Vol 97, No 10 (2025): Issues of endocrinology

The rates of increase in the incidence of type 2 diabetes mellitus (T2DM) and obesity in the world are steadily increasing and exceed even the wildest forecasts, which forces specialists to seek, develop and implement more effective therapeutic methods for these two interrelated non-communicable pandemics. This article discusses promising areas in the pharmacotherapy of obesity and T2DM with an emphasis on the development of a class of incretin hormone receptor agonists. Monoagonists (liraglutide, dulaglutide, semaglutide) and dual incretin receptor agonists (tirzepatide), as well as triple- and tetra-agonists of gastrointestinal hormones currently under development, which are expected to be even more effective in the complex treatment of both type T2DM and obesity, are being discussed.

Background. Obesity is associated with some types of cancer including breast cancer (BC). But still there are not so much studies on the relationship between the adipose tissue distribution, visceral obesity (VO), and insulin resistance with the development of BC. This study is devoted to the effect of VO and insulin resistance on the development of BC.

Aim. To assess the frequency of VO and insulin resistance in patients with newly diagnosed BC in an outpatient setting.

Materials and methods. An observational retrospective study was conducted, including 160 electronic medical records of women with suspected cancer. The control group (n=103) consisted of women with negative histological results. The study group consisted of patients in whom BC was confirmed histologically. Anthropometric data, glycemia, and lipid profile were studied. Statistical processing of the results was performed using the method of descriptive statistics and calculation of the Spearman correlation coefficient with reliability assessment by the Student's t-test.

Results. The maximum frequency of BC is observed in women over 60 years old (80%). The average age in the group of participants with confirmed BC was 64.51±10.30, in the control group 55.81±12.20 (p<0.0004%). The average Body Mass Index in patients in the group with BC was 30.50±4.98, in the control group – 25.76±5.70 (p<0.05). The average Body Mass Index in the BC group was 30.50, in the control group – 25.76 (p<0.05). A high level of VO was found in 82% of patients with BC. We have found that in the group of patients with BC the frequency of occurrence of high Total Cholesterol values is 72%, Triglycerides – 61%, Low-Density Lipoprotein – 68%, while in the group of patients with unconfirmed BC 10, 33, 24% respectively. When assessing indirect signs of insulin resistance in patients with BC high values of the indicators were recorded, which indicates the presence of insulin resistance. In the control group, Visceral Adiposity Index was detected in 22% of cases above normal values, the Triglycerides to High-Density Lipoprotein Cholesterol index was detected above normal values in 12% of cases, Metabolic Index – 1%, Lipid Accumulation Product – 14%.

Conclusion. The results of the study emphasize the importance of VO and insulin resistance in the pathogenesis of breast cancer, which is important for early diagnosis and prevention of the disease.

Aim. To investigate the presence of statistically significant correlations between clinical and laboratory characteristics and features of contrast-enhanced computed tomography (CT) images, as well as to assess the possibility of predicting group classification according to the PASS scale based on clinical, laboratory, and contrast-enhanced CT imaging data.

Materials and methods. A retrospective analysis was performed on preoperative four-phase contrast-enhanced CT images of 230 patients with a pathomorphologically verified diagnosis of pheochromocytoma/paraganglioma. Clinical manifestations such as the presence and duration of arterial hypertension, carbohydrate metabolism disorders, and dyslipidemia were assessed. In the first stage, comparative and correlation analyses were conducted between hormonal parameters and contrast-enhanced CT data. In the second stage, based on morphological characteristics, patients were divided into two groups: with PASS scores <4 (n=155) and PASS scores ≥4 (n=56). Logistic regression analysis was conducted to evaluate the possibility of predicting group classification based on clinical, laboratory, and contrast-enhanced CT imaging data.

Results. Pheochromocytomas/paragangliomas with isolated normetanephrine secretion type accumulate significantly more contrast agent in the arterial and venous phases of the study (p<0.001) compared to other secretion types. Correlation analysis revealed statistically significant moderate positive correlations between blood normetanephrine levels and the volume of functioning tumor tissue without necrotic areas, as well as a moderate negative correlation between blood metanephrine levels and the maximum density in the venous phase, the percentage of venous contrast enhancement, and the 90th percentile of X-ray density of the functioning tumor tissue in the venous CT phase. A statistically significant association was also found between the presence/absence of necrosis and tumor size (p<0.001), as well as between structure and tumor size (p=0.004). No statistically significant correlations were identified between laboratory parameters, imaging data, and clinical manifestations (arterial hypertension, carbohydrate metabolism disorders, dyslipidemia, and carotid artery atherosclerosis). CT image characteristics allow for prediction of group classification according to the PASS scale with an AUC of 0.647 (95% confidence interval 0.471–0.797), sensitivity of 0.923 (0.727–1.000), specificity of 0.400 (0.250–0.548), PPV of 0.333 (0.176–0.500), and NPV of 0.941 (0.800–1.000).

Conclusion. Pheochromocytomas/paragangliomas are heterogeneous pathologies with diverse clinical, hormonal, and radiological characteristics that are associated with pathomorphological findings (PASS scale).

The article presents a description of a clinical case of an ectopic focus of adrenocorticotropic hormone (ACTH) hypersecretion located in the adrenal medulla in a 64-year-old obese woman without other characteristic clinical signs of hypercorticism, with complaints of rapidly progressing lower limb edema, severe muscle weakness, loss of appetite, weight loss by 4 kg, as well as stage 2 arterial hypertension and type 2 diabetes mellitus. The patient's blood biochemistry showed severe hypokalemia, up to 2.2 mmol/l, despite infusion and oral therapy with potassium preparations. Taking into account the clinical picture and ECG and Echo-CG results, coronary heart disease, functional class II angina, and stage II A chronic heart failure, functional class II according to the New York Heart Association scale were diagnosed. During the laboratory and instrumental examination, endogenous hypercorticism was confirmed, high ACTH values were revealed, there were no visualized pituitary formations – ACTH ectopic syndrome was diagnosed. The patient's severe condition (severe hypokalemia, myopathy, progressive edema of the lower extremities) against the background of the added SARS-CoV-2 infection did not allow for a full topical diagnosis, and therefore the patient underwent a life-saving operation in the amount of bilateral adrenalectomy. In the postoperative period, a significant decrease in the ACTH level was noted, which became the basis for searching for the primary focus of ACTH ectopia in the removed adrenal tissue. According to the results of the immunohistochemical study, ACTH -secreting cells were detected in the medulla of both adrenal glands. This clinical case demonstrates the need for clinical alertness regarding endogenous hypercorticism and demonstrates the uniqueness of the localization of the primary focus of ACTH ectopia.

Immunoinflammatory rheumatic diseases (IIRD), such as rheumatoid arthritis and systemic lupus erythematosus, are characterized by common mechanisms of development and similar comorbid pathology, including diabetes mellitus (DM) type 2. Patients with IIRD with concomitant DM represent one of the most difficult groups to manage due to serious complications and forced polypharmacy. The article considers risk factors for carbohydrate metabolism disorders, both traditional and directly associated with rheumatoid arthritis and systemic lupus erythematosus, including the effect of anti-inflammatory therapy on insulin resistance, the risk of DM type 2 and glycemic control, as well as positive pleiotropic properties of some hypoglycemic drugs for the treatment of IIRD, and shows the prospects for further clinical research in this area.

The parathyroid glands (PG) and diseases associated with changes in their functional activity have been studied since the 19th century. In the last few decades, the basic principles of calcium-phosphorus metabolism, diagnostic methods, and treatment options for mineral disorders has changed significantly. The knowledge and experience of previous investigators in the anatomical, physiological, morphological, molecular, and genetic aspects of normal and abnormal PG, along with the introduction of innovative laboratory and instrumental methods, has been instrumental in the development of the field. Recent advances have opened new possibilities for personalized patient care. In our historical review, we describe the approaches to mineral and bone pathology, starting with the discovery of the PG and ending with modern achievements using the single endocrinology center as an example.