Vol 13, No 2 (2019)

Review of literature
Progress in adrenal surgery: future widening of indications for the gold standard treatment
Khripun A.I., Makhuova G.B., Avdeeva T.F., Yusufov M.P.

Laparoscopic adrenalectomy is regarded as a golden standard for surgical treatment of patients with adrenal pathology. Its advantages over the traditional surgery were shown by the experience and it explain commitment of surgeons to this method. However, implementation of this surgery is still discussible in some groups of the patients. Most relevant questions arouse about using laparoscopic technologies in patients with huge and malignant adrenal tumors. Objectively worse outcomes in these groups of patients and concerns about oncological results dictate need for future researches in this sphere. The article is devoted to the last achievements in adrenal surgery, connected with the implementation and wide spreading of laparoscopic operations. It covers most discussible in medical literature indications for such kind of surgery. Major attention is given to the modern concepts of indications and contraindications for laparoscopic procedures. A review of complications is done and we discuss ways of preventing them. Also, the article addresses to the role of endovascular embolization, in particular to the preoperative embolization, in complex treatment of patients with adrenal tumors.

Endocrine Surgery. 2019;13(2):65-74
Original study
Prognostic value of somatic mutation testing and different methods of treatment of low-risk differentiated thyroid cancer
Kachko V.A., Vanushko V.E., Platonova N.M.

Background: Using molecular testing for prediction the course of the disease could possibly help doctors in making therapeutic decisions about the management of patients, because it remains controversial issues in low-risk differentiated thyroid cancer patients. The expert’s opinions are different on the volume of treatment of these patients: the adequacy of hemitireoidectomy, the need to remove the lymph nodes of the central zone (level VI) and the need for radioiodine therapy.

Aims: to evaluate the frequency of recurrences in different complex treatment options of low-risk differentiated thyroid cancer; to evaluate the frequency of somatic mutations in the hot spots of BRAF, KRAS, KRAS, EIF1AX and TERT genes in histological material and to evaluate their prognostic value.

Materials and methods: A prospective, observational, cohort, sample, single-center, open-label, controlled, nonrandomized clinical trial was performed, which included patients with the thyroid neoplasms, recruited in the period from 2012 to 2014. Samples of histological material were tested for the presence of somatic mutations in hot spots of the genes BRAF, KRAS, NRAS, TERT, and EIF1AX. After the treatment, the low-risk differentiated thyroid cancer patients group were observed for 43–68 months.

Results: The study included 90 patients with low-risk well differentiated thyroid cancer. Mutations in the hot spots of the BRAF gene (exon 15, codon area 600-601) were found in 53 patients, mutations in the hot spots of the NRAS gene (exon 3, codon 61) – in 3 patients; mutations in the hot spots of the KRAS, TERT and EIF1AX genes were not detected. The median follow-up in the well differentiated thyroid cancer group was 56 months. Recurrence diagnosed in 12 patients (13.3%), significant differences in the frequency of recurrence depending on the surgical treatment option was not revealed, significant differences in the frequency of recurrence between the groups BRAF+/BRAF was not revealed.

Conclusions: Low-risk well differentiated thyroid cancer patients have characterized a very favorable the course of disease and prognosis, even in the case of recurrence. In this study, complex treatment has not shown significant advantages over thyroidectomy in treating patients with thyroid microcarcinomas. Mutation testing of histological material in hot spots of genes BRAF, KRAS, NRAS, EIF1AX and TERT can’t be used as an additional marker in low-risk well differentiated thyroid cancer patients to predict the course of the disease, although the lack of detection of aggressive genes of the disease may indicate a favorable prognosis in these patients.

Endocrine Surgery. 2019;13(2):75-88
Complications of the genitourinary system in girls with disorders of sex development and hypospadias
Anikiev A.V., Volodko E.A., Brovin D.N., Kolodkina A.A., Okulov A.B.

Series of clinical cases demonstrates functional state of lower urinary tract in girls with disorders of sex development (DSD) and hypospadias after the first stage of feminization. The study included 27 girls and women with DSD with hypospadias. Most of them have congenital adrenal hyperplasia (24), fewer girls have partial gonadal dysgenesis (1) and idiopathic virilization (2). Patients were examined before second stage surgical feminization in 1–15 years after the first stage. Concomitant pathology of the urogenital tract was detected in 19 (70%) patients. Urinary tract infection (UTI) was verified in 13 (48%), bladder dysfunction (BD) was diagnosed in 7 (26%), trapped menstrual secretions presented as hematometra, hematocolpos, and urine accumulation and stagnation in the vagina in anamnesis or as a result of preoperative studies were diagnosed in 9 (33%). Combination of the listed complications were observed in five patients (14%). Results of second stage of feminization confirmed connection of hypospadias with listed complications. This were detected in 11 (69%) patients after introitoplasty without separation of urinary and genital tracts (UGT). Introitoplasty with separation of UGT and elimination of hypospadias was complicated only four patients (36%), herewith the UTI and BD were eliminated. Hypospadias in girls with DSD is risk of development such complication as urinary tract infection, trapped menstrual secretions and bladder dysfunction. This circumstance requires change in surgical feminization tactics in girls with DSD, taking into account the anatomical components of genitalia malformations.

Endocrine Surgery. 2019;13(2):89-94
Clinical Case
Special case of primary hyperparathyroidism late diagnosis
Troshina V.V., Latkina N.V., Mamedova E.O., Belaya Z.E., Kuznetzov N.S.

Primary hyperparathyroidism is a socially significant problem due to the fact that the analysis of blood calcium in Russia is not a routine biochemical test, and diagnosis is carried out at the stage of irreversible complications. So, a patient addressed to our clinic which had a clinical picture of hyperparathyroidism complications over time. In the hospital diagnostic studies were carried out, including, first of all, a determination of calcium in blood, followed by more comprehensive survey, on the basis of which hyperparathyroidism has been confirmed. An adenoma of the left lower parathyroid gland was found by the method of topical diagnosis (ultrasound of the parathyroid glands and scintigraphy with Tc-99m-technetril). After the surgical treatment a level of calcium and a level of PTH have declined significantly. The combination of calcium and vitamin D supplementation was prescribed about intensive saturation therapy was needed with intense post-operative hyperparathyroidism. Given the existence of osteo-visceral complications by hyperparathyroidism, at the moment the patient needs a long rehabilitation course. This case shows that in order to avoid late diagnostics, it seems necessary to determine the level of calcium for routine. Therefore, it is possible to prevent the development of complications of the disease and the disability of patients.

Endocrine Surgery. 2019;13(2):95-100

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