The metabolic syndrome is defined as a condition characterized by a set of clinical criteria: insulin resistance, visceral obesity, atherogenic dyslipidemia, and hypertension. The major risk factors leading to the epidemic of this syndrome in the United States are visceral obesity, physical inactivity, and an atherogenic diet. The available current evidence suggests that the first step in management of patients with metabolic syndrome should be focused on lifestyle modifications (eg, weight loss and physical activity). The treatment should be based on two major components: behavioral change to reduce caloric intake and an increase in physical activity. A realistic goal for weight reduction should be 7% to 10% over 6 to 12 months. The general dietary recommendations include low intake of saturated fats, trans fats and cholesterol, and diets with low glycemic index. Soy protein could be more beneficial than animal protein in weight reduction and correction of dyslipidemia. Physical activity is associated with successful weight reduction and these therapeutic lifestyle changes can reduce by half the progression to new-onset diabetes in patients with metabolic syndrome. Physical activity recommendations should include practical, regular, and moderated regimens of exercise, with a daily minimum of 30 to 60 minutes. An equal balance between aerobic exercise and strength training is advised. Medication therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals. There is no single best therapy and the treatment should consist of treatment of individual component(s). Atherogenic dyslipidemia should be controlled with statins if there is concomitant increase in low-density lipoprotein cholesterol and if indicated with combination therapy, including fibrates, nicotinic acid, bile acid-binding resins, or ezetimibe. Drugs such as thiazolidinediones and renin-angiotensin system blockers are a few of the available agents in this category. Some evidence suggests that angiotensin-converting enzyme inhibitors and b blockers are more beneficial for treatment of hypertension in patients with metabolic syndrome. Patients with metabolic syndrome also have elevations in fibrinogen and other coagulation factors leading to prothrombotic state and aspirin may be beneficial for primary prevention in these patients. The new developments in the treatment of metabolic syndrome with drugs, such as peroxisome proliferator-activated receptor agonists, will broaden the horizons of the current treatment options in metabolic syndrome.

The present guidelines on diagnostics, differential diagnostics, and methods of treatment of Cushing’s disease have been developed by a group of Russian specialists.

As known insulin therapy is associated with induration of subcutaneous fat at injections sites called lypohypertrophy. It develops at any age and at anysite regardless of duration of the treatment. The size of lypohypertrophy varies in a wide range. Numerous studies have been conducted to elucidatemechanisms of lypohypertrophy (LH) and its risk factors including young age, low or high body mass index, frequency of the change of needles andinjection sites, female gender, and type 1 diabetes mellitus. It was shown that insulin crystals induce a local immune reaction and thereby interfere withadipocyte differentiation. At the same time, patients with LH have elevated titters of anti-insulin antibodies. The problem with LH is uncontrollableabsorption of insulin from injection sites. We noticed that patients with a target glucose level due to insulin therapy undergo its apparently causelessperiodic rises. Comparative ultrasonic examination of subcutaneous fat at different injection sites and control body areas revealed specific pathologicalchanges in adipose issue. This finding provided a basis for the hypothesis that LH can be detected by ultrasonography of subcutaneous fat. It wasconfirmed by the results of examination of 50 patients with DM1 treated with insulin of whom 41 were found to have pathological changes at injectionsites.

Клинические рекомендации «Ожирение»*: на что обратить внимание В декабре 2020 г. Научно-практическим советом Минздрава России были утверждены клинические рекомендации «Ожирение», разработанные Российской ассоциацией эндокринологов в сотрудничестве с Обществом бариатрических хирургов. Этот документ был подготовлен в соответствии с методическими рекомендациями Минздрава России и опубликован на сайте cr.rosminzdrav.ru. Одной из задач, поставленных в ходе работы над обновленными рекомендациями, было отразить то новое, что появилось в клинической практике врача-эндокринолога за последние годы, а именно: • новые подходы к классификации ожирения; • новые препараты для лечения ожирения; • объединение бариатрической хирургии и практической эндокринологии. Следует отметить, что эти клинические рекомендации посвящены первичному ожирению. Патогенез, эпидемиология, особенности клинической картины и лечения вторичного ожирения, когда оно является симптомом какого-либо другого заболевания, в данном документе не рассматриваются.Чл.-кор. РАН Е.А. Трошина

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