Among all endocrine diseases complicating pregnancy, gestational diabetes mellitus (GSD) is the most common. Th is violation of carbohydrate metabolism poses a serious threat to the health of the mother and fetus, associated with a high risk of perinatal complications. At the same time, the eff ective achievement of normoglycemia in a woman suff ering from GSD can signifi cantly improve the prognosis. Th e choice of GSD therapy depends on a number of factors and is decided individually in each case. One of the factors determining the eff ectiveness of non-drug therapy and the need for pharmacological correction may be related to the pathophysiological aspects of the formation of hyperglycemia during pregnancy. Currently, they talk about the heterogeneity of GSD and distinguish its various subtypes depending on the predominance of pancreatic beta-cell dysfunction, insulin resistance (IR) or a combination of these factors in the pathogenesis. Since the prevailing criterion for the verifi cation of GSD subtypes is the presence and severity of IR, various methods of its verifi cation are considered in this review. It is shown that the currently available methods for detecting IR have a number of disadvantages, consisting both in the complexity and complexity of implementation (hyperinsulinemic euglycemic clamp) and in the absence of clear reference intervals (mathematical models). It is necessary to continue research aimed at studying IR methods for the subsequent identifi cation of GSD subtypes.

In recent years, the ability to determine the nature of thyroid nodules has been signifi cantly improved both through the improvement of traditional methods, such as ultrasound examination (ultrasound) and fi ne needle aspiration biopsy (TAB), and through the creation of fundamentally new approaches. Th e review contains the most relevant achievements of recent years. Th e literature search was carried out in the bibliographic base of the Russian Science Citation Index for the words «node», «thyroid gland», «diagnosis», «cancer» on the site «https://www.elibrary.ru», as well as in the database of medical and Biological publications of the US National Center for Biotechnology Information on «nodule», «thyroid», «diagnostics», «cancer» at https://pubmed.ncbi.nlm.nih.gov. Th e analysis of sources for the last 5 years has been carried out.

It has now been established that the intestinal microbiota (CM) is one of the 11 links in the pathogenesis of type 2 diabetes mellitus (DM2). Th e fact is that when the composition of BM is disrupted and the concentration of its active metabolites changes, the processes of synthesis and secretion of incretin hormones are disrupted, the homeostasis of carbohydrates and fats in the body is disrupted, the processes of central regulation of appetite change, chronic infl ammation and insulin resistance of peripheral tissues develop. Th is review discusses possible ways of impairing the synthesis of incretin hormones and the incretin eff ect in patients with T2DM through the prism of BM and its active metabolites, and discusses possible ways of correcting the altered composition of BM with incretin drugs.A systematic literature search was carried out using the Scopus, PubMed, Web of Science databases.

According to clinical guidelines self-monitoring of blood glucose is a part of the treatment of type 2 diabetes mellitus. However, self-monitoring of glycemia is associated with signifi cant costs. Th at’s why the issue if there is a possibility to decrease the use of self-monitoring of blood glucose is actual. Since the United Kingdom Prospective Study (UKPDS) showed that every 1% decrease in glycated hemoglobin leads to a 37% decrease in the risk of microvascular complications and 14% decrease in the risk of macrovascular complications as well as it leads to a decrease in mortality, the article mainly examined the eff ect of selfmonitoring on the level of glycated hemoglobin in various clinical situations.

Th e diagnosis of adrenal tumors has improved signifi cantly over the past decades thanks to laboratory research and anatomical imaging techniques. In some cases, these methods make it possible to distinguish a benign tumor from a malignant one, and in combination with invasive methods, the accuracy of such diagnostics varies from 80 to 100%. However, in cases of pheochromocytoma, this invasive intervention can induce a hypertensive crisis. Hybrid molecular imaging techniques such as single-photon emission tomography (SPECT) and positron emission tomography (PET), coupled with CT or MRI, have come to the rescue. Molecular imaging techniques are non-invasive and safe for patients, and the information obtained allows you to more accurately determine the optimal treatment tactics. Purpose: in our review, we will try to cover all modern and promising methods of molecular imaging of adrenal formations and radionuclide therapy, which constitute a new trend in the development of nuclear medicine in the world - radiotheranostics (radionuclide therapy based on radionuclide diagnostics). Methods: We conducted a systematic review of the literature obtained from the open databases Scopus and Pubmed describing the latest methods of radiotherapy of adrenal tumors. We then classifi ed the findings based on mechanism of action, point of application, and relevance of radioactive tracers, comparing their effectiveness and availability.

Purpose: evaluate the fi rst complaints of patients with pituitary macroadenomas, as well as the specialization of doctors, to whom they referred at the fi rst time.

Material and methods: data of medical records of 343 patients with pituitary macroadenomas (at least one tumor size >10 mm) were analyzed: non-functioning pituitary adenomas (NFPA, n=143), prolactinomas (n=67), somatotropinomas (n =133). Patients were examined prior to any treatment.

Results: In total, the most common fi rst complaints of patients with pituitary macroadenomas were: headache - 137/343 (40%), visual impairment - 86/343 (25%), general weakness and fatigue - 69/343 (20.1%), in female patients of reproductive age - menstrual irregularities. Headache did not depend on tumor size and volume, while visual disturbances were more common in patients with larger tumor volume and MR signs of chiasm compression. Th e most oft en patients with pituitary macroadenomas referred to: a neurologist 91/343 (26.5%), an ophtalmologist 44/343 (12.8%), 44/265 (16.6%) a gynecologist and a general practitioner – according to 41/343 (12%).

Conclusions: A neurologist, ophthalmologist, gynecologist, and general practitioner should be aware of a pituitary macroadenoma in patients with headaches, visual disturbances, menstrual disorders (in women of reproductive age) and non-specific general complaints that may be a marker of the presence of a pituitary tumor macroadenoma.

Objective: to measure the serum TSH level in hospitalized patients with moderate-to-severe COVID-19.

Material and methods: this was a retrospective study at Almazov National Medical Research Centre enrolled 133 hospitalized COVID-19 patients without known thyroid disorders. Clinical data, biochemical parameters (TSH, 25(OH)D, C-reactive protein, Lactate dehydrogenase and Ferritin), fi ndings of chest computed tomography (CT) imaging as well as obtained corticosteroids therapy were analyzed.

Results: the median TSH level at the 1st-2nd day of hospitalization and at the 9-10th day was 1,15 mIU/L [0, 76; 1, 8] and 1,04 mIU/L [0,7; 1,78] respectively. Th e initial level of TSH <0,4 mIU/L was found in four patients, while by the 9-10th day of hospitalization their number doubled and reached 9 (11,7%). Furthermore, by the 9-10th day of hospitalization the TSH level more than 4,5 mIU/L was detected in four patients (4,2%). Th us, 13 out of 77 patients had the serum TSH level outside the reference range by the 9-10th day of hospitalization.

Conclusions: in case of alteration in the serum TSH level it is necessary to take into account the personal history of thyroid disorders. Th e level of thyroid hormones and autoimmune markers as well as thyroid ultrasound results may be useful in clinical interpretation of thyroidal insults during and aft er COVID-19. Th e hypothalamic-pituitary-thyroid axis may also be aff ected by drugs used to treat COVID-19.

Objective: to analyze the features of diagnosis, course and outcomes of pregnancy in women with manifest diabetes mellitus.

Materials and methods: the study included 19 delivery medical records of women with MDM (manifest diabetes mellitus during pregnancy) and 500 records of women with GDM (gestational diabetes mellitus).

Results: Th irteen women out of nineteen were diagnosed with MDM in the fi rst half of pregnancy. Th e average level of glycemia at the onset of the disease was 9,3±3,0 mmol/l. Mean HbA1c was 7,2±1,1%, which signifi cantly exceeded this indicator in GDM. All women with MDM required insulin therapy, while in the group of women with GDM insulin therapy was used in 27.8% of cases. MDM women showed increased rates of preeclampsia (36,8%) compared to GDM women (15%). Fetal macrosomia was more common in MDM women (36.8%) than in GDM women (17%).

Conclusion: Th e high frequency of obstetric and perinatal complications of MDM during pregnancy requires the early detection of hyperglycemia and the prompt initiation of insulin therapy. Screening for carbohydrate metabolism disorders at the fi rst prenatal visit and early initiation of insulin therapy reduce maternal and perinatal mortality.

Purpose: evaluate the eff ects of DPP4i on fasting and postprandial insulin and glucagon secretion by examining basal secretion and response to food loading.

Materials and methods: patients (n = 54) were divided into treatment groups: long-term (more than a year) therapy with iDPP4 with Metformin, Metformin + sulfonylurea, fi rst-time therapy with iDPP4. Biochemical parameters, levels of insulin, glucagon, C-peptide before and aft er a standard breakfast were measured. Th e HOMA IR and HOMA β indices were calculated. Results: we obtained a signifi cant diff erence in fasting glucagon and insulin levels between the iDPP4 over a year and Metformin + SM groups. In addition, insulin levels before and aft er standard breakfast, C-peptide aft er standard breakfast, and fasting glucagon decreased aft er 6 months of fi rst-time DPP4 therapy.

Summary: the data obtained indicate the ability of iDPP4 to positively infl uence the two earliest and most signifi cant links in the pathogenesis of type 2 diabetes.

A clinical case of a pregnant patient with gestational arterial hypertension resulting from pheochromocytoma is presented. Th e article presents an algorithm for diff erential search for the cause of gestational arterial hypertension, clinical and laboratory data and therapeutic measures provided to the patient, on the basis of which endocrinologists together with obstetricians and gynecologists can determine the tactics of pregnancy and delivery of women with hormone-active adrenal tumors.

Fibrocystic osteitis is a rare but severe primary hyperparathyroidism (PHPT) complication. We describe a 66-year-old female presented with fi brocystic osteitis and nephrocalcinosis with eGFR reduction to CKD stage 4 due to primary hyperparathyroidism. Delayed diagnosis of long-term hypercalcemia, high parathyroid hormone level, unsubstituted 25(OH)D defi ciency, and the use of bisphosphonates in high doses caused development of «hungry bones» syndrome in early postoperative period. Severe hypocalcemia required prescription of active and native vitamin D metabolites, oral calcium supplements as well as intravenous calcium. Delay in diagnosis of PHPT with fi brocystic osteitis formation led to lower well-being, reduced quality of life and also provoked sever postoperative hypocalcemia («hungry bone» syndrome).

Objective: to determine the diagnostic signifi cance of endothelial dysfunction (ED) laboratory markers.

Material and methods: we examined 276 men with type 2 diabetes mellitus (age 54.0[49;60] years). Patients underwent general clinical studies, analysis of carbohydrate and lipid metabolism parameters, adipohormones: leptin, resistin, adiponectin. Endothelial function was assessed by ultrasound examination of endothelium-dependent vasodilation (EDVD) of the brachial artery during a test with reactive hyperemia and determination of biochemical parameters of endothelial function — nitric oxide (NO), endothelial synthase NO type3, endothelin, ICAM-1, VCAM-1, p- and e-selectins, cadherin, PAI-1, VEGF-1, homocysteine B, C-reactive protein (CRP), osteoprotegerin. To assess the diagnostic signifi cance of the methods and to determine the cut-off , ROC analysis was used.

Results: independent signifi cance in the diagnosis of ED was demonstrated by NO, ICAM-1, resistin (p<0.001), CRP (p=0.006). Th e odds ratio of ED for resistin was 6.97, which is 1.9 times higher than NO and ICAM-1 and 3.7 times higher than CRP. Th e cut-off  for diagnostic of ED are: NO — 97.3 μmol/L, ICAM-1 — 309.4 ng/ml, resistin — 6.32 ng/ml, CRP — 6.25 mg/L.

Conclusion: the diagnostic platform for determining ED, along with the ultrasound assessment of EDVD, should include the analysis of its biochemical markers: NO, ICAM-1, resistin, CRP. Resistin is an independent, high-precision marker of ED, which is the pathogenetic link between endothelial dysfunction and adipose tissue dysmetabolism.

Purpose: to study the functional parameters of the innate immune response in various clinical courses of seasonal allergic rhinitis.

Materials and methods: a comparative prospective study was conducted. 62 participants (patients with seasonal allergic rhinitis) were divided into subgroups with mild (34 people) and moderate (28 people). Th e parameters of the innate immune response were studied. Th e assessment was carried out during the exacerbation period, before the appointment of therapy and in remission, outside the palination season.

Results: changes in the cells of the innate immune response in patients with seasonal allergic rhinitis are formed at the earliest stages of clinical manifestation, aff ect the functional potential of natural killer cells and the oxygen-producing activity of the neutrophilic link, and are stable outside the palination season. Increased production of proinfl ammatory and immunoregulatory mediators is a key manifestation of the progression of seasonal allergic rhinitis.

Conclusion: inhibition of the functional resources of innate immunity cells and cytokine dysregulation can play a significant role in the development of complications of seasonal allergic rhinitis caused by secondary immune defi ciency.

Objective: to evaluate the detection of in vitro hypersensitivity to local anesthesia drugs by fl ow cytometry.

Materials and methods: in the test of activation of basophils, the determination of the hypersensitivity reaction to local anesthetics of groups I, II (154 preparations) in 106 patients and T-lymphocytes of type 2 immune response (CD3 + CD294 +) was carried out by fl ow cytometry using the Allergenicity kit test system. In the history of the examined patients, there was a certain food and/ or drug intolerance.

Results: Th e levels of sensitization to diff erent groups of local anesthetics were compared in the basophil activation test. Th e highest levels of hypersensitivity were observed to local anesthetics containing vasoconstrictors, stabilizers. In patients with hypersensitivity to drugs for local anesthesia, an increase in the number of T-lymphocytes of type 2 of the immune response was observed.

Conclusions: based on the identifi ed hypersensitivity in the basophil activation test to local anesthesia drugs, the safest anesthetics were established. Th e diagnostic signifi cance of determining the level of T-lymphocytes of type 2 of the immune response in drug hypersensitivity is shown.