In this review we highlight the pathogenesis of vitamin D deficiency, the development of secondary hyperparathyroidism in obesity and after malabsorptive bariatric surgery. We also discuss vitamin D supplementation and calcium metabolism disorders correction in obesity as well as after previous malabsorptive bariatric surgery

Adult-onset growth hormone deficiency (GHD) remains one of the issues in clinical endocrinology. In this article, which is addressed to practitioners, physiology of growth hormone in adults is reviewed along with etiology and diagnostic criteria of this medical condition. In general, a stimulation test is required to recognize GHD. Insulin tolerance test (ITT) has been considered the gold standard by the most important scientific societies, although alternative tests, in particular GHRH plus arginine have been proposed as valuable alternative to ITT. The results of different clinical studies regarding the impact of adult-onset GH-deficiency on metabolism and quality of life are summarized and beneficial effects of growth hormone replacement therapy on many of the manifestations of GHD reviewed. The management of GHD in adults is discussed including initiation of GH treatment, dose titration and assessment of response during trail period.

Elevation of the arterial stiffness is one of the important pathogenic factors associated with a high risk of cardiovascular complications and mortality rate in patients with diabetes and metabolic syndrome. Correction of the arterial stiffness has a great value for decrease of the risk of atherosclerosis progress and organ protection. Therapy with ACE inhibitor ramipril provides not only high antihypertensive effect but also significant improvement of parameters of the arterial stiffness which indicates an additional vasoprotective effect of the drug.

The aim of the study was to investigate the pharmacodynamic characteristics of the modern antihypertensive therapy in obese hypertensive patients. Materials and methods. The activity of leptin, adiponectin and endothelin-1 and cardiohemodynamics were studied in 61 patients with essential hypertension and obesity (body mass index 34,3±4,8 kg/m2) before and after the 12-weeks treatment with zofenopril (n=31) and nebivolol (n=29). Results. It was revealed that obese hypertensive patients had abnormal circadian profile of blood pressure (63.9%), hyperleptinemia together with the decrease of the adiponectin activity (67%), as well as the increased activity of endothelin-1 (54%). The 12-weeks therapy with zofenopril and nebivolol has resulted in the improvement of the daily profile of the arterial pressure with the achievement of the target level of the arterial pressure in 72% and 79% of patients correspondingly. The following was recorded: the decrease in the activity of leptin and endothelin-1 in both groups; upward trend of the adiponectins activity under the influence of zofenopril. Conclusion. Zofenopril and nebivolol in obese hypertensive patients in addition to the antihypertensive action reduce negative cardiometabolic effects of the activation of adipocytes and endothelin-1.

The study was undertaken to investigate the clinical, biochemical, electrocardiographic, echocardiographic correlations of lipomatosis of
interatrial septum (atrial septum thickness more than 1 cm) and visualized epicardial fat. The prevalence of excessive body weight and abdominal
obesity, atherogenic changes in the lipid profile were revealed in 87 patients. The range of atrial septum thickness was 11-17 mm, lipomatosis
of interatrial septum was revealed in 85% of patients. The epicardial fat was present in 39 patients (44,8%). During Holter monitoring of ECG
supraventricular arrhythmias were registrated more frequent in patients with lipomatosis of interatrial septum. The results of correlative analysis
demonstrate correlation of atrial septum thickness in patients with lipomatosis with changes in carbohydrate and lipid metabolism, with left
ventricle hyperthrophy and decreased left ventricular ejection fraction. Presence of epicardial fat correlates with abdominal obesity, diastolic
dysfunction and hyperthrophy of left ventricle. The findings indicate that lipomatosis of interatrial septum and epicardial fat may serve as markers
of metabolic syndrome.

The aim of the study was to assess the effect of metformin plus lifestyle modification on procoagulant and proinflammatory state
associated with metabolic syndrome in postmenopausal women. Materials and methods: The 12-month prospective, open, randomized
study included 58 postmenopausal women (age 55 [53; 56]; postmenopause 5 [4; 8] years) with metabolic syndrome (IDF, 2005).
Participants were randomized into two groups receiving either metformin (1 g per day) plus lifestyle modification (n=29), or lifestyle
modification alone (control group) (n=29). Blood tests were performed before and after the treatment period to evaluate parameters
of coagulant and anticoagulant blood systems: prothrombin index, activated partial tromboplastin time (APTT), thrombin time, activities
of factors VII (FVII),VIII (FVIII), von Willebrand factor (vWF), antithrombin III, plasminogen activator inhibitor-1 (PAI-1),
tissue-type plasminogen activator (t-PA) and screening test for the protein C pathway. Also we assessed fibrinogen, C-reactive protein
(CRP) and adiponectin concentrations. Results: After one year of treatment in metformin group CRP level decreased significantly
from 4,98 [2,72; 11,95] to 2,56 [1,92; 6,76] mg/l (р<0,0001), fibronolysis improved (PAI-1 activity decreased from 21,1 [8,86; 33,59]
to 9,5 [4,69; 16,14] U/ml (p=0,0005)) and adiponectin level increased from 10,89 [6,84; 16,78] to 14,36 [7,71; 17,4] mcg/ml (р=0,0013).
All these changes were independent from improvements in insulin sensitivity (HOMA-IR reduction) as a result of metformin use.
Also we observed moderate decreases in FVII activity, fibrinogen concentration and increase in protein C anticoagulant pathway,
but these changes were not significant. In control group there were no any significant changes in observable parameters. Conclusion:
Metformin plus lifestyle modification, in contrast to lifestyle modification alone, resulted in improvements of proinflammatory state
(CRP and adiponectin levels) and impaired fibrinolysis (decreased PAI-1 activity), associated with metabolic syndrome.

The aim of this work was to evaluate the prevalence of obesity, pathologic weight gain and metabolic syndrome among pregnant women (n=521) in Tyumen Region of Russia. We found that high prevalence of obesity, pathologic gestational weight gain and disturbances of glucose metabolism were increased in non-native than native residents of the studied region. Metabolic syndrome in gestational period is seen very rarely and includes up to three of its components. Women of reproductive age with obesity form the risk group for the development of the metabolic infringement during gestation period. It is necessary to provide specific activities to decrease a body weight among women before pregnancy in order to prevent metabolic disturbances and reproductive losses.

Overweight and obesity are the most actual problems nowadays. Number of overweight patients steadily raises and duplicates every three decades. Obesity is associated with some factors of cardiovascular risk like diabetes mellitus and arterial hypertension, frequently leads to kidney disfunction. Obesity itself can result in poor renal hemodynamics, well-known risk factor of kidney disease. We studied impact of overweight and obesity in children and adolescents on renal tubular function and glomerular filtration rate.

Nighttime salivary cortisol (NSC) has been suggested to be a useful diagnostic test for Cushings syndrome (CS). However, the reference range and cut-off value are assay-specific and discordant. The goal of this study was to assess the analytical performance of automated elecrochemiluminiscence immunoassay method (ECLIA) in CS. Ninety eight healthy volunteers and 123 obese patients including 45 proved to be CS provided salivary samples collected by them at 23:00 using Sallivette. Two hundred and five subjects collected salivary samples for two consecutive days and samples from 197 subjects were frozen to perform Enzyme-linked immunosorbent assay (ELISA). Obese patients underwent the 1-mg overnight dexamethasone suppression test (1-DST). CS was confirmed by the histologic diagnosis after surgical treatment or autopsy. The reference range for healthy volunteer has been set 0,5-9,4 nmol/l. Reproducibility was assessed in all subjects by a day-to-day variability and reflected by an intraclass correlation coefficient of 0,785. The cut-off value of 9,4 nmol/l has been suggested to differentiate CS among obese patients to achieve sensitivity of 84,4% (95%confidence interval 71,2-92,2%); specificity of 92,3% (95%CI 84,2-96,4%) and diagnostic odds ratio 65,1 (95% CI 20,4-207,6). Likelihood ratio positive was 11,0 (95% CI 5,0-23,9), with a likelihood ratio negative of 0,17 (95%CI 0,08-0,33). The comparison of the total areas under the ROC-curve for the measurement of NSC once, twice with mean level by ECLIA, the same samples by ELISA and 1-DST have not shown any statistically significant difference among the tests performance. Conclusion: Based on its remarkable reproducibility, easy noninvasive nature, automated assay and at least similar diagnostic performance, NSC measured by ECLIA on Cobas e601 is a preferable first-line screening test for CS.

Von Hippel-Lindau syndrome - a systemic disease manifesting with multiple tumor growth, inherited by autosomal-dominant type with high penetrance. Understanding the pathogenesis of the disease is important for determining the start time of screening for the presence of the tumors and adequate treatment, including metabolic disorders.