Metabolic syndrome (MS) is a major problem of public health and health care system, with rising prevalence in the world. There is evidence that obesity, as the main component of MS, is strongly associated with the presence of gestational complications: fetal growth retardation, fetal macrosomia, gestational diabetes, preeclampsia, preterm delivery, stillbirth and perinatal death. The underlying mechanisms of this association are actively investigated nowadays. The importance of MS in pregnancy is also determined by the increase of the risk of venous trombosis.

Obesity is a major risk factor for diabetes mellitus type 2, cardiovascular diseases and associated comorbid conditions. It is traditionally considered that insulin resistance is dependent on glucose metabolism. However, in recent years more and more attention is devoted to the fatty acids metabolism, the increase in concentrations of which plays a significant role in the pathophysiological mechanisms associated with insulin resistance.

In order to estimate the quality of life in bariatric surgery patients usually two scales are used: GIQLI (gastrointestinal Quality of life index) and BAROS (Bariatric analysis and reporting outcome system). In our work we used the original estimation of the quality of life, based on the questionnaire GIQLI. This questionnaire consists of two parts: universal and specific. For the estimation of the level of morbid obesity two main scores are utilized: overweight and the Body Mass Index (BMI). We estimated the quality of life of patients with morbid obesity before the operation (25 patients), after gastric banding (25 patients) and gastric bypass (25 patients). For the control group we show the answers for the same questionnaire of 26 volunteers without any chronic diseases, including morbid obesity. Gastric bypass was performed in patients with BMI more than 40 kg/m2, gastric banding was performed in patients with BMI less than 40 kg/m2. The median periods of supervising the patients after gastric bypass and gastric banding were 3±1,9 years and 4,3±1,7 years for each. After the surgery the percentage of reduction of the overweight was significantly higher in the patients after the gastric bypass. It means that the weight loss is more effective after gastric bypass than gastric banding. The index of the quality of life of the patients with the morbid obesity was much lower than in the control group (р<0,05). After the surgical treatment all the scores increased in the group of the patients being operated on, than in the group of the patients with obesity before the operations (р<0,05). While comparatively estimating the two operations we got practically the same results after gastric bypass and gastric banding. For gastric banding a very important index of the improvement of the quality of life is the level of the weight loss, but after the gastric bypass there were no such outcome.

The increased interest in non-alcohol liver disease research is due to the increased incidence of obesity in developed countries. Thus liver disease is prevalent in 20-40 % of population. Nevertheless fibrosis is found not in every patient, which makes the importance to investigate the factors that are associated with fibrosis. Aim. The purpose of our research was to investigate lipid and glucose metabolism in patients with metabolic syndrome in dependence of liver fibrosis intensity. Materials and methods. We investigated 129 patients with obesity and metabolic syndrome aged 18-59 years old (average age 44 (38+47) years), who underwent elastometry and fibrosis intensity was estimated in dependence of accompanying metabolic disorders (lipid and glucose). Results. Glucose metabolic disorders are accompanied by non-alcohol fatty liver disease in 100%, and elastometric fibrosis features are present in 61% of these patients. If liver fibrosis is present, independently of its intensity, in patients without glucose metabolism disturbances insulin resistance is twofold more often (HOMA index >2.7), while there was no significant correlation of fibrosis with atherogenic profile changes. Conclusion. According to elastometry lipid and glucose disorders are not associated with liver fibrosis intensity.

Aim. The aim of this study was to investigate the influence of insomnia on eating behavior, anxiety, depression, metabolic and hormonal parameters in obese patients. Materials and Methods. The study involved 104 patients with primary obesity from 20 to 55 years old: 47 men and 57 women, mean age 39 years, mean body weight 118 kg, BMI 39.6. Patients were divided into 2 groups: the first group consisted of patients with complaints of insomnia (n=45), the second (control) group (n=59) were patients without sleep disorders. Results. Mean levels of anxiety and depression were significantly higher in the first group. The results of research showed a statistically significant association emotional eating and insomnia. Patients with chronic insomnia without obstructive sleep apnea had low levels of free cortisol in 24-hour urinary compared with patients without sleep disorders (169 [145, 194] vs. 324 [244, 330], respectively, p=0.001), positive correlation with total sleep time, sleep efficiency, and negative with wake time during sleep period time. Conclusions. Sleep disorders in obese patients are one of the factors contributing to the increase in food intake in response to changes in emotional state on the background of "hidden" anxiety and depressive disorders. It is possible that the data eating disorders and psychological status may have a negative impact on the dynamics of weight during the treatment of obesity.

Hypogonadism in men - a clinical and laboratory syndrome caused by decreased secretion of testosterone by the testes. Depending on the level of destruction of the hypothalamic-pituitary-gonadal axis we distinguish two main forms of hypogonadism: hypergonadotrophic or primary hypogonadism and hypogonadotropic or secondary hypogonadism, clinical manifestations, diagnosis and treatment of which are presented in this clinical lecture. Keywords: hypogonadism, testosterone, hypergonadotrophic hypogonadism, hypogonadotropic hypogonadism, treatment.

Numerous studies showed an association between prolactin levels and body weight, with increased prevalence of obesity in patients with prolactinomas. Recent data indicate potential positive influence of cabergoline treatment to metabolic disorders in these patients. This clinical case demonstrates of a man with morbid obesity and giant prolactinoma which was successfully treated by high-dose cabergoline.