Endocrine Surgery

"Endocrine Surgery" is the first journal in Russia devoted to the problems of diagnosis and surgical treatment of endocrine diseases, and also to the problems of surgical treatment of complications of diabetes, including diabetic foot, diabetic ophthalmopathy, etc. The success of the treatment of diseases in the area depends on close cooperation between doctors of different medical disciplines - endocrinologists, surgeons, oncologists, radiologists, pathologists, anesthesiologists, intensive care specialists, geneticists - using the most advanced high-tech methods of diagnosis, treatment and rehabilitation.

"Endocrine Surgery" journal collect and summarize the views of all these experts on their pages, but it guarantees the strict selection criteria of articles based on evidence and international standards. Necessity of edition of the journal "Endocrine Surgery" is caused by a lot of factors. This is a huge number of patients who need of specialized medical care, and the large number of professionals involved in the surgery of endocrine organs.

Today in our country there are no industry standards for treatment, as well as registers of patients. The main sources that guide professionals in the treatment of endocrine diseases are various publications of surgery, endocrinology and oncology, which often are contradictory and mutually exclusive information. In this regard, articles in "Endocrine Surgery" journal has focused on the clinical recommendations of international associations on the issues of Endocrine Surgery, surveyed the most interesting publications of foreign literature of evidence-based medicine.

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Current Issue

Vol 14, No 1 (2020)

Original study
Modern possibilities of the urine steroid profile testing applying for the adrenocortical cancer diagnosis
Shcherbakov I.E., Chernikov R.A., Rusakov V.F., Fedorov E.A., Fedotov U.N., Sablin I.V., Chinchuk I.K., Sleptcov I.V., Krasnov L.M., Rebrova D.V., Uvarova M.A., Ivanov A.V.
Abstract

BACKGROUND: X-ray diagnostics methods are important in detection of adrenal neoplasms malignant nature. The sensitivity and specificity of these methods are high enough. However the hormonal tests are also necessary to make an accurate clinical diagnosis with the high diagnostic efficiency of modern X-ray methods for adrenal tumors diagnosing. The urine steroid profile violations are detected with the adrenal glands various pathologies (primary hyperaldosteronism, hypercorticism, congenital hyperplasia of the adrenal cortex and adrenocortical cancer). Urine steroid profile tests in patients with diagnosed adrenal neoplasms are intended primarily to confirm or refute the adrenocortical cancer risk. At the same time in the medical community to date there are a number of disagreements accumulated regarding the accuracy and significance of the urine steroid profile tests.

AIMS: The study aims to determine the urine steroid profile determination accuracy limits for the adrenocortical cancer diagnosis.

MATERIALS AND METHODS: In total 62 samples were tested for urine steroid profile by gas chromatography-mass spectrometry. 58 patients had morphologically confirmed adrenal neoplasms. The study was blind prospective. To increase the study accuracy the 30 patients with adrenocortical adenomas (n = 17) and adrenocortical cancer (n = 13) were selected out of 58 tested persons. The sensitivity, specificity and accuracy of the urine steroid profile were determined in order to assess information content of such method for the adrenocortical carcinoma diagnosis.

RESULTS: The possibilities of the urine steroid profile determining for the adrenocortical cancer diagnosis are estimated. The method sensitivity was 46.2%, specificity and accuracy were 70.6% and 60% respectively. The most reliable of adrenocortical cancer markers were tetrahydro-11-deoxycortisol and dehydroepiandrosterone (38.5% of cases) increasing concentrations.

CONCLUSIONS: The present study demonstrates relatively low diagnostic efficacy of the urine steroid profile as a primary diagnostic method for adrenocortical cancer determining. This is especially evident in comparison with X-ray diagnostic methods. The technique interpretation is complex and accessible only to specialists with extremely high qualifications. Such fact complicates the distribution and widespread use in clinical practice of this testing method. At the same time the urine steroid profile determination in the future (after additional study) may be apply as an auxiliary diagnostic method which in some cases determines the treatment tactics for patients undergoing adrenocortical cancer adrenalectomy treatment.KEYWORDS: dPheochromocytoma; intraoperative hemodynamic instability; laparoscopic adrenalectomy; Endovascular embolization of preoperative; сase report.

Endocrine Surgery. 2020;14(1):4-13
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Review of literature
Promising immunohistochemical and circulating markers of insulinoma
Yukina M.Y., Selivanova L.S., Nuralieva N.F., Troshina E.A., Izmailova N.S., Abrosimov A.Y.
Abstract

Insulinoma is the most common functioning pancreatic neuroendocrine tumor. The review examines the currently used immunohistochemical and circulating markers for its diagnosis, and discusses the sensitivity and specificity of these parameters. At the same time, the relevance of searching for new biochemical indicators of the presence of insulinoma and its characteristics, as well as studying the mechanisms of tumor growth and hormonal hypersecretion is emphasized. One of the primary methods for solving these problems is immunohistochemical testing with the determination of circulating markers. The results of recent studies of alternative secretory products, in particular, cocaine - and amphetamine - regulated transcript (CART), chromogranin B, and neuroendocrine secretory protein 55 (NESP55) are presented. In addition, the question of expression of various receptors in the insulinoma tissue is considered, including in the context of determining molecular targets for its visualization or radiotherapy. In particular, the expression of receptors for glucagon-like peptide 1 in the tumor tissue is characterized. The possible role of melatonin receptors MT1 (MTNR1a) and MT2 (MTNR1b) in the pathogenesis of insulinoma is clarified. The article also discusses the possible use of tumor protein D52 (TPD52) as a new predictive biomarker for the differential diagnosis of benign and malignant insulinoma.

Endocrine Surgery. 2020;14(1):14-21
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Clinical Case
The use of preoperative embolization as a method of preventing intraoperative hemodynamic disorders in a patient with pheochromocytoma
Khripun A.I., Makhuova G.B., Avdeeva T.F., Yusufov M.P.
Abstract

A clinical case of treating a patient with large pheochromocytoma complicated by acute cerebrovascular accident is presented. Its peculiarity is the implementation of preoperative embolization of the adrenal vessels in order to prevent intraoperative bleeding and intraoperative hemodynamic instability — independent risk factors for perioperative complications and mortality. Such an approach allowed us to successfully perform laparoscopic adrenalectomy with minimal blood loss in conditions of stable hemodynamics.

The treatment of patients with pheochromocytoma was discussed, special attention was paid to the category of patients with large tumors. The technical features of adrenalectomy in this group of patients, modern ideas about the safety of laparoscopic interventions are highlighted. The topics of the effectiveness of preoperative drug prevention of blood pressure fluctuations, as well as the use of endovascular methods in the treatment of patients with catecholamine-producing tumors are discussed.

Endocrine Surgery. 2020;14(1):22-29
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Ovarian adrenal rest tumor in a patient with salt-wasting form of congenital adrenal hyperplasia
Molashenko N.V., Babaeva D.M., Derkatch D.A., Vladimirova V.P., Soldatova T.V., Vorontsov A.V., Selivanova L.S., Troshina E.A., Andreeva E.N., Ponomareva T.A.
Abstract

The article describes the clinical case of diagnosing and choosing the tactics for treating ovarian adrenal rest tumors (OART) in a patient with a salt-wasting form of congenital adrenal hyperplasia (CAH). There are only several clinical cases descriptions of OART in the world literature. At present, the tactics of observation and treatment of the ovarian adrenal rest tumors has not been developed. In each case, individual tactics are chosen. The main predisposing factor to the occurrence of OART is considered to be long periods of decompensation of CAH. ACTH stimulates the hyperplasia and hypertrophy of the residual adrenal tissue in the ovaries and secondary tumors develop. The instrumental methods that allow to diagnose OART include ultrasound, MRI of the pelvic organs, PET with 18FDG. The tactics of treating OART, in contrast to the testicular adrenal rest tumors in men (TART), according to world literature are mainly surgical. Organ-preserving operations were performed, as well as the removal of tumors along with the ovary. Cases of a combination of adenocarcinoma and CAH are also described. Each new case of OART is unique and with the accumulation of international experience, a consensus will be developed.

Endocrine Surgery. 2020;14(1):30-37
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