Summary Insulin autoimmune syndrome (Hirata’s disease) is a disorder caused by development of autoantibodies to insulin and manifested by hypoglycaemic syndrome. The overwhelming majority of physicians do not include it in the differential diagnosis of hypoglycaemic states because of a misconception of an extremely low prevalence of this condition. This results in unnecessary drug therapy and unjustified surgical interventions in patients that otherwise would be successfully treated conservatively. This disease is strongly associated with certain alleles of the HLA gene. In most cases, this condition develops in predisposed individuals taking drugs containing sulfhydryl groups. Formation of autoantibodies to insulin may be observed in patients with other autoimmune disorders, as well as in those with multiple myeloma or monoclonal gammopathy of undetermined significance. This paper presents the first Russian case report of insulin autoimmune syndrome in an adult patient. Learning points: Insulin autoimmune syndrome, Hirata’s disease, anti-insulin antibodies, and hypoglycaemia.

Список сокращений АГ-артериальная гипертензия АД-артериальное давление ВMК-ванилилминдальная кислота КТ-компьютерная томография МАО-моноаминоксидаза МЙБГ-метайодбензилгуанидин МРТ-магнитно-резонансная томография МЭН-множественная эндокринная неоплазия ОФЭКТ-однофотонная эмиссионная компьютерная томография ПЭТ-позитронно-эмиссионная томография ФДГ-фтордезоксиглюкоза ФДОФА-фтордофамин ФХЦ/ПГ-феохромоцитома и параганглиома ЦНС-центральная нервная система ЧСС-частота сердечных сокращений HU-единица Хаунсфилда NF1-нейрофиброматоз I типа SDH-сукцинатдегидрогеназа VHL-болезнь фон Гиппеля-Линдау

Background. In the Russian Federation (RF), the problem of iodine deficiency(ID) remains in. Major ongoing events are regional program. In our opinion it is necessary to evaluate their effectiveness and suggestions for improvements of preventive measures if necessary. Aims — to analyze the dynamics of the main epidemiological indicators of iodine deficiency disorders (IDD) in children, adolescents and adults population of the RF, sing the figures in the statistical form № 63 «Information on diseases related to micronutrient deficiency» and the statistical form №12 «Data on number of diseases registered at patients, living in area of medical service of medical institutions» (retrospective study), to evaluate the effectiveness of preventive measures for elimination of ID and formulate possible solutions. Material and methods. It have been analyzed the main epidemiological indicators of IDD among children (0—14 years), adolescents (15—17 years) and adult (18 and older) population of the RF for the period 2009—2015. For the assessment of the key epidemiological indicators was constructed a linear regression model, calculated the slope of the trend line (k-factor; a quantitative expression of the dynamics of prevalence/incidence), using Student’s t-test assessed the significance of k: were considered reliable (presence of speakers) at the level of p value p<0.05. Data processing was performed using Microsoft Excel 2010, R (version 3.2.3). Results. Latest analytical data on the prevalence and incidence of IDD has shown that despite preventive actions, the problem IDD is still remaining, as evidenced by the increase in the prevalence and incidence of IDD. The downward trend in the prevalence and incidence of some IDD is likely to be associated with the implementation of regional programs for the prevention of IDD. Also challenges and successes in managing ID in RF highlighted, given some normative-legal acts related to salt iodization. Conclusions. Formulate practical proposals to improve preventive measures to prevent the development of IDD.

The lifestyle change that underlies the treatment of such a prevalent chronic disease as obesity is often insufficient to successfully clinically relevant reduce body weight, especially in the presence of comorbid conditions and diseases (type 2 diabetes, atherogenic dyslipidemia, arterial hypertension, ischemic heart disease, hyperuricemia and gout, obstructive sleep apnea syndrome, polycystic ovary syndrome and other menstrual irregularities etc.). The availability in our country until recently, only two drugs for the treatment of obesity is extremely limited choice in the case of existing contraindications to this or another drug or the appearance of any side effects. The registration in Russia in 2016 of a new drug for the treatment of obese patients, including morbid or complicated concomitant diseases and conditions, an analogue of human glucagon-like peptide-1 — liraglutide in a dose of 3.0 mg, has replenished the arsenal of obesity pharmacotherapy and substantially extended capabilities of management of obesity and overweight including patients with severe comorbidities.