MON-328 Disorders of Glucose Metabolism in Cushing Syndrome in Uzbekistan

Relevance. Cushing’s Syndrome (CS) is a serious risk factor for developing impaired glucose tolerance disorder (GTD) and a manifestation of secondary diabetes mellitus (DM). On the other hand, the development of impaired glucose metabolism affects not only the course but also the outcome of SC. Moreover, their frequency varies from 10% to 45% of all cases of SC. The aim of investigation - to evaluate the frequency of various forms of impaired glucose metabolism in patients with SC according to the national registry in the Republic of Uzbekistan. Materials and methods. The object of the study was 264 patients included in the register, 182 women (68.9%); men 82 (31.1%) aged 16 to 49 years. Including ACTH dependent CS (ACTH-DS) 219 (82.9%), ACTH independent CS (ACTH-IS) 41 (15.5%), ACTH ectopic CS (ACTH-ES) 4 (1.5%). The levels of ACTH, cortisol, insulin, glucose, glycated hemoglobin were studied, tests with dexamethasone and an oral glucose tolerance test (OGTT) were performed; MSCT of the adrenal gland and MRI of the pituitary gland. Fasting glucose (IH), NTG and diabetes were determined according to international criteria (EASD 2019, IDF 2018) Results. It was found that out of 264 patients with SC, 136 (51.5%) had various disorders of carbohydrate metabolism (CM), including diabetes in 32.6 ± 2.9% (86 bp), GTD in 18, 6 ± 2.4% (49 bp) and NGN - in 0.4 ± 0.4% (1 bp). At the same time, diabetes developed in 33.3% of cases in patients with ACTH-DS, 24.4% of ACTH-IS and 75% with ACTH-ESC (p˂ 0.01; p˂ 0.001). Cases of prediabetes were mainly found in the form of NTG in 17.4% of ACTH-DS and 26.8% in ACTH-IS. Conclusions. In the Republic of Uzbekistan, CM took place in the overwhelming majority of patients with CS (51.5%) and clearly depended on the type of CS (ACTH-ES, AKTG-DS, AKTG-IS) and correlated with the degree of hypercortisolism.

Acromegaly and comorbid conditions. New possibilities of diagnosis and treatment (literature review)

Based on the data published in Russian and foreign reference sources, an analysis of clinical-hormonal peculiarities, modern methods of treatment of acromegaly combined with polyendocrinopathies (diabetes mellitus, diffuse and nodular goiter, hypocorticoidism) and cardiovascular diseases was conducted. According to different authors, a decline in the quality and duration of life of patients is associated with significant changes in the endocrine system caused by contrainsular and stimulating effect of somatotropic hormone (STH) and insulin-like growth factor 1 (IGF-1) on organs and tissues. Secondary diabetes mellitus was identified in 16-46% of patients, nodular goiter in 30-70%, secondary adrenal insufficiency in 11-20% of patients. The most common cause of acromegaly is an active pituitary tumor – somatotropinoma, rarely STH is overproduced by neuroendocrine cells, located endo- and extracranially. Recent achievements in neuroendocrinology provided significant improvement of management of patients. The aim of treatment for acromegaly is to achieve clinical and biochemical remission of the disease. At present three basic methods of treatment for acromegaly are used: surgical (endonasal transsphenoidal adenomectomy), drug therapy, radiation therapy and stereotactic radiosurgery (cyber knife). Differential and combined use of modern medical drugs in the form of monotherapy and in a combination with surgical and radiation treatment permits to achieve both clinical and hormonal remission of acromegaly improving in this way the quality and duration of life of patients. In the given review of literature modern concepts of etiology, pathogenesis, clinical peculiarities, modern methods of diagnosis and treatment of this disease are presented.

Acromegaly and comorbid conditions. New possibilities of diagnosis and treatment (literature review)

Based on the data published in Russian and foreign reference sources, an analysis of clinical-hormonal peculiarities, modern methods of treatment of acromegaly combined with polyendocrinopathies (diabetes mellitus, diffuse and nodular goiter, hypocorticoidism) and cardiovascular diseases was conducted. According to different authors, a decline in the quality and duration of life of patients is associated with significant changes in the endocrine system caused by contrainsular and stimulating effect of somatotropic hormone (STH) and insulin-like growth factor 1 (IGF-1) on organs and tissues. Secondary diabetes mellitus was identified in 16-46% of patients, nodular goiter in 30-70%, secondary adrenal insufficiency in 11-20% of patients. The most common cause of acromegaly is an active pituitary tumor – somatotropinoma, rarely STH is overproduced by neuroendocrine cells, located endo- and extracranially. Recent achievements in neuroendocrinology provided significant improvement of management of patients. The aim of treatment for acromegaly is to achieve clinical and biochemical remission of the disease. At present three basic methods of treatment for acromegaly are used: surgical (endonasal transsphenoidal adenomectomy), drug therapy, radiation therapy and stereotactic radiosurgery (cyber knife). Differential and combined use of modern medical drugs in the form of monotherapy and in a combination with surgical and radiation treatment permits to achieve both clinical and hormonal remission of acromegaly improving in this way the quality and duration of life of patients. In the given review of literature modern concepts of etiology, pathogenesis, clinical peculiarities, modern methods of diagnosis and treatment of this disease are presented.

Secondary Diabetes Mellitus in Patients with Endogenous Cushing’s Syndrome - Clinical Characteristics at Diagnosis

Background and aims. Endogenous Cushing’s syndrome is a rare disease associated with severe morbidity and increased mortality if untreated. Diabetes mellitus is a frequent initial complaint of these patients. Our aim was to investigate the clinical characteristics at the time of diagnosis in a cohort of patients with endogenous Cushing’s syndrome (CS). Material and methods. A retrospective analysis of the presentation of 68 cases diagnosed with endogenous Cushing’s syndrome followed-up in our institution was performed. Results: There were 57 women and 11 men, aged 18-74 years (mean 45.57±14.2). 38 had Cushing’s disease (CD) while 30 had adrenal CS. The most frequent signs/symptoms leading to the initial consultation and diagnostic suspicion were central obesity (55 cases, 80.88%), purple striae (28 cases, 41.1%), secondary arterial hypertension (27 cases, 39.7%), secondary diabetes mellitus (24 cases, 35.29%), hirsutism in 23/55 women (41.81%), hypogonadism in 23 cases (33.82%), proximal myopathy in 17 cases (25%), edema (10 cases, 14.7%). 13 cases (19.11%) also had secondary osteoporosis (diagnosed by dual energy x-ray absorptiometry - DXA osteodensitometry). Among the two diagnostic groups there were several differences. Proximal myopathy, secondary hypertension and diabetes mellitus were all more frequent in cases with adrenal Cushing compared to those with CD. (p= 0.011, 0.006 and 0.024, respectively). This did not reflect more severe hypercortisolism in adrenal CS, as the hormonal values were similar in the two groups. Conclusion: If associated with certain clinical signs, some nonspecific (central obesity, edema, arterial hypertension), other more suggestive of CS (purple striae, proximal myopathy) diabetes mellitus could be the initial sign of this severe condition.

Management of Microvascular Complications in Secondary Diabetes Associated with Autoimmune Diseases — Case Report

The association of multiple autoimmune diseases may represent the main focus of physicians treating patients with such pathology presenting no comorbidities of different etiology. However, autoimmune diseases and side effects of drugs may lead to development of silent health-threatening diseases that should be identified promptly. We present the case of an elderly, obese, Caucasian female patient suffering of autoimmune thyroiditis, rheumatoid arthritis, and psoriasis, who developed arterial hypertension and insulin-treated secondary diabetes mellitus (due to long-term oral corticotherapy) with microvascular end-organ changes. Retinal imaging for capillary anomalies identified mild non-proliferative diabetic retinopathy with apparent diabetic macular edema and hypertensive retinopathy. Laboratory investigations looking for further vascular risk factors revealed zinc deficiency, elevated serum homocysteine levels, and constantly high C-reactive protein concentration. Attention should be payed to the proper investigation of patients with autoimmune diseases, targeting the early diagnosis of microvasculopathies due to autoimmune diseases or possible medication side effects, in order to prevent end-organ damage.