Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and mеn over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to –2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4—L5) in order to verify the presence of compression vertebral fractures (B1). Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1). Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1). Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1).

Extracellular fluid of the brain, consisting of cerebrospinal fluid and interstitial fluid, is normally isotonic to blood plasma. Problems arise with a rapid change in osmolality of circulating blood or interstitial brain fluid. The permeability of the blood-brain barrier is lower than in the peripheral capillaries, but this permeability is still several times greater than the passive permeability for electrolytes or glucose. Because of this difference, it is believed that the brain is like an osmometer: it swells with reduced plasma osmolality and contracts (dehydrated) when the plasma becomes hypertonic. Osmotic stress has a direct effect on the functioning of the brain and triggers physiological compensatory mechanisms, in the absence of which due to the intensity or duration of stress, irreversible serious complications may develop. Knowledge and understanding of these processes are the basis for preventing their development and treatment.

Hyperprolactinemia is one of the most common endocrine diseases in the practice of different specialists. Interdisciplinary approach and unified principles of patient management are extremely relevant for this pathology due to the variety of clinical forms. The article demonstrates typical clinical manifestations of hyperprolactinemic syndrome on the example of three patients and shows the different approach to management and treatment.

Введение Г иперпролактинемия является одной из самых частых эндокринных патологий и имеет повсеместную распространенность. Заболевание обусловлено повышением уровня пролактина, что, в свою очередь, приводит к развитию галактореи, аменореи, половой дисфункции, гипогонадизму, бесплодию. Этиология гиперпролактинемии достаточно сложна, а в ряде случаев генез установить не удается. В физиологических концентрациях про-лактин секретируется лактотрофными клетками передней доли гипофиза, выделение гормона регулируется нейромедиатором дофамином, поступающим к лактотрофам по портальной системе ножки гипофиза. Гиперпродукция пролактина наблюдается при развитии лактотрофной опухоли гипофиза (пролактинома), нарушении дофаминовой регуляции при сдавлении гипоталамо-гипофизарного тракта новообразованием, хирургическом вмешательстве, диссеминированном патологическом процессе ФГБУ «Эндокринологический научный центр» Минздрава России, Москва Мельниченко Г.А., Дзеранова Л.К., Пигарова Е.А., Воротникова С.Ю.*, Тарасова Т.C. Цель. Изучить особенности ведения и лечения пациентов с гиперпролактинемией врачами-эндокринологами из 30 субъектов Российской Федерации. Материалы и методы. Для реализации поставленной цели применялся специально разработанный анонимный онлайн опросник. В исследовании приняли участие 74 врача-эндокринолога с 30 регионов Российской Федерации в период с 2014 по 2015 год. Результаты. В регионах Российской Федерации наблюдается удовлетворительная доступность различных методов диагностики заболевания и его осложнений, для лечения используются препараты агонистов дофамина, врачи неоднократно сталкиваются с проблемами лекарственно-индуцированной гиперпролактинемии, беременности на фоне приема медикаментозной терапии. Выводы. Согласно данным опроса наблюдается недостаточный уровень осведомленности врачей о ведении и лечении пациентов с гиперпролактинемиией, что диктует необходимость проведения экспертами в этой области дополнительных семинаров и образовательных лекций. Ключевые слова: гиперпролактинемия, агонисты дофамина, лекарственно-индуцированная гиперпролактинемия, медицинский опрос.Hyperprolactinemia is one of the most common endocrine pathology, which doctors of different specialties face in real clinical practice. Aim of the study was to determine the features of management and treatment of patients with hyperprolactinemia in different regions of Russian Federation. Material and methods. The national medical interview on hyperprolactinemia treatment was conducted in 2014-2015 among 74 endocrinologists from 30 regions of Russia. Results. Endocrinologists in regions of Russian Federation have satisfactory access to various methods of diagnostics of the disease and its complications, knowledge of different dopamine agonists for treatment, and have practice in management of patients with drug-induced hyperprolactinemia. Conclusion. According the data of the interview majority of doctors have insufficient level of knowledge in management and treatment of patients with hyperprolactinemia that is why additional lectures a...

Cerebrospinal fluid (CSF) leak is a rare complication in of the prolactinomas treatment with dopamine agonists. In most cases CSF leak develops within the first three months of treatment starting. The article presents a rare clinical case – later development of CSF leak after pharmacological treatment of giant prolactinoma. Women 29 years with giant endo-supra-infra-laterasellar pituitary adenoma (8,7 cm in diameter), visual impairment, cachexia, secondary amenorrhea and prolactin level more than 2 million 200 thousand mU/l treated with cabergoline. On this background, complete regression of the tumor, recovery of visual function, body mass and normalization of prolactin level was marked. Nevertheless, after 6.5 years after beginning of cabergoline therapy CSF leak occured, which required endoscopic endonasal surgery with the plastic of a CSF fistula. All patients with large and giant prolactinomas which invade into skull base structures, receiving cabergoline even for a long time, should be aware of the possibility of such complications as CSF leak and, if necessary, should urgent appeals to the otolaryngologist and the neurosurgeon. In this case closure of skull base defect is a main tactics of treatment.