancy in the world, which inevitably increases the frequency of comorbid pathology, one of which is sarcopenia. According to international experts, sarcopenia will become a global problem by 2045. The urgency of the problem of sarcopenic obesity is due to the steadily increasing prevalence of obesity worldwide. An important aspect that is often overlooked in the context of combating obesity is the preservation of muscle mass, which plays a key role in maintaining health and quality of life. The purpose of our review is to analyze data on the effect of modern drugs such as tirzepatide and semaglutide on muscle tissue.

Diabetes mellitus (DM) is associated with an increased risk of cerebral circulatory disorders and a worse stroke outcome, and is also characterized by a high incidence of cognitive impairment (CI). The vulnerability of the brain to metabolic and vascular damaging factors accompanying the course of diabetes determines the need to understand the mechanisms of the pathological process in conditions of comorbidity, to search for and implement measures of cerebroprotection.DM treatment includes lifestyle modification, glycemic control, and optimization of other risk factors for cardiovascular diseases. Intensification of glycemic control makes it possible to reduce the risk of microvascular diabetic complications, but it has not proven effective in preventing vascular diseases of the brain and heart failure. The newest class of antihyperglycemic drugs, sodium–glucose cotransporter-2 (SGLT-2) inhibitors, has taken a strong place in the treatment of type 2 diabetes (DM2). There is increasing evidence that the use of SGLT-2 inhibitors can reduce the risk of stroke in patients with T2DM, as well as contribute to the preservation of cognitive functions.

Diabetic retinopathy (DR) and diabetic macular edema (DME) are the most common microangiopathic complications of diabetes mellitus, that represent one of the most relevant problems of modern healthcare. DR is the fifth most common cause of blindness worldwide and the main cause of vision loss in patients with diabetes. Proliferative DR (PDR) is the last stage of this complex retinal disease and is characterized by abnormal production of vascular endothelial growth factor (VEGF), which is one of the most important pathogenic factors of DR. based on the current data on DR development and the role of VEGF, there can be identified several therapeutic strategies. Panretinal photocoagulation (PRP) is the standard treatment for proliferative diabetic retinopathy. In addition, combination of PRP and intravitreal administration of antiVEGF drugs is considered the most effective method for the management of DME. Modern strategies in diabetology and ophthalmology include anti-VEGF therapy that has radically changed the outcome of DR due to its antiangiogenic activity. Currently, the most effective anti-VEGF drugs are ranibizumab, brolucizumab and aflibercept. They have significantly changed the prognosis of patients, due to achieving better visual acuity and preventing the progression of DR and vision-threatening complications. In the present review, we have provided up-to-date information on the role of VEGF in the pathogenesis of DR, as well as on the current management strategies of DR and DMO. 

Subacute thyroiditis (ST; synonyms: granulomatous thyroiditis, De Kerven’s thyroiditis, viral thyroiditis, giant cell thyroiditis) is a inflammatory disease of thyroid gland (TG), presumably viral etiology, lasting from one week to several months, аt the height of the disease most often manifested by a pronounced pain in the area of TG and fever, sometimes with attachment of symptoms of thyrotoxicosis; having a tendency to reccurence. The COVID-19 pandemic has changed established perceptions about epidemiology, pathogenesis, clinical characteristics of thyroid infections associated with viral infections. Clinical symptoms and laboratory signs that were previously considered pathognetic for ST (neck pain, fever, pronounced increase in erythrocyte sedimentation rate) can no longer be considered as such. Despite the availability of instrumental and laboratory methods of investigation, there are currently some difficulties in the diagnosis and differential diagnosis of ST. Thus, the objective of this review is to synthesize new data on the diagnosis of ST, its clinical course and approaches to patient management.

Type 2 diabetes mellitus (T2DM) and cognitive impairment (CI), including dementia, are global medico-social problems that are pathogenetically closely linked and form a vicious cycle. Despite an understanding of the shared mechanisms, the traditional approach focused solely on glycemic control proves insufficient for preventing cognitive decline.

The aim: to summarize current insights into the pathogenetic relationship between T2DM and CI and to substantiate the need for a shift towards a new paradigm of preventive, pathogenetically targeted therapy aimed at preserving cognitive health.

Material and methods. An analysis of modern epidemiological, observational, and randomized clinical trials, as well as systematic reviews and meta-analyses, dedicated to studying the relationship between T2DM, cardiometabolic risk factors, and CI, and assessing the potential neuroprotective properties of specific classes of glucose-lowering drugs was conducted.

Results. The key role of comprehensive management of cardiometabolic risk factors (blood pressure control, dyslipidemia, insulin resistance) and subclinical atherosclerosis (carotid intima-media thickness) in CI prevention is demonstrated. The promise of using drugs with pleiotropic activity, such as pioglitazone (thiazolidinedione) and alogliptin (DPP-4 inhibitor), which target common pathogenetic links of T2DM and neurodegeneration (cerebral insulin resistance, neuroinflammation, atherosclerosis), is substantiated. Evidence of their ability to reduce the risk of dementia, recurrent stroke, and atherosclerosis progression is presented. Particular attention is paid to the benefits of early combination therapy, specifically the fixed-dose combination of alogliptin and pioglitazone, which provides powerful glycemic control with a minimal risk of hypoglycemia and a comprehensive impact on multiple defects of T2DM.

Conclusion. The implementation of an integrative, preventive strategy, including aggressive control of cardiometabolic risk factors, early screening for CI, and targeted prescription of pathogenetically justified glucose-lowering therapy with neuroprotective potential, is a necessary condition for reducing the risk of cognitive impairment and dementia in patients with T2DM.

We present the first reported case of a juvenile fibroadenoma (FA) in a seven-year-old girl with gonadotropin-dependent precocious puberty (PP). The girl was admitted to the Endocrinology Research Centre with accelerated growth and breast asymmetry. Examination revealed central PP and a solid mass in the left breast. Surgical excision of the mass was performed at the N.N. Blokhin National Medical Research Center of Oncology, juvenile FA was confirmed. Postoperative ultrasound showed residual fibromatous tissue, oncologic follow-up was recommended. At the age of 7.5 years, therapy with gonadotropin-releasing hormone analogs was initiated, resulting in regression of the tumor foci over the course of 20 months. The clinical data suggest a potential association between the FA and PP: manifestation at the onset of puberty and regression in response to a decrease in sex hormone levels. FA may therefore represent a possible complication of PP. This hypothesis requires further investigation.

Thyroid hormone resistance syndrome (THRS) is a rare genetic disorder caused by mutations in the thyroid hormone receptor beta (THRB) gene. It is characterized by an unusual combination of elevated levels of thyroid-stimulating hormone and thyroid hormones. The primary symptom of THRS is goiter. The clinical presentation is diverse, with the same patient exhibiting both symptoms of thyrotoxicosis and hypothyroidism. Even patients with the same mutation in the thyroid hormone receptor gene within the same family demonstrate completely different clinical pictures. All this creates difficulties in choosing a therapy. A peculiarity of the treatment of THRS is the administration of high-dose thyroid hormone preparations in combination with beta-blockers. The use of thyrostatic drugs, thyroidectomy, and radioiodine therapy should be avoided. This article aims to raise awareness among physicians about this disease.