Summary endocrine system: Endocrine System (for Teens) – Nemours KidsHealth

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17.1 An Overview of the Endocrine System – Anatomy and Physiology

Learning Objectives

By the end of this section, you will be able to:

Distinguish the types of intercellular communication, their importance, mechanisms, and effects
Identify the major organs and tissues of the endocrine system and their location in the body

Communication is a process in which a sender transmits signals to one or more receivers to control and coordinate actions. In the human body, two major organ systems participate in relatively “long distance” communication: the nervous system and the endocrine system. Together, these two systems are primarily responsible for maintaining homeostasis in the body.

Neural and Endocrine Signaling

The nervous system uses two types of intercellular communication—electrical and chemical signaling—either by the direct action of an electrical potential, or in the latter case, through the action of chemical neurotransmitters such as serotonin or norepinephrine. Neurotransmitters act locally and rapidly. When an electrical signal in the form of an action potential arrives at the synaptic terminal, they diffuse across the synaptic cleft (the gap between a sending neuron and a receiving neuron or muscle cell). Once the neurotransmitters interact (bind) with receptors on the receiving (post-synaptic) cell, the receptor stimulation is transduced into a response such as continued electrical signaling or modification of cellular response. The target cell responds within milliseconds of receiving the chemical “message”; this response then ceases very quickly once the neural signaling ends. In this way, neural communication enables body functions that involve quick, brief actions, such as movement, sensation, and cognition.In contrast, the endocrine system uses just one method of communication: chemical signaling. These signals are sent by the endocrine organs, which secrete chemicals—the hormone—into the extracellular fluid. Hormones are transported primarily via the bloodstream throughout the body, where they bind to receptors on target cells, inducing a characteristic response. As a result, endocrine signaling requires more time than neural signaling to prompt a response in target cells, though the precise amount of time varies with different hormones. For example, the hormones released when you are confronted with a dangerous or frightening situation, called the fight-or-flight response, occur by the release of adrenal hormones—epinephrine and norepinephrine—within seconds. In contrast, it may take up to 48 hours for target cells to respond to certain reproductive hormones.

Interactive Link

Visit this link to watch an animation of the events that occur when a hormone binds to a cell membrane receptor. What is the secondary messenger made by adenylyl cyclase during the activation of liver cells by epinephrine?

In addition, endocrine signaling is typically less specific than neural signaling. The same hormone may play a role in a variety of different physiological processes depending on the target cells involved. For example, the hormone oxytocin promotes uterine contractions in women in labor. It is also important in breastfeeding, and may be involved in the sexual response and in feelings of emotional attachment in both males and females.

In general, the nervous system involves quick responses to rapid changes in the external environment, and the endocrine system is usually slower acting—taking care of the internal environment of the body, maintaining homeostasis, and controlling reproduction (Table 17.1). So how does the fight-or-flight response that was mentioned earlier happen so quickly if hormones are usually slower acting? It is because the two systems are connected. It is the fast action of the nervous system in response to the danger in the environment that stimulates the adrenal glands to secrete their hormones. As a result, the nervous system can cause rapid endocrine responses to keep up with sudden changes in both the external and internal environments when necessary.

Endocrine and Nervous Systems

	Endocrine system	Nervous system
Signaling mechanism(s)	Chemical	Chemical/electrical
Primary chemical signal	Hormones	Neurotransmitters
Distance traveled	Long or short	Always short
Response time	Fast or slow	Always fast
Environment targeted	Internal	Internal and external

Table 17.1

Structures of the Endocrine System

The endocrine system consists of cells, tissues, and organs that secrete hormones as a primary or secondary function. The endocrine gland is the major player in this system. The primary function of these ductless glands is to secrete their hormones directly into the surrounding fluid. The interstitial fluid and the blood vessels then transport the hormones throughout the body. The endocrine system includes the pituitary, thyroid, parathyroid, adrenal, and pineal glands (Figure 17.2). Some of these glands have both endocrine and non-endocrine functions. For example, the pancreas contains cells that function in digestion as well as cells that secrete the hormones insulin and glucagon, which regulate blood glucose levels. The hypothalamus, thymus, heart, kidneys, stomach, small intestine, liver, skin, female ovaries, and male testes are other organs that contain cells with endocrine function. Moreover, adipose tissue has long been known to produce hormones, and recent research has revealed that even bone tissue has endocrine functions.

Figure 17.2 Endocrine System Endocrine glands and cells are located throughout the body and play an important role in homeostasis.

The ductless endocrine glands are not to be confused with the body’s exocrine system, whose glands release their secretions through ducts. Examples of exocrine glands include the sebaceous and sweat glands of the skin. As just noted, the pancreas also has an exocrine function: most of its cells secrete pancreatic juice through the pancreatic and accessory ducts to the lumen of the small intestine.

Other Types of Chemical Signaling

In endocrine signaling, hormones secreted into the extracellular fluid diffuse into the blood or lymph, and can then travel great distances throughout the body. In contrast, autocrine signaling takes place within the same cell. An autocrine (auto- = “self”) is a chemical that elicits a response in the same cell that secreted it. Interleukin-1, or IL-1, is a signaling molecule that plays an important role in inflammatory response. The cells that secrete IL-1 have receptors on their cell surface that bind these molecules, resulting in autocrine signaling.

Local intercellular communication is the province of the paracrine, also called a paracrine factor, which is a chemical that induces a response in neighboring cells. Although paracrines may enter the bloodstream, their concentration is generally too low to elicit a response from distant tissues. A familiar example to those with asthma is histamine, a paracrine that is released by immune cells in the bronchial tree. Histamine causes the smooth muscle cells of the bronchi to constrict, narrowing the airways. Another example is the neurotransmitters of the nervous system, which act only locally within the synaptic cleft.

Career Connection

Endocrinologist

Endocrinology is a specialty in the field of medicine that focuses on the treatment of endocrine system disorders. Endocrinologists—medical doctors who specialize in this field—are experts in treating diseases associated with hormonal systems, ranging from thyroid disease to diabetes mellitus. Endocrine surgeons treat endocrine disease through the removal, or resection, of the affected endocrine gland.

Patients who are referred to endocrinologists may have signs and symptoms or blood test results that suggest excessive or impaired functioning of an endocrine gland or endocrine cells. The endocrinologist may order additional blood tests to determine whether the patient’s hormonal levels are abnormal, or they may stimulate or suppress the function of the suspect endocrine gland and then have blood taken for analysis. Treatment varies according to the diagnosis. Some endocrine disorders, such as type 2 diabetes, may respond to lifestyle changes such as modest weight loss, adoption of a healthy diet, and regular physical activity. Other disorders may require medication, such as hormone replacement, and routine monitoring by the endocrinologist. These include disorders of the pituitary gland that can affect growth and disorders of the thyroid gland that can result in a variety of metabolic problems.

Some patients experience health problems as a result of the normal decline in hormones that can accompany aging. These patients can consult with an endocrinologist to weigh the risks and benefits of hormone replacement therapy intended to boost their natural levels of reproductive hormones.

In addition to treating patients, endocrinologists may be involved in research to improve the understanding of endocrine system disorders and develop new treatments for these diseases.

15.1A: Overview of the Endocrine System

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Key Points
Key Terms
The Endocrine System
Key Endocrine Glands

The endocrine system is a system of ductless glands that secrete hormones—chemical messengers that are carried for long distances.

Learning Objectives

Produce a brief overview of the endocrine system

Key Points

The endocrine system is a system of ductless glands that secrete hormones directly into the circulatory system to be carried long distances to other target organs that regulate key body and organ functions.
The major endocrine glands include the pituitary, pineal, ovaries, testes, thyroid, hypothalamus, and adrenal glands.

Key Terms

hormone: A molecule released by a cell or a gland in one part of the body that sends out messages affecting cells in other parts of the organism.
endocrine system: The system of ductless glands that secretes hormones directly into the circulatory system.

The Endocrine System

The endocrine system is a system of ductless glands that secretes hormones directly into the circulatory system to be carried long distances to other target organs regulating key body and organ functions. For example, the pineal gland, located at the base of the brain, secretes the hormone melatonin, responsible for regulating sleep patterns.

Endocrine glands are typically well vascularized and the cells comprising the tissue are typically rich in intracellular vacuoles or granules that store hormones prior to release. Endocrine signaling is typically slow to initiate but is prolonged in response; this provides a counterpoint to the more rapid and short-lived nervous system signals.

The endocrine system is in contrast to the exocrine system, which features ducted glands that secrete substances onto an epithelial surface; for example, a sweat gland. Additionally the endocrine system is differentiated from shorter distance signaling such as autocrine (a cell affecting itself), juxtacrine (a cell affecting it’s direct neighbors), and paracrine (a cell affecting other nearby cells) signaling.

Key Endocrine Glands

The major endocrine glands include the pituitary, pineal, ovaries, testes, thyroid, hypothalamus and adrenal glands, additionally other tissues such as the kidney and liver also display secondary adrenal functions.

Endocrine glands of the head and neck: The endocrine systems found in the head and neck include the hypothalamus, pineal, pituitary and thyroid glands.

Overview of Endocrinology

How is it that humans and animals maintain quite constant blood concentrations of glucose throughout their lives despite wildly varying frequencies of meals? If your blood glucose concentration drops much below 1 mg per ml, your neurons will begin to misbehave, leading ultimately to coma and death. Yet skipping breakfast is rarely life-threatening.

The answer is that a battery of chemical messengers – hormones – are secreted into blood in response to rises and falls in blood glucose concentration and stimulate metabolic pathways that pull glucose concentrations back into the normal range.

Two systems control all physiologic processes:

The nervous system exerts point-to-point control through nerves, similar to sending messages by conventional telephone. Nervous control is electrical in nature and fast.
The endocrine system broadcasts its hormonal messages to essentially all cells by secretion into blood and extracellular fluid. Like a radio broadcast, it requires a receiver to get the message – in the case of endocrine messages, cells must bear a receptor for the hormone being broadcast in order to respond.

As will be repeatedly demonstrated, the nervous and endocrine systems often act together to regulate physiology. Indeed, some neurons function as endocrine cells.

Endocrinology is the study of hormones, their receptors and the intracellular signalling pathways they invoke. Distinct endocrine organs are scattered throughout the body. These are organs that are largely or at least famously devoted to secretion of hormones, and no introduction to endocrinology would be complete without some kind of endocrine organ “map” such as that below:

In addition to the classical endocrine organs, many other cells in the body secrete hormones. Myocytes in the atria of the heart and scattered epithelial cells in the stomach and small intestine are examples of what is sometimes called the “diffuse” endocrine system. If the term hormone is defined broadly to include all secreted chemical messengers, then virtually all cells can be considered part of the endocrine system.

A final introductory comment is warranted. Pursuit of an understanding of endocrinology is complicated by several of its principles:

All pathophysiologic events are influenced by the endocrine milieu: There are no cell types, organs or processes that are not influenced – often profoundly – by hormone signaling.
All “large” physiologic effects are mediated by multiple hormones acting in concert: Normal growth from birth to adulthood, for example, is surely dependent on growth hormone, but thyroid hormones, insulin-like growth factor-1, glucocorticoids and several other hormones are also critically involved in this process.
There are many hormones known and little doubt that others remain to be discovered.

Consequently, endocrinology is presented here in two ways. First, the major endocrine organs and the hormones they produce are introduced, with delineation of major effects. Second, an integrated approach to understanding the multi-hormone control of several important phenomena is provided. Importantly, a considerable amount of endocrinology is incorporated into other sections. Gastrointestinal hormones, for example, are discussed throughout the section on pathophysiology of the digestive system.

Another useful overview of the endocrine system, with links to external sites, is provided at The Endocrine System

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Chapter 35 – An Overview of the Endocrine System – BIO 140 – Human Biology I – Textbook

Chapter 35

An Overview of the Endocrine System

By the end of this section, you will be able to:

Distinguish the types of intercellular communication, their importance, mechanisms, and effects
Identify the major organs and tissues of the endocrine system and their location in the body

Neural and Endocrine Signaling

Visit the video linked to below to watch an animation of the events that occur when a hormone binds to a cell membrane receptor. What is the secondary messenger made by adenylyl cyclase during the activation of liver cells by epinephrine?

In general, the nervous system involves quick responses to rapid changes in the external environment, and the endocrine system is usually slower acting—taking care of the internal environment of the body, maintaining homeostasis, and controlling reproduction (Table 1). So how does the fight-or-flight response that was mentioned earlier happen so quickly if hormones are usually slower acting? It is because the two systems are connected. It is the fast action of the nervous system in response to the danger in the environment that stimulates the adrenal glands to secrete their hormones. As a result, the nervous system can cause rapid endocrine responses to keep up with sudden changes in both the external and internal environments when necessary.

Table 1: Endocrine and Nervous Systems

	Endocrine system	Nervous system
Signaling mechanism(s)	Chemical	Chemical/electrical
Primary chemical signal	Hormones	Neurotransmitters
Distance traveled	Long or short	Always short
Response time	Fast or slow	Always fast
Environment targeted	Internal	Internal and external

Structures of the Endocrine System

The endocrine system consists of cells, tissues, and organs that secrete hormones as a primary or secondary function. The endocrine gland is the major player in this system. The primary function of these ductless glands is to secrete their hormones directly into the surrounding fluid. The interstitial fluid and the blood vessels then transport the hormones throughout the body. The endocrine system includes the pituitary, thyroid, parathyroid, adrenal, and pineal glands (Figure 1). Some of these glands have both endocrine and non-endocrine functions. For example, the pancreas contains cells that function in digestion as well as cells that secrete the hormones insulin and glucagon, which regulate blood glucose levels. The hypothalamus, thymus, heart, kidneys, stomach, small intestine, liver, skin, female ovaries, and male testes are other organs that contain cells with endocrine function. Moreover, adipose tissue has long been known to produce hormones, and recent research has revealed that even bone tissue has endocrine functions.

Endocrine System

Figure 1: Endocrine glands and cells are located throughout the body and play an important role in homeostasis.

Other Types of Chemical Signaling

Career Connection

Endocrinologist

In addition to treating patients, endocrinologists may be involved in research to improve the understanding of endocrine system disorders and develop new treatments for these diseases.

Chapter Review

The endocrine system consists of cells, tissues, and organs that secrete hormones critical to homeostasis. The body coordinates its functions through two major types of communication: neural and endocrine. Neural communication includes both electrical and chemical signaling between neurons and target cells. Endocrine communication involves chemical signaling via the release of hormones into the extracellular fluid. From there, hormones diffuse into the bloodstream and may travel to distant body regions, where they elicit a response in target cells. Endocrine glands are ductless glands that secrete hormones. Many organs of the body with other primary functions—such as the heart, stomach, and kidneys—also have hormone-secreting cells.

Microscope Slides of Endocrine Glands

Chapter 13 – Endocrine Glands

The endocrine system is composed of glands that synthesize and secrete products, called hormones, directly into the blood rather than through a duct. Hormones are transported throughout the body where they influence only those cells that have receptors for that hormone.

Hormones can be:

Proteins/peptides (e.g., insulin, growth hormone)

Lipid derivatives – derived from cholesterol or fatty acids (e.g., steroids, eicosanoids)

Amino acid derivatives – derived from tyrosine or tryptophan (e.g., epinephrine, melatonin, thyroid hormones)

Hormone effects are described as:

Endocrine – released into blood and act at long distances

Paracrine – diffuse a short distance through tissue fluids to nearby cells

Autocrine – act on the same cell that produced the hormone

Endocrine glands are highly vascular and often contain fenestrated capillaries to facilitate the diffusion of hormones into blood.

Pituitary

The pituitary is often called the “master gland” of the body because it produces hormones that regulate other endocrine glands, as well as, have direct effects on target tissues.

Thyroid

The thyroid gland produces hormones, triiodothyronine (T3) and thyroxine (T4), that primarily influence the basal metabolic rate and protein synthesis.

Parathyroid

Parathyroid glands secrete parathyroid hormone (PTH) in response to low blood levels of calcium. PTH secretion causes the release of calcium from bones by stimulating osteoclasts, inhibition of osteoblasts, and increased reabsorption of calcium in the kidney.

Thyroid-Parathyroid-Thymus

This specimen is unusual in that thyroid, parathyroid gland and thymus failed to migrate to their proper locations during development.

Adrenal Glands

Adrenal glands produce a variety of hormones that help regulate metabolism, blood pressure, response to stress, and other essential functions.

Pancreatic Islets

Pancreatic islets (or islets of Langerhans) are ‘islands’ of endocrine cells located within the pancreas. They secrete hormones (insulin and glucagon) important in the regulation of glucose in blood.

Endocrine System and Syndromes | Lab Tests Online

Sources Used in Current Review

Chawla, J. 2016. Endocrine System Anatomy. Available online at http://emedicine.medscape.com/article/1948709-overview#a2. Accessed April 7, 2017.

Hormone Health Network. 2017. Adrenal Disorders. Available online at http://www.hormone.org/diseases-and-conditions/adrenal. Accessed April 7, 2017.

Hormone Health Network. 2017. Thyroid Disorders. Available online at http://www.hormone.org/diseases-and-conditions/thyroid. Accessed April 7, 2017.

Hormone Health Network. 2017. Pituitary Disorders. Available online at http://www.hormone.org/diseases-and-conditions/pituitary. Accessed April 7, 2017.

Norman, J. 2013. M.E.N. Syndromes: Multiple Endocrine Neoplasia. Available online at https://www.endocrineweb.com/conditions/endocrine-disorders/men-syndromes-multiple-endocrine-neoplasia. Accessed April 7, 2017.

Ranabir, S. and Reetu, K. 2011. Stress and hormones. Indian Journal of Endocrinology and Metabolism. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079864/. Accessed April 7, 2017.

Sargis, R. 2016. About the Endocrine System. Available online at https://www.endocrineweb.com/endocrinology/about-endocrine-system. Accessed April 7, 2017.

U.S. National Library of Medicine. 2017. Cushing’s Syndrome. Available online at https://medlineplus.gov/cushingssyndrome.html. Accessed April 7, 2017.

U.S. National Library of Medicine. 2017. Endocrine Diseases. Available online at https://medlineplus.gov/endocrinediseases.html. Accessed April 7, 2017.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

(2005 September 30). Multiple endocrine neoplasia type 1. Genetics Home Reference [On-line information]. Available online at http://ghr.nlm.nih.gov/condition=multipleendocrineneoplasiatype1.

(2005 September 30). Multiple endocrine neoplasia type 2. Genetics Home Reference [On-line information]. Available online at http://ghr.nlm.nih.gov/condition=multipleendocrineneoplasiatype2.

(2004 August, Updated). Multiple Endocrine Neoplasia Type 1. NIDDK, NIH Publication No. 02-3048 [On-line information]. Available online at http://www.niddk.nih.gov/health/endo/pubs/men1/men1.htm.

Mrotek, J., and Chase, C. [Henwood, M. and Annaswamy, R., Editors] (2005 January, Review). Endo 101, The Endocrine System, Hormones, and Glands. The Hormone Foundation [On-line information]. Available online at http://www.hormone.org/endo101/endo101_2.html.

Multiple Endocrine Neoplasia Type 1. GeneReviews [On-line information]. Available online at http://www.genetests.org.

Multiple Endocrine Neoplasia Type 2. GeneReviews [On-line information]. Available online at http://www.genetests.org.

(Reviewed November 2005). Principles of Endocrinology. Merck Manual of Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec12/ch250/ch250a.html. Accessed 1/18/09.

Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson RA and Pincus MR, eds. Philadelphia: 2007, Pp. 326-358.

Reviewed by Robert M. Sargis MD, PhD. (Updated Jan. 11, 2011). An Overview of the Hypothalamus. Endocrine Web. Available online at http://www.endocrineweb.com/endocrinology/overview-hypothalamus. Accessed October 13, 2012.

(Reviewed December 28, 2011). Diabetes incipidus. Pubmed Health. Available online at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001415/. Accessed October 13, 2012.

January 2010. Thyroid Function Tests. National Endocrine and Metabolic Diseases Information Service. PDF available for download at http://endocrine.niddk.nih.gov/pubs/thyroidtests/thyroidtests_508.pdf. Accessed October 13, 2012.

(Updated October 3, 2012) Endocrine System Anatomy. Medscape reference. Available online at http://emedicine.medscape.com/article/1948709-overview#a1. Accessed October 11, 2012.

(Reviewed April 2009). Principles of Endocrinology. Merck Manual of Healthcare Professionals [On-line information]. Available online through http://www.merck.com/mmpe. Accessed October 11, 2012.

(Updated July 8, 2010). Adrenal Gland Disorders. Available online at http://www.nichd.nih.gov/health/topics/adrenal_gland_disorders.cfm. Accessed October 13, 2012.

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(October 12, 2012). Genetics Home Reference. Multiple endocrine neoplasia. Available online at http://www.nichd.nih.gov/health/topics/adrenal_gland_disorders.cfm. Accessed Oct. 16, 2012.

Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry. AACC Press, Washington, DC., Pp 352-363.

What Does the Endocrine System Do? (Endocrine System and Exercise)

Exercise is physical stress applied to the human body. The endocrine system consists of glands that release the chemicals and hormones that control physiological functions in the body.

Do you know which hormones are responsible for muscle growth vs. breaking down muscle tissue? Are you proficient in designing safe and effective exercise programs that maximize muscle growth and fat utilization based on hormonal response to training stimuli?

Knowing the answers to these questions is key to your training success with clients. This know-how also greatly enhances your credibility with clients and your employer. Moreover, it will help you establish the rapport that is pivotal in developing long-term, successful relationships with clients as outlined in the new ACE Integrated Fitness Training^TM (ACE IFT^TM) Model.

Here is a quick overview of the endocrine system:
Pituitary Gland
During exercise, the pituitary gland releases human growth hormone, which tells the body to increase bone, muscle and tissue production.

Thyroid Gland
When you start exercising, the thyroid gland (located at the base of the neck) sends out hormones that regulate the body’s temperature, heart rate and blood pressure. It also regulates the alertness and focus that are needed to work at a high intensity.

Adrenal Gland
Located at the top of the kidneys, the adrenal glands are responsible for the release of cortisol into the bloodstream. Cortisol levels control blood pressure, glucose and acts as an anti-inflammatory agent. The adrenal glands also release aldosterone, a hormone that regulates hydration levels, the speed of the heart and the strength of contractions. It also turns stored carbohydrates into energy.

Pancreas
Insulin regulates glucose, or blood sugar, by transporting it to the muscles and tissue that use glucose for energy. Excessive insulin in the blood reduces your sensitivity to insulin and can cause diabetes, which is also linked to overweight and obesity. Exercise improves insulin sensitivity and reduces the reliance on insulin injections.

Moreover, the effects of exercise on the endocrine system are also psychological. Exercise-induced testosterone can increase an individual’s libido and confidence, researchers have found. Endorphins can help reduce tension and anxiety and facilitate the proverbial “runner’s high.”

For more details on the link between the endocrine system and exercise, visit ACE Exercise Physiologist Pete McCall’s session at the IDEA Personal Trainer Institute, February 16–19, 2012, in Alexandria, Va.

Endocrinology, endocrinologist services

Endocrine glands and products of their secretory activity have a great influence on our body. Endocrinology – a field of medicine that studies the structural features and functions of the endocrine glands, their diseases and the effect on the vital activity of the body.

The main task of the endocrine glands is the production and release into the bloodstream of biologically active substances – hormones. The hormone-forming function of the endocrine system is influenced by the central and peripheral nervous system.In turn, the endocrine system regulates the body’s metabolic processes, ensuring the constancy of the internal environment and the normal course of all biochemical processes.

Endocrine glands are the pituitary gland, hypothalamus, thyroid and parathyroid glands, islets of the pancreas, adrenal glands, sex glands of male and female organisms, in addition, a number of body elements are the source of tissue hormones entering the bloodstream. Endocrinology studies the system of endocrine glands, hormones, and target organs.The balance of all components of this system ensures the health of the body and the physiological course of all processes in it. The transfer of information contained in hormones is carried out using receptors located on the surface of the target organ or tissue. A highly informative research method in endocrinology is study of the hormonal mirror of the patient’s body. The Akron Medical Center conducts a comprehensive study of hormones using modern techniques and laboratory equipment.Ultrasound examination of the structure of the endocrine glands is of great importance for the diagnosis of endocrine diseases. The endocrinologist analyzes the patient’s complaints, the data of an objective examination, instrumental and laboratory methods of research, and then selects a scheme for correcting the disease. In the future, he dynamically monitors the progress of recovery.

90,000 COVID-19 pandemic and endocrinopathies

N. G. Mokrysheva, G.R. Galstyan, M.A. Kirzhakov, A.K. Eremkina, E.A. Pigarova *, G.A. Melnichenko
National Medical Research Center of Endocrinology, Moscow, Russian Federation

Most diseases of the endocrine system have a chronic course, up to 80% of cases occur in patients with endocrinopathies, primarily diabetes mellitus and thyroid diseases, who receive regular outpatient care. For such people, an endocrinologist is most often a general practitioner, so it is they who are responsible for promptly explaining to patients with diabetes, diseases of the thyroid, pituitary and adrenal glands, endocrine system tumors how to behave in the new conditions of the coronavirus pandemic (COVID-19 ).This infectious disease is most severe in people over 65 with chronic diseases, especially endocrinopathies. This literature review summarizes the information available to date on the pathogenesis and course of COVID-19, including in the most vulnerable groups. The article provides up-to-date information on measures to prevent infection, the peculiarities of patient-doctor contact in conditions of self-isolation and quarantine measures, as well as what additional therapeutic measures are necessary for the development of COVID-19 in patients with the most severe endocrinopathies.

KEYWORDS: COVID-19, SARS-CoV-2, endocrinopathy, diabetes mellitus, self-isolation, telemedicine, remote con-
counseling.

INTRODUCTION

Many endocrinopathies have a chronic course, and, at least in our country, up to 80% of people with chronic diseases receiving regular outpatient care are patients with endocrine disorders, primarily diabetes mellitus and thyroid diseases.For these people, an endocrinologist is most often a general practitioner, and therefore it is precisely today, in our prosperous and so unaccustomed to epidemics world, when only yesterday antivaccinators gathered huge audiences listening to them, and convincing people of the need for vaccination against influenza and other acute respiratory infections was it is extremely difficult, these specialists are responsible for promptly explaining to people with diabetes, diseases of the thyroid gland, pituitary and adrenal glands, tumors of the endocrine system, how to behave in new conditions.

COVID-19 – A NEW CHALLENGE TO PUBLIC HEALTH

Dangerous infectious diseases continue to emerge and pose a threat to public health. Since the early 2000s, several new viral diseases have been registered, which have been assigned epidemic status, including severe acute respiratory syndrome coronavirus (SARS-CoV, 2002-2003), h2N1 influenza virus (2009), and See also Middle East respiratory syndrome (MERS-CoV, 2012).On December 31, 2019, the Chinese Bureau of the World Health Organization (WHO) reported cases of lower respiratory tract disease of unknown etiology in the population. The literature data make it possible to track the debut of suspicious symptoms until the beginning of December 2019, but such a delay in the official WHO report confirms the fact that the pathogen was not immediately identified. The Center for Disease Control and Prevention of the People’s Republic of China organized an operational investigation of the infectious focus, which revealed a new strain of coronavirus (CoV), which had not previously been detected in humans.On February 11, 2020, WHO Director-General Dr. Tedros Adhanom Ghebreyesus announced the official name of the new disease – Coronavirus Disease 2019, or COVID-19. Subsequently, the experts of the International Committee on the Taxonomy of Viruses named it SARS-CoV-2, since it is very similar in structure to SARS-CoV [1].

Coronavirus SARS-CoV-2 is an RNA virus belonging to the genus Betacoronavirus of the Coronaviridae family. Virions of all coronaviruses have a supercapsid with large spiny processes in the form of clubs 5-10 nm long, formed by S-glycoproteins.The presence of these processes, resembling the teeth of the crown, gave the name to the entire family. The new pathogen is believed to be a recombinant strain between bat coronavirus and an unknown coronavirus. This assumption is based on the fact that the genetic sequence of SARS-CoV-2 is 79% similar to the sequence of SARS-CoV [2].

The pathogenesis of COVID-19 is currently insufficiently understood. The leading theory explaining the features of the clinical picture of the disease is the high affinity of S-glycoproteins of coronaviruses (both SARSCoV and SARS-CoV-2) for the receptors of the angiotensin-converting enzyme type 2.Also, in experimental studies with virus particles, the role of the serine protease TMPRSS2 was established [3, 4]. It is necessary for the priming of the S-protein of the SARS-CoV-2 virus, which is a mandatory step in the penetration of the virus into the host cells, during which the membranes of the virus and the host cell merge. The biological role of type 2 angiotensin-converting enzyme is to convert angiotensin I to angiotensin 1-9 and angiotensin II to angiotensin 1-7. In this case, not only the inactivation of angiotensin II occurs, but also the formation of the peptide angiotensin 1-7, which itself has a number of biological effects [5, 6].

In the cells of the respiratory system, type 2 angiotensin-converting enzyme is considered a key regulator of the angiotensin system. When the activity of angiotensin-converting enzyme 1 type increases
and the activity of angiotensin-converting enzyme type 2 is inhibited, intact angiotensin II acts through angiotensin receptors type 1 and 2, promoting pro-inflammatory reactions and stimulating the secretion of aldosterone. This leads not only to an increase in blood pressure, but also to an increase in local vascular permeability, which increases the risk of respiratory distress syndrome [6].Angiotensin 1-7
has opposite effects, it binds to Mas receptors, which mediate vasodilation and antiproliferative functions, probably through an NO-dependent mechanism [7]. It can be assumed that in people with a more severe course of COVID-19 there is an imbalance of these receptor pathways with an increase in the activation of angiotensin receptors types 1 and 2, which can occur in type 2 diabetes mellitus, insulin-resistant conditions and hypertension [ 4, 5].

The main target cells for SARS-CoV-2 are the cells of the alveolar epithelium, where the receptors for the angiotensin-converting enzyme type 2 are localized. In addition, these receptors are found in enterocytes of the small intestine and vascular endotheliocytes. In individuals with a reduced immune response, the infectious process spreads to the alveoli, which leads to the destruction of the surfactant, excessive exudation and a sharp decrease in respiratory function. The most common symptoms of the disease are fever, general and muscle weakness, myalgia, dry cough with little phlegm.Less common symptoms from the gastrointestinal tract (dyspepsia, diarrhea). With further progression of the disease, approximately 15–20% of patients develop respiratory failure [2]. In severe forms of the disease, the affected areas are replaced with connective tissue with the development of pulmonary fibrosis. According to modern concepts, persistent type-specific immunity develops in persons who have undergone an infection [8].

COVID-19 is a fairly aggressive virus, and the number of diseases in the world continues to grow to the present day.At a meeting on January 30, 2020, WHO declared a public health emergency of international concern in accordance with international health regulations. And already on March 11, 2020, the disease acquired the status of a pandemic. Health organizations coordinate information flows, issue directives and various infection control guidelines to best mitigate the impact of the threat.

High susceptibility to SARS-CoV-2 is noted among all population groups, but risk groups for severe course and death due to COVID-19 include, first of all, persons over 65 years of age, patients with chronic diseases (respiratory system, cardiovascular systems, diabetes mellitus, malignant tumors) [9].

Data on the characteristics of the course of COVID-19 in patients with diabetes are limited. In one of the first reports of Chinese colleagues from Wuhan, diabetes mellitus was present in 42. 3% of 26 deaths [10]. The results of other observations in the same population in the city of Wuhan were contradictory: J. Zhang et al. [11] did not confirm the presence of diabetes mellitus as a risk factor for a severe course of the disease (n = 140), and Q. Ruan et al. [12] reported that the number of concomitant chronic diseases is a significant predictor of mortality (n = 150, 68 deaths and 82 recovered patients).An analysis of 11 studies on major laboratory abnormalities in patients with COVID-19 found no relationship between hyperglycemia and severe infection [13].

However, a cumulative report of 72,314 cases of COVID-19 published by the China Center for Disease Control and Prevention confirmed an increased mortality rate in people with diabetes (7.3% versus 2.3% of patients without carbohydrate metabolic disorders) [14]. According to W. Guan et al. [15], among 2020 patients (1590 people had a laboratory-confirmed diagnosis of COVID-19) who were admitted to the intensive care unit from mid-December to January 31, 2020.and those who required invasive ventilation of the lungs or died, the most common were patients with hypertension (16.9%) and diabetes mellitus (8.2%). Another 8.2% had several diseases. After adjusting for age and smoking, the most frequently aggravated course of COVID-19 was chronic obstructive bronchitis (hazard ratio, RR, 2.681; 95% confidence interval, CI, 1.424-5.048), diabetes mellitus (RR 1.59; 95% CI 1.03 −2.45), hypertension (RR 1.58; 95% CI 1.07-2.32) and malignant tumors (RR 3.50; 95% CI 1.60-7.64) [15].

The results are not surprising. The vast majority of patients with type 2 diabetes mellitus are people over 65 years of age, for whom the risks of a severe course of viral (with the influenza virus) or bacterial pneumonia (for example, caused by pneumococcus) have been proven. This is why many countries are so aggressively offered annual preventive influenza vaccinations for diabetic patients.

In the current conditions of the pandemic, international diabetological associations began to promptly cover the issues of adaptation of people with diabetes to the changed conditions of medical care. In our country, one of the authors of this article has already delivered a lecture at a professional medical forum on the topic “COVID-19 and diabetes” [16]. In many ways, the position of Russian doctors coincides with the position of associations of endocrinologists and diabetologists in other countries. Undoubtedly, the challenge that doctors in the world have received amid a pandemic requires a quick response. Patients with various endocrinopathies should have all the necessary information and understand that the best care in the available conditions will be provided to them.

SPECIFIC FEATURES OF THE ORGANIZATION OF MEDICAL CARE FOR PATIENTS WITH DIABETES IN THE CONDITIONS OF THE COVID-19 PANDEMIC

General rules and personal responsibility
It is important for our patients to know that diabetes in itself does not predispose to infection, but in this group of people, both due to age and due to concomitant cardiac pathology, the risks of having severe interstitial pneumonia are higher [17 ], therefore, for this cohort, self-isolation and the implementation of all general measures for the prevention of coronavirus infection are especially important.All recommendations for self-isolation and hygiene must be followed with utmost care. No specific “anti-COVID-19 immunity-boosting” therapy currently exists. The personal responsibility of the person with diabetes and their family members is important.

Organization of work with patients
It must be said that an excellent model of doctor-nurse-patient interaction has long been created in diabetology, and diabetes schools are already more than 50 years old. In the new hypostasis of communication through gadgets, this form has become acceptable for the majority of socially active people with diabetes, therefore, in essence, just a new page in communication will be added [18].

It is important to understand that in the context of the growing shortage of medical personnel engaged in the fight against the pandemic, the organization of patient care is changing: minimizing risky exits to crowded places will require doctors to modify their interaction with patients with diabetes.

Of course, patients with diabetes should be provided with the necessary supply of drugs and test strips. The pharmaceutical industry recognizes the importance of ensuring that diabetics have the right medicines without interruption.In turn, doctors should remind their patients of strict adherence to the rules of diabetes control, including in the event of any infection, in no case should the dosage be reduced, and even less so, the insulin administered should not be canceled. The new rules for issuing prescriptions should be used as much as possible and thus try to ensure a supply of medicines and consumables for several months.

The possibilities of telemedicine and remote consulting are expanding. At the Federal State Budgetary Institution “National Medical Research Center of Endocrinology” of the Ministry of Health of Russia (https: // www.endocrincentr.ru), a telemedicine consultation center is constantly operating and updated information on the topic of COVID-19 and endocrinopathies is being updated. Of course, one should not refuse urgent consultations and hospitalizations. There will always be those patients who need urgent help – people with ketoacidosis or diabetic foot syndrome.

As you know, at least 18% of hospital beds in the world are usually occupied by patients with diabetes mellitus, and one should not expect that their number will be less among hospitalized with coronavirus infection.Moreover, this number may increase in the near future. Therefore, it should be as energetic as possible to transfer to outpatient follow-up care for patients who have already received inpatient treatment, to warn them about the importance and greater safety of home treatment, especially since many hospitals will be temporarily redesigned to provide assistance with COVID-19.

For all non-urgent questions, people with diabetes should contact their doctors by phone or
using telemedicine technologies.Specialists now should postpone for a while all non-urgent issues with diabetes patients, although if contacts are weakened in the future, a sharp jump in new calls can be expected, therefore it is important for endocrinologists to understand and prevent these calls.

Continuation of hypoglycemic and cardiac therapy.
Hypoglycemic therapy should be substantially revised in the presence of COVID-19 in patients with type 2 diabetes mellitus. Today, the unanimous position of many diabetic communities is that in case of suspicion of COVID-19 in patients with type 2 diabetes mellitus, they should stop treatment with drugs that include metformin, sodium glucose cotransporter type 2 inhibitors or glucagon-like receptor agonists. peptide-1, and they are immediately transferred to alternative glucose-lowering, most often insulin, therapy.Data on the need to cancel or the advisability of continuing to take dipeptidyl peptidase-4 inhibitors are still controversial [17].

Another alarming topic, which patients turn to, is the mechanism of the virus’s influence on the lung tissue by means of a type 2 angiotensin-converting enzyme [6]. Speculations on this topic in open sources of information cannot but alarm patients receiving angiotensin-converting enzyme inhibitors. It is very important to recall the position of the European Society of Cardiology (ESC), American Heart Failure Society (HFSA), Hypertension Societies of Canada (CHS), American College of Cardiology / American Association American College of Cardiology / American Heart Association ACC / AHA – statement regarding angiotensin-converting enzyme inhibitors and angiotensin receptor blockers [19-21].Global associations remind that “there are currently no experimental or clinical data indicating favorable or unfavorable outcomes with the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or other antagonists of the renin-angiotensin system in patients with COVID-19 and a history of cardiovascular disease taking these drugs ”. The HFSA, ACC, and AHA experts recommend that renin-angiotensin antagonists continue to be used in patients who are currently prescribed such drugs for indications and for whom they are effective for conditions such as heart failure, arterial hypertension or coronary artery disease. In the event that patients with cardiovascular diseases are diagnosed with COVID-19, individual treatment decisions should be made in accordance with the hemodynamics and clinical picture of each patient, and it is not recommended to add or cancel any therapy methods related to the renin-angiotensin system. outside the scope of standard clinical practice [19-21].

According to Russian cardiologists, in case of a stable course of chronic heart failure, it is necessary to continue taking all recommended drugs, since there is no evidence of the risks of using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers when infected with SARS-CoV-2 [22].Cancellation of basic drug therapy (angiotensin converting enzyme / angiotensin receptor and neprilysin inhibitors, angiotensin receptor inhibitors and neprilysin / angiotensin receptor blockers) in a patient with stable heart failure or in a patient with mild forms of COVID-19 (without lung damage) is not justified. In case of development of pneumonia associated with infection with SARS-CoV-2, therapy with angiotensin-converting enzyme inhibitors / angiotensin receptor blockers can be temporarily stopped [22].

Type 2 angiotensin-converting enzyme receptors are also present in the islets of Langerhans in the pancreas, which increases the likelihood of a direct virus effect on the endocrine pancreas [23]. Previously, it was shown that SARS (and its causative agent is close to the causative agent of COVID) can induce transient insulin resistance, but currently there is no evidence for COVID-19 and possible predictions for COVID-19 do not yet have an evidence base.However, as with any infection, it may be necessary to increase the dose of insulin and replace the oral medication with insulin depending on the clinical situation. It is assumed that the availability of continuous glucose monitoring will allow for better compensation of carbohydrate metabolism in the context of the onset of COVID-19.

Unfortunately, as with any infection, patients with type 1 diabetes mellitus and COVID-19 may develop ketoacidosis (rather than typical pulmonary symptoms), which complicates patient management and differential diagnosis with pulmonary lesions in COVID-19.Non-diabetic patients admitted to the intensive care unit may develop hyperglycemia, which will require more aggressive management than the normal stress hyperglycemia of the critically ill person [23]. It should also be borne in mind the possibility of seasonal flu overlap in unvaccinated individuals, or even a combination of influenza and COVID-19.

A special category – pregnant women with diabetes, who should be managed according to the general laws of managing pregnant women with COVID-19 and who should be especially closely monitored for their glycemic profile.By now, data on such clinical situations have already been accumulated, and they are quite optimistic.

FEATURES OF THE ORGANIZATION OF MEDICAL CARE FOR PATIENTS WITH OTHER ENDOCRINOPATHIES UNDER COVID-19 PANDEMIC CONDITIONS

Thyroid diseases
The second most common group of people with endocrinopathies are people with thyroid diseases. In the absence of dysfunction of the gland, there are no additional risks or special rules for prevention and management in the event of a COVID-19 infection.But there are a number of special questions that arise in relation to situations with impaired thyroid status. Many of our patients, who are on substitution therapy for hypothyroidism, as well as patients with diffuse toxic goiter, are worried about whether their background endocrine disease of an autoimmune nature or taking medications creates an unfavorable soil from the standpoint of high risks of infection.
or a greater likelihood of the severity of the course.

Of course, there is no evidence that these people are more likely to be infected than the general population, but it is worthwhile to assess the risk / benefit ratio as much as possible before violating maximum possible isolation or hygiene in a pandemic.

For patients with hypothyroidism, it is important to remember that adherence to the rules of thyroxine replacement therapy increases their resistance to any infection, and poor compensation for hypothyroidism can artificially lower body temperature, making it difficult to adequately assess the severity of an infectious disease and thereby reducing the likelihood of timely help. Interruption of thyroxine substitution is unacceptable and should be continued both in the hospital and in the intensive care unit.

With diffuse toxic goiter , selected monotherapy with thyrostatics or combined treatment with thyrostatics and thyroxine should also be continued.Since at present planned surgical interventions or treatment with radioactive iodine will be postponed, conservative tactics should be continued and the indications for control studies should be discussed remotely with the doctor.

Patients with diffuse toxic goiter who have recently started thyrostatic therapy should not forget that these drugs have side effects (sore throat and diarrhea) with fever, and these phenomena, formally resembling infection, may be associated with agranulocytosis …Careful adherence to the instructions will avoid extremely unwanted mistakes.

Persons treated for highly differentiated thyroid cancer (operatively or operatively in combination with radioactive iodine) must also comply with all necessary preventive measures. And although the form of cancer they have undergone and the treatment they do do not create any additional risks of infection, anxiety may arise due to delays in the planned follow-up examination. It is important to warn patients about the possible delay of the examination by several months and that this will not harm their health.

Quite a psychologically difficult situation with patients in whom surgery for highly differentiated thyroid cancer or surgical treatment for neoplasia with undetermined cytology was planned for the next month as the final stage of diagnosis. It is important to understand that after the elimination of the pandemic, these patients will receive priority treatment and the forced delay will not negatively affect their health.

Patients with rare forms of malignant tumors of the thyroid gland (medullary carcinoma, aggressive forms of cancer) receiving tyrosine kinase inhibitors should remotely contact their doctor to monitor treatment.At present, there is no information about such rare situations that makes it possible to single out these groups of patients.

Adrenal diseases
Patients with primary or secondary adrenal insufficiency, as well as parents of children with a salt-wasting form of congenital adrenal cortex dysfunction, when an infection occurs, follow the same rules as in other situations with intercurrent diseases. In adrenal insufficiency, the dose of glucocorticosteroids should be increased and injectable drugs (hydrocortisone, dexamethasone) should always be in stock, which are administered when an addison crisis is threatened (a sharp drop in pressure, nausea, vomiting, impaired consciousness).Sufficient salting of food is necessary.

Diseases of the parathyroid glands
Persons with hypoparathyroidism should carefully follow the recommended treatment regimen, and in the event of complaints typical for decompensation of the disease (numbness, convergence of fingers and toes), increase the therapy taken (by 500-1000 mg of elemental calcium and by 0.25-0.5 μg of active forms vitamin D). If symptoms persist, it is necessary to discuss further management with a doctor, which can be implemented through telemedicine technologies.In the case of the development of life-threatening hypocalcemic conditions, hospitalization in a specialized hospital is necessary.

Persons with primary hyperparathyroidism who postponed the planned surgical treatment should reduce their calcium intake with food, increase fluid intake: in these conditions, postponing the operation for several months will not harm their health. In the event of nausea, polyuria, polydipsia, you should contact your doctor by phone to analyze the situation and correct treatment.Persons receiving symptomatic therapy with calcimimetics and bisphosphonates should continue treatment. Persons with secondary hyperparathyroidism (especially due to chronic kidney disease) should strictly follow the recommendations for planned therapy (calcimimetics, calcium and vitamin D preparations, phosphate binders). In the case of planned surgical treatment, regular medication can delay the operation for several months.

It is extremely important to stock up on the maximum possible amount of drugs that are indicated for the underlying disease, and to follow the regimen of their intake as carefully as possible.

Pituitary gland diseases
Persons with pituitary adenomas should continue their treatment and also carefully observe hygiene and self-isolation regimes. In the presence of hypopituitarism, which consists in the development of secondary adrenal insufficiency and secondary hypothyroidism, it is necessary to adhere to the same recommendations as in the primary forms of the disease given above.

For patients with central diabetes insipidus, it is necessary to continue taking desmopressin preparations in previously selected dosages, as well as “out of thirst”, avoiding excessive fluid intake.In the event of an emergency related to a severe form of COVID-19, hospitalization in an intensive care unit, [24]:
• continuation of desmopressin therapy with indication of the drug and dose;
• monitoring the level of sodium and potassium in the blood;
• monitoring of water balance;
• correction of doses of desmopressin if massive infusion therapy is necessary, the impossibility of replenishing fluid loss with urine or the development of dysnatremia.

CONCLUSION

The COVID-19 pandemic clearly demonstrates that outbreaks of new viral infections continue to be an urgent problem for global health.Taking into account the rate of spread of SARS-CoV-2 and the large number of infected, as well as the lack of pathogenetic therapy, at present, the efforts of all specialists should be thrown into coordinated joint work on prevention, diagnosis, development of new treatments and the creation of vaccines against COVID-19. …

Type 2 diabetes mellitus and arterial hypertension are the most common and unfavorable comorbidities in patients with coronavirus infections.Fundamental studies indicate a direct relationship between the pathogenesis of the disease and the most important metabolic and endocrine processes. Thus, endocrinologists have been assigned new tasks – to inform patients with endocrinopathies as quickly as possible, especially those with diabetes, about the risks that a pandemic can potentially cause to their health, about methods of preventing infection and about the tactics of managing people with endocrinopathies in case of illness.

Endocrinologists can and should arrange remote consultations for our patients.On the website of the National Medical Research Center of Endocrinology of the Ministry of Health of the Russian Federation, telemedicine consultations, including video communication, are carried out in full for all persons previously treated on an outpatient basis or in a hospital of the center. In all difficult cases, assistance can be provided in the doctor-doctor mode. Patients with endocrine disorders should consider that in a pandemic, visits to doctors should be made only when problems cannot be resolved in absentia. It is advisable to make the most of the possibilities of modern information technologies, and it is better to carry out the necessary analyzes at home.

This article was provided by the EAT Partner – Scientific and practical medical peer-reviewed journal “Problems of Endocrinology”

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ADDITIONAL INFORMATION
Source of funding. Search and analytical work and preparation of the article were carried out at the personal expense of the team of authors.
Conflicts of interest. The authors declare no obvious and potential conflicts of interest related to the publication of this article.
Contribution of authors. All authors made a significant contribution to the search and analytical work and preparation of the article, read and approved the final version before publication.

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AUTHOR INFORMATION
* Pigarova Ekaterina Aleksandrovna, MD [Ekaterina A. Pigarova, MD, PhD]; address: (117036, Moscow,
st. Dmitry Ulyanova, 11) [address: 11 Dm.Ulyanova street, 117036 Moscow, Russia]; e-mail: [email protected];
SPIN code: 6912-6331; ORCID: http://orcid.org/0000-0001-6539-466X;
Melnichenko Galina Afanasyevna, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences [Galina A. Melnichenko, MD, PhD, Professor];
e-mail: teofrast2000 @ mail.ru, SPIN code: 8615-0038, ORCID: http://orcid.org/0000-0002-5634-7877
Mokrysheva Natalia Georgievna, MD, DSc, Corresponding Member RAS [Natalia G. Mokrysheva, MD, PhD]; e-mail: [email protected],
SPIN: 5624-3875, ORCID: http://orcid.org/0000-0002-9717-9742
Eremkina Anna Konstantinovna, Ph.D. [Anna K. Eremkina, PhD]; address: Russia, 117036, Moscow,
st. Dm. Ulyanov, 11 [address: 11 Dm. Ulyanova street, 117036 Moscow, Russia]; e-mail: [email protected],
SPIN: 8848-2660, ORCID: http: // orcid.org / 0000-0001-6667-062X
Galstyan Gagik Radikovich, Doctor of Medical Sciences, Professor [Gagik R. Galstyan, MD, PhD, Professor];
e-mail: [email protected], SPIN code: 9815-7509, ORCID: https://orcid.org/0000-0001-6581-4521
Kirzhakov Mikhail Anatolyevich [Michael A. Kirzhakov]; e-mail: [email protected], SPIN-code: 9815-7509,
ORCID: https://orcid.org/0000-0001-6809-3504
QUOTE:
Mokrysheva N.G., Galstyan G.R., Kirzhakov M.A., Eremkina A.K., Pigarova E.A., Melnichenko G.A. Pandemic COVID-19 and EN-
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9. Molitch ME, Clemmons DR, Malozowski S, et al. Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline.J Clin Endocrinol Metab. 2011; 96 (6): 1587-1609. doi: https://doi.org/10.1210/jc.2011-0179

10. van Iersel L, Li Z, Srivastava DK, et al. Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors: Prevalence, Risk Factors and Long-Term Health Outcomes. J Clin Endocrinol Metab. 2019; 104 (12): 6101-6115. doi: https://doi.org/10.1210/jc.2019-00834

11.Bobrova EI, Pavlova MG, Sotnikov VM, et al. Hypopituitarism after irradiation of the hypothalamic-pituitary system // Clinical and Experimental Thyroidology. – 2013. – T. 9. – No. 3. – S. 15-20. doi: https://doi.org/10.14341/ket20139315-20

12. Tselovalnikova T.Yu., Pavlova MG, Zilov AV, et al. Growth hormone deficiency and metabolic disorders in patients after radiation and polychemotherapy of malignant tumors of the posterior cranial fossa // Problems of endocrinology.- 2014. – T. 62. – No. 2. – S. 12-24. doi: https://doi.org/10.14341/probl201662212-24

13. Brignardello E, Felicetti F, Castiglione A, et al. Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics. Eur J Endocrinol. 2013; 168 (3): 465-472. doi: https://doi.org/10.1530/EJE-12-1043

14.Chemaitilly W, Li Z, Huang S, et al. Anterior Hypopituitarism in Adult Survivors of Childhood Cancers Treated With Cranial Radiotherapy: A Report From the St Jude Lifetime Cohort Study. J Clin Oncol. 2015; 33 (5): 492-500. doi: https://doi.org/10.1200/JCO.2014.56.7933

15. Yang H, Yan K, Yuping X, et al. Bone microarchitecture and volumetric bone density impairment in young male adults with childhood-onset growth hormone deficiency.Eur J Endocrinol. 2019; 180 (2): 145-153. doi: https://doi.org/10.1530/EJE-18-0711

16. Rodari G, Cattoni A, Albanese A. Final height in growth hormone-deficient childhood cancer survivors after growth hormone therapy. J Endocrinol Invest. 2020; 43 (2): 209-217. doi: https://doi.org/10.1007/s40618-019-01102-w

17. Tselovalnikova T.Yu., Pavlova MG, Zilov AV, et al. Growth disorders and metabolic disorders in patients who underwent treatment of oncological diseases in childhood // Problems of endocrinology. – 2016. – T. 62. – No. 5. – S. 62-63. doi: https://doi.org/10.14341/probl201662562-63

18. D’Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): Pathogenesis and clinical implications. Cancer Treat Rev. 2015; 41 (9): 798-808.doi: https://doi.org/10.1016/j.ctrv.2015.09.003

19. Sabir S, Akhtar MF, Saleem A. Endocrine disruption as an adverse effect of non-endocrine targeting pharmaceuticals. Environ Sci Pollut Res. 2019; 26 (2): 1277-1286. doi: https://doi.org/10.1007/s11356-018-3774-4

20. Dixit M, Poudel SB, Yakar S. Effects of GH / IGF axis on bone and cartilage.Mol Cell Endocrinol. 2021; 519 (2): 111052. doi: https://doi.org/10.1016/j.mce.2020.111052

21. Chemaitilly W, Cohen LE. Diagnosis of endocrine disease: Endocrine late-effects of childhood cancer and its treatments. Eur J Endocrinol. 2017; 176 (4): R183-R203. doi: https://doi.org/10.1530/EJE-17-0054

22. Ambroszkiewicz J, Gajewska J, Rogowska E, et al.Decreased bone mineral density and alteration in biochemical bone metabolism markers in children affected by bone tumors after completion of therapy. Neoplasma. 2015; 62 (02): 288-294. doi: https://doi.org/10.4149/neo_2015_034

23. Petraroli M, D’Alessio E, Ausili E, et al. Bone mineral density in survivors of childhood brain tumors. Child’s Nerv Syst. 2006; 23 (1): 59-65. doi: https://doi.org/10.1007/s00381-006-0175-7

24.Pietilä S, Sievänen H, Ala-Houhala M, et al. Bone mineral density is reduced in brain tumor patients treated in childhood. Acta Paediatr. 2006; 95 (10): 1291-1297. doi: https://doi.org/10.1080/08035250600586484

25. Kang MJ, Lim JS. Bone mineral density deficits in childhood cancer survivors: Pathophysiology, prevalence, screening, and management. Korean J Pediatr. 2013; 56 (2): 60. doi: https://doi.org/10.3345/kjp.2013.56.2.60

26. Wilson CL, Ness KK. Bone Mineral Density Deficits and Fractures in Survivors of Childhood Cancer. Curr Osteoporos Rep. 2013; 11 (4): 329-337. doi: https://doi.org/10.1007/s11914-013-0165-0

27. Remes TM, Arikoski PM, Lähteenmäki PM, et al. Bone mineral density is compromised in very long-term survivors of irradiated childhood brain tumor.Acta Oncol (Madr). 2018; 57 (5): 665-674. doi: https://doi.org/10.1080/0284186X.2018.1431401

28. Cohen LE, Gordon JH, Popovsky EY, et al. Bone density in post-pubertal adolescent survivors of childhood brain tumors. Pediatr Blood Cancer. 2012; 58 (6): 959-963. doi: https://doi.org/10.1002/pbc.23300

29. Hartley H, Pizer B, Lane S, et al.Incidence and prognostic factors of ataxia in children with posterior fossa tumors. Neuro-Oncology Pract. 2019; 6 (3): 185-193. doi: https://doi.org/10.1093/nop/npy033

30. Hart NH, Newton RU, Tan J, et al. Biological basis of bone strength: anatomy, physiology and measurement. J Musculoskelet Neuronal Interact. 2020; 20 (3): 347-371.

31.Delyagin V.M. Decrease in bone density in different age periods (multifaceted problem) // Medical Council. – 2012. – No. 2. – S. 94-99.

32. Shuhart CR, Yeap SS, Anderson PA, et al. Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics.J Clin Densitom. 2019; 22 (4): 453-471. doi: https://doi.org/10.1016/j.jocd.2019.07.001

33. Tsoriev T.T., Belaya Zh.E., Melnichenko G.A. Trabecular Bone Index is a non-invasive method for assessing bone quality based on routine dual energy densitometry. Prospects for use in clinical practice // Almanac of Clinical Medicine. – 2016. – T. 44. – No. 2. – S. 462-476. doi: https://doi.org/10.18786/2072-0505-2016-44-4-462-476.

34. Golounina OO, Belaya Zh.E. Bisphosphonates: 50 years in medical practice // Consilium Medicum. – 2020. – T. 22. – No. 4. – S. 66-73. doi: https://doi.org/10.26442/20751753.2020.4.200102

35. White J.E., Rozhinskaya L.Ya. New directions in the therapy of osteoporosis – the use of monoclonal human antibodies to RANKL (Denosumab) // Osteoporosis and Osteopathy.- 2011. – T. 14. – No. 2. – S. 23-26. doi: https://doi.org/10.14341/osteo2011223-26

36. White J.E., Rozhinskaya L.Ya. Anabolic therapy for osteoporosis. Teriparatide: efficacy, safety and field of application // Osteoporosis and osteopathy. – 2013. – T. 16. – No. 2. – S. 32-40. doi: https://doi.org/10.14341/osteo2013232-40

37. Kralick AE, Zemel BS.Evolutionary Perspectives on the Developing Skeleton and Implications for Lifelong Health. Front Endocrinol (Lausanne). 2020; 11: 99. doi: https://doi.org/10.3389/fendo.2020.00099

endocrine disorders – Russian translation – Linguee

In addition to oncological diseases, to draw attention to the following pathological conditions: hypertensive disease, ischemic heart disease, liver diseases, diseases of

[…]

nervous system and sense organs, diseases of blood

[…]
and blood-forming organs, respiratory disea se s , endocrine disorders .

urcrm.ru

In addition to oncological diseases, draw attention to the following pathologies: hypertension, coronary artery disease, liver disease, diseases

[…]

nervous system, sensory organs,

[…]
diseases of the blood and blood in orn s x organs , diseases d s hut ate other pathways, endocrine […]

violations.

urcrm.ru

Endocrine disorders , p ar ticularly diabetes, are responsible for a significant […]

morbidity and mortality rate.

daccess-ods.un.org

B ol ez n and endocrine system , in especial diabetes, are among the causes […]
markedly high morbidity and mortality.
daccess-ods.un.org

According to Ministry of Health research, the following ailments are the primary causes of

[…]

disability in children under 18 years of age:

[…]
neoplasia; malignant neoplasm; and bl oo d , endocrine , e ye and nervous-system diseases or me nt a 903.

daccess-ods.un.org

Research by the Ministry of Health of the Republic of Belarus shows that the main causes of disability in children under the age of 18 are the following:

[…]

neoplasms,

[…]
malignant neoplasms, b o lez n and blood , b o lez ni endocrine and nn n 9033 9033 9033 9033 ps of them andh European disorders, diseases […]

nervous system, eye diseases.

daccess-ods.un.org

Chronic health impacts associated with

[…]
pesticides include cancers and tumors, nervous sy st e m disorders , r ep roductive problems, immune system effects, a n endocrine s y st em disruption.9

ipen.org

Pesticide-related

[…]

chronic effects include malignant and

[…]
benign tumors, diseases of the nerve n oi systems, re pr oductive disorders, suppressed e ny immune s is those we and endocrine disorders

ipen.org

It is especially good for the

[…]
heart, blood vessels, skin, metabo li s m disorders , endocrine s y st em, other rheumatisms and many …

ailments.

president.gov.ge

It is especially good for the treatment of diseases

[…]
heart and blood vessels from o su to in , skin, e nd ok r in but nd n r ar ush en Iya exchange of things, rheumatism […]

and many other diseases.

president.gov.ge

Reasons for stay at the Dead Sea resorts of Jordan are varying: from rejuvenation, face, hair and body care programs, to skin diseases,

[…]

rheumatic diseases, ENT-pathologies, diseases of

[…]
bronchi and lungs, post-operative rehabilitat io n , disorders o f c ardio-vascu la r , r ep roductive, and nervous system.

intmedtourism.com

Indications for staying in the resorts of the Dead Sea Jordan are varied: from rejuvenation, programs for face, hair and body care, to skin diseases,

[…]

rheumatic diseases, ENT pathologies, diseases

[…]
broncho-pulmonary system, postoperative and on but n rehabilitation, n ar us en s yd e vascular, e nd o cree nn oops, reproductive and nervous systems.

intmedtourism.com

Programs are being carried out with technical and financial support from international organizations to ensure safe motherhood, neonatal care, immunization, the early growth and

[…]

development of children, the

[…]
prevention of micronutr ie n t disorders , a nd also to implement the […]

WHO recommended strategy on

[…]

the integrated management of childhood illnesses.

daccess-ods.un.org

With the technical and financial support of international organizations, programs for safe motherhood, neonatal are being implemented

[…]

care, immunization,

[…]
early growth and development de those th , prevention m and cr he ut rent disorders, […]

as well as the implementation of the strategy

[…]

Integrated Management of Childhood Illness, recommended by WHO.

daccess-ods.un.org

By the end of November 2002, the International Union for Pure and Applied Chemistry (IUPAC) and the Scientific Committee on Problems of the Environment (SCOPE) had prepared a synthesis and state-of-the-art assessment of

[…]

existing knowledge on the

[…]
environmental implication s o f endocrine a c ti ve substances […]

and submitted it to an international

[…]

symposium held in Yokohama (Japan).

unesdoc.unesco.org

By the end of November 2002, the International Union of Pure and Applied Chemistry (IUPAC) and the Scientific Committee on Environmental Problems

[…]

(SCOPE) prepared a synthesis report and

[…]
assessment of modern zn en and nd about e to ol og ich ..]

active endocrine substances and

[…]

submitted them to the international symposium held in Yokohama (Japan).

unesdoc.unesco.org

In its function a s a n endocrine o r ga n, adipose […]

tissue secretes hormones, cytokines, and growth factors that help to regulate

[…]

insulin sensitivity, inflammation, nutrient and energy homeostasis, and lipid metabolism.

herbalifenutritioninstitute.com

Within their fu n cc n c c a ch tv e endocrine […]

organ adipose tissue secretes hormones, cytokines and growth factors, which

[…]

helps regulate insulin sensitivity, inflammation, nutrient and energy homeostasis, and lipid metabolism.

herbalifenutritioninstitute.com

Kappa receptors,

[…]
when activated, can pro du c e endocrine c h an ges and analgesia but appear […]

to produce dysphoria rather than euphoria.

uiphp.org.ua

Upon activation

[…]
kappa receptors can s s wa t s endocrine from m en en oi and analgesia, but […]

provoke dysphoria rather than euphoria.

uiphp.org.ua

Author and co-author of numerous works on various topics in psychiatry, such as psychopharmacology, early intervention of schizophrenia, mental health and HIV / AIDS and

[…]

drug use, mental

[…]
health outcome of harmful alcohol use, neuropsychology of me nt a l disorders , n eu roimaging of late life depression, late onset psychosis, […]

and assessment, treatment and care for dementia.

incb.org

Author and co-author of numerous works on psychiatry, including topics such as psychopharmacology, early diagnosis and treatment of schizophrenia, mental health of HIV / AIDS patients and

[…]

drug addiction, consequences

[…]
alcohol abuse for the psyche s kog o health, n eir op sychological ac n ek t mental s 9033 , neuroimaging depressive […]

disorders in individuals

[…]

elderly, blueness psychosis, diagnosis and treatment of dementia and care for patients with dementia.

incb.org

The Committee is deeply concerned that the years of turmoil and violence in the State party have resulted in high

[…]

levels of mental health problems and yet there are no

[…]
provisions for treatment of people suffering from me nt a l disorders .

daccess-ods.un.org

The Committee is deeply concerned that, owing to years of turmoil and violence in the State party to

[…]

mental health has taken on a large scale and that

[…]
not provided with treatment e l and c, suffering from d at shev n disorders.

daccess-ods.un.org

In addition, one of Maamar Ouaghlissi’s daughters, Khaoula Ouaghlissi, who is now 18 years old, was particularly affected by her father’s disappearance and suffers to this day from chronic psych ot i c t h at require constant and regular medical treatment.

daccess-ods.un.org

In addition, one of Maamar Waghlissi’s daughters, Kaula Waghlissi, now 18 years old, was particularly affected by the disappearance of her father and still suffers from chronic psychosis that requires constant and regular medical care.

daccess-ods.un.org

They are empowered to restore any violated rights and protect

[…]

the legitimate interests of

[…]
persons affected by me nt a l disorders , a nd to bring charges against […]

offenders in that regard.

daccess-ods.un.org

In accordance with the authority granted, they accept

[…]

recovery measures

[…]
of violated rights and protection z and to nn s x interests l ic , pp ad psychic […]

disorders, involvement

[…]

violators to responsibility.

daccess-ods.un.org

The Kootenay National Park in the Valley of a Thousand Peaks is the site of hot mineral springs which

[…]

have an especially healthful effect on the musculoskeletal

[…]
apparatus, blood circulat or y , endocrine , a nd nervous system.

intmedtourism.com

In the Kutney National Park, in the valley of “Thousand Peaks”, there are hot minerals

[…]

sources that have a particularly beneficial effect

[…]
for musculoskeletal e l n n apparatus, to po ve but nasal, endocrine […]

and the nervous system.

intmedtourism.com

Mu and delta receptors are involved in systems

[…]

that influence mood, reinforcing behaviors, respiration, pain,

[…]
blood pressure a n d endocrine a n d gastrointestinal […]

function.

uiphp.org.ua

The mu and delta receptors are involved in systems affecting

[…]

mood, behavior, breathing, pain,

[…]
blood pressure n ue and functions f barely zy internal secretion […]

and the gastrointestinal tract.

uiphp.org.ua

8. 7. 2 . endocrIne d I sr uptors: thyocyanates, Isoflavons, dIsulfIdes, chlorIne-contaInIng organIc substances, IncludIng synthetIc pestIcIdes and InsectIcIdes (dIchlorInepIphenIldIchloretan, atrasIn, hexachlorobenzene, chlorInephenoxI-contaInIng herbIcIdes; polychlorInated bIphenyl’s , polychlorInated dIoxIns, furans and other.

scienceagainstaging.org

8.7.2. nocrine disruptors: thiocyanins, isoflavones, disulfides, chlorine-containing organic substances, including pesticides and insecticides formed in the course of chemical synthesis (ddT, aTrazine, hexachlorobenzine, chlorophenoxy-containing herbicides, polychlorinated bichloroids.

This is one of the most outstanding spas for treating diseases

[…]

of the respiratory, motor and cardiovascular systems, together with

[…]
diseases of t h e endocrine s y st em and the […]

metabolism.

staypoland.com

Kolobrzeg is one of the most famous spas specializing in the treatment of diseases

[…]

respiratory system, cardiovascular

[…]
diseases, illness e th locomotor -dv ig of the […]

as well as endocrinological and metabolic diseases.

staypoland.com

It also uses

[…]
three additional categor ie s : endocrine d i sr uption, inhalative toxicity […]

and bee toxicity.

ipen.org

In addition to them, three were also used

[…]
additional categories: p earlier n ni endocrine n p ots eu s b, toxicity at […]

inhalation and bee toxicity.

ipen.org

Hormone replacement therapy may

[…]

alleviate the debilitating

[…]
conditions of secondary par ti a l endocrine d e fi ciencies by preventing or […]

delaying some aspects of aging (1).

scienceagainstaging.com

Hormone replacement therapy can improve disruptive

[…]

health pathological

[…]
states of secondary parts s ty chn s x endocrine not d os ta then chn by preventing […]

or slowing down some

[…]

aspects of aging (1).

scienceagainstaging.com

Female mortality rates exceeded male mortality rates in

[…]

diseases of the circulatory system (especially

[…]
cerebral-vascular diseas es ) , endocrine , n ut rition and metabolism […]

diseases.

daccess-ods.un.org

Female mortality rates are higher than male mortality rates for diseases of the system

[…]

blood circulation (especially

[…]
cerebrovascular disease c en iya ), endocrine si s s, digestive system […]

and metabolism.

daccess-ods.un.org

Terme Sirmione at lake Garda produces an invigorating and relaxing

[…]

effect, lowers arterial pressure,

[…]
stimulates the functio n o f endocrine s y st em, relieves allergic […]

reactions, produce a healthful

[…]

effect on bone tissues, and possess a pain-relieving effect.

intmedtourism.com

Terme Sirmione on Lake Garda has a tonic and

[…]

relaxing effect, reduce

[…]
arterial pressure, stim y li ru r t work en d ok ri nn system, remove […]

allergic reactions,

[…]

has a beneficial effect on bone tissue and has an analgesic effect.

intmedtourism.com

Substances and preparations, or the breakdown products of such, which have been proved to possess carcinogenic or mutagenic properties or properties which

[…]

may affect steroidogenic,

[…]
thyroid, reproduction or o th e r endocrine – r e la ted functions in or […]

via the aquatic environment.

blacksea-riverbasins.net

Substances and preparations or their decomposition products which have established carcinogenic or mutagenic properties, or may affect the action of steroids,

[…]

thyroid gland, at

[…]
reproductive system or at in s e functions en d ok ri nn systems in water […]

medium, or through such an aqueous medium.

blacksea-riverbasins.net

Oestrogen mimicking chemicals are part of a

[…]

group of chemicals called

[…]
hormone disruptors o r “ endocrine d i sr upting” chemicals (t h e 903 903 903 903 903 903 903 903 903 903 903 g an ds secrete hormones […]

in the body).

chemicalshealthmonitor.org

Chemicals that mimic estrogen belong to group

[…]

substances called

[…]
“Hormonal destroyers m and” or “e nd ocrinn s mi destroyers” (e nd the circumferential glands secrete […]

hormones in the body).

chemicalshealthmonitor.org

As is well known, the APUD system,

[…]
along with nervous a n d endocrine s y st ems, is a specific […]

integraa tive system of organismal

[…]

regulations which consists of special cells: apudocytes located everywhere in tissues and having specific ultrastructural and cytochemical characteristics.

mavis.science-center.net

As you know,

[…]
APUD-system for p poison y c nervous and e nd ca rinal systems […]

is a special integrative regulation system

[…]

organism, which consists of special apudocyte cells located throughout the tissues and possessing specific ultrastructural and cytochemical properties.

mavis.science-center.net

It is known that many brain diseases, supramaxillary and

[…]
ethmoidal cells and al s o endocrine d i se ases are accompanied […]

by the syndrome of unilateral or bilateral exophthalmos.

uk.metatron-nls.ru

It is known that many

[…]

diseases of the brain, maxillary

[…]
and lattice pa zu x , a t a kzh e en precrine diseases […]

are accompanied by a syndrome of unilateral

[…]

or bilateral exophthalmos, which in many cases raises suspicion of oncological eye pathology.

metatron-nls.ru

List of contraindications for donating blood and its components

List of contraindications for donating blood and its components

If you have questions about blood donation
call (343) 351-11-14

I.ABSOLUTE CONTRAINDICATIONS
(withdrawal from donation regardless of the duration of the disease and treatment results)

1. Bloodborne diseases:
1.1. Infectious:
– AIDS, HIV infection and persons at risk (homosexuals, drug addicts, prostitutes)
– Syphilis, congenital or acquired
– Viral hepatitis, positive test result for markers of viral hepatitis (HBsAg, anti- HCV antibodies)
– Tuberculosis, all forms
– Brucellosis
– Typhus
– Tularemia
– Lepra.
1.2. Parasitic:
– Echinococcosis
– Toxoplasmosis
– Trypanosomiasis
– Filariasis
– Rishta
– Leishmaniasis.

2. Somatic diseases:
2.1. Malignant neoplasms.
2.2. Diseases of the blood.
2.3. Organic diseases of the central nervous system.
2.4. Complete lack of hearing and speech.
2.5. Mental illness.
2.6. Drug addiction, alcoholism.
2.7. Cardiovascular diseases:
– hypertension II – III st.
– ischemic heart disease
– atherosclerosis, atherosclerotic cardiosclerosis
– obliterating endoarteritis, nonspecific aortoarteritis, recurrent thrombophlebitis
– endocarditis, myocarditis
– heart disease.
2.8. Respiratory diseases:
– bronchial asthma
– bronchiectasis, pulmonary emphysema, obstructive bronchitis, diffuse pneumosclerosis in the stage of decompensation.
2.9. Diseases of the digestive system:
– achilic gastritis
– peptic ulcer of the stomach and duodenum.
2.10. Diseases of the liver and biliary tract:
– chronic liver diseases, including toxic nature and unclear etiology
– calculous cholecystitis with recurrent attacks and phenomena of cholangitis
– cirrhosis of the liver.
2.11. Diseases of the kidneys and urinary tract in the stage of decompensation:
– diffuse and focal lesions of the kidneys
– urolithiasis.
2.12. Diffuse connective tissue diseases.
2.13. Radiation sickness.
2.14. Diseases of the endocrine system in case of severe dysfunction and metabolism.
2.15. Diseases of the ENT organs:
– ozena
– other acute and chronic severe purulent – inflammatory diseases.
2.16. Eye diseases:
– residual effects of uveitis (iritis, iridocyclitis, chorioretinitis)
– high myopia (6 D or more)
– trachoma
– complete blindness.
2.17. Skin diseases:
– common skin diseases of an inflammatory and infectious nature
– generalized psoriasis, erythroderma, eczema, pyoderma, sycosis, lupus erythematosus, blistering dermatoses
– fungal skin lesions (microsporia, trichophytosis, favus, epidermophytosis) and internal organs ( deep mycoses)
– pustular skin diseases (pyoderma, furunculosis, sycosis).
2.18. Osteomyelitis is acute and chronic.
2.19. Surgical interventions for organ resection (stomach, kidney, gallbladder, spleen, ovaries, uterus, etc.) and organ and tissue transplantation.

II. TEMPORARY CONTRAINDICATIONS

Items	Duration of withdrawal from donation
1.Factors of infection with blood-borne diseases: 1.1. Transfusion of blood and its components (with the exception of burn convalescents and persons immunized to the Rh factor)	6 months
1.2. Surgical interventions, incl. abortion (medical certificate is required) (extracts from the medical history) about the nature and date of the operation)	6 months from the date of surgery
1.3. Tattooing or acupuncture treatment	1 year from the end of the procedure
1.4. Stay on business trips abroad lasting more than 2 months	6 months
1.5. Stay in malaria-endemic countries of tropical and subtropical climates (Asia, Africa, South and Central America) for more than 3 months	3 years
1.6. Contact with patients with hepatitis: hepatitis A hepatitis B and C	3 months 1 year
2. Past diseases: 2.1. Infectious diseases not listed in the section “Absolute contraindications”: – a history of malaria in the absence of symptoms and negative results of immunological tests – typhoid fever after recovery and complete clinical examination in the absence of pronounced functional disorders – tonsillitis, influenza, SARS	3 years 1 year 1 month after recovery
2.2. Other infectious diseases not listed in the section “Absolute contraindications” and clause 2.1 of this section	6 months after recovery
2.3. Extraction of tooth	10 days
2.4. Acute or chronic inflammatory processes in the stage of exacerbation, regardless of localization	1 month after stopping the acute period
2.5. Vegeto – vascular dystonia	1 month
2.6. Allergic diseases in the acute stage	2 months after stopping the acute period
3. Period of pregnancy and lactation	1 year after childbirth, 3 months after the end of lactation
4.Menstruation period	5 days from the end of menstruation
5. Vaccinations: – vaccination with killed vaccines (hepatitis B, tetanus, diphtheria, whooping cough, paratyphoid fever, cholera, influenza), toxoid – vaccination with live vaccines (brucellosis, plague, tularemia, BCG vaccine, smallpox, rubella, polymyelitis oral), administration of tetanus toxoid (in the absence of severe inflammation at the injection site) – administration of immunoglobulin against hepatitis B – vaccination against rabies	10 days 1 month 1 year 2 weeks
6.Taking medications: – antibiotics – analgesics, salicylates	2 weeks after the end of admission 3 days after the end of admission
7. Drinking alcohol	48 hours
8. Changes in blood biochemical parameters: – an increase in the activity of alanine aminotransferase (ALT) less than 2 times – a repeated increase or increase in ALT 2 or more times – dysproteinemia	3 months removal from donation and referral for examination 1 month

If the donor has diseases that are not included in this List, the issue of admission to donation is decided on a commission by the transfusion doctor and the corresponding specialist (s).

Health risk assessment from foodborne pesticides that disrupt the endocrine system

Keikotlhaile, B.M., & Spanoghe, P. (2011). Pesticide residues in fruits and vegetables. In: Pesticides – Formulations, Effects, Fate. pp. 243 – 252. DOI: 10.5772 / 13440. https://www.intechopen.com/books/pesticides-formulations-effects-fate/pesticide-residues-in-fruits-and-vegetables (accessed 08.09.2020).

Government Decision of the Republic of Moldova. Sanitary Regulation approved by Government Decision 1191 of 23 December 2010, art. 3, pp. 5 – 14 (in Romanian).

Vitku, J., Heracek, J., Sosvorova, L., Hampl, R., Chlupacova, T., Hill, M., Sobotka, V., Bicikova, M., & Starka, L. (2016). Associations of bisphenol A and polychlorinated biphenyls with spermatogenesis and steroidogenesis in two biological fluids from men attending an infertility clinic.Environment International, 89-90, 166-173.https: //doi.org/10.1016/j.envint.2016.01.021

Hond, DE, Tournaye, H., De Sutter P., Ombelet, W., Baeyens, Covaci, A., Cox, B., Nawrot, TS, Larebeke, NV, & D’Hooghe, T. (2015) … Human exposure to endocrine disrupting chemicals and fertility: a case-control study in male subfertility patients. Environment International, 84, 154 – 160.https: //doi.org/10.1016/j.envint.2015.07.017

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Combarnous, Y. (2017). Endocrine Disruptor Compounds (EDCs) and agriculture: The case of pesticides. Comptes Rendus Biologies, 340 (9-10), 406 – 409.https: //doi.org/10.1016/j.crvi.2017.07.009

Orton, F., Rosivatz, E., Scholze, M., & Kortenramp, A. (2011). Widely used pesticides with previously unknown endocrine activity revealed as in vitro antiandrogenes Environmental Health Perspectives, 119 (6), 794 – 800.https://doi.org/10.1289/ehp.1002895

Lan, Z., Kim, H.T, Shun, B.K., Chen, H.X., & Kim, S.H. (2015). Triclosan exhibits a tendency to accumulate in the epididymis and shows sperm toxicity in male Sprague-Dawley rats. Journal of Environmental Toxiology and Public Health, 30, 83 – 91. https://doi.org/10.1002/tox.21897

Jurewicz, J., Radwan, M., Wielgomas, B., Kałużny, P., Klimowska, A., Radwan, P., & Hanke, W. (2018). Environmental levels of triclosan and male fertility.Environmental Science and Pollution Research International, 25 (6), 5484-5490.https: //doi.org/10.1007/s11356-017-0866-5

Akoto, O., Gavor, S., Appah, M.K., & Apau, J. (2015). Estimation of human health risk associated with the consumption of pesticide-contaminated vegetables from Kumasi, Ghana. Environmental Monitoring and Assessment, 187 (5), 244 – 253. https://doi.org/10.1007/s10661-015-4471-0

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90,000 Treatment of psoriasis without hormones and agents that suppress the immune system

directions

Psoriasis is a chronic non-infectious disease. It is characterized by dry, red rashes on the skin – psoriatic plaques.Plaques first appear on the surfaces of the knees, elbows, and other places subject to friction, then the palms, soles of the feet, and the head can form.

If psoriasis is affecting your quality of life and you would like to improve your skin, you should know that psoriasis is a treatable problem.

Medical specialists

Dermatovenereologist

Currently, work is underway on the site to change the price list, check the current information by phone: 640-55-25 or leave a request, the operator will contact you.

Prices for services

Prescription of drugs for diseases of the skin, subcutaneous fat, skin appendages
100a
Appointment of a therapeutic and recreational regimen for diseases of the skin, subcutaneous fat, skin appendages
100a
Dermatoscopy (skin diagnostic method)
270a
Luminescent diagnostics (inspection under a Wood lamp)
400a
Cutaneous administration of drugs
150a
Appointment (examination, consultation) of a dermatovenerologist repeated
1100a
Appointment (examination, consultation) at a dermatovenerologist, primary
1250a

The information and prices presented on the site are for reference only and are not a public offer.

Our clinics in St. Petersburg

Medical Center South-West

Marshal Zhukov Ave. 28k2
Kirovsky district

Avtovo
Veterans Avenue
Leninsky prospect

You can get detailed information and make an appointment by calling
+7 (812) 640-55-25

For the treatment of psoriasis, we use modern highly effective techniques that not only eliminate skin manifestations, but also affect the mechanisms of development of this disease.Our treatment regimens are not only effective but also safe. An individual scheme of complex pathogenetic therapy is selected for each patient. We will help you achieve long-term remission, and subsequently control the course of the disease. It is difficult to reliably determine what factors influence the appearance of psoriasis, but an autoimmune nature of the disease is currently assumed. The influence of such factors as endocrine, metabolic, immunopathological are known.

Severe skin itching and pain, characteristic external signs cause psychological and physical discomfort in patients, difficulties in social adaptation.The advanced stages of psoriasis can lead to disability.

Currently, medicine is not able to completely cure psoriasis. But with the help of professional dermatologists of the Medicenter network of clinics, you can completely free the skin from psoriatic rashes for a long period. Doctors of “Medicenter” use European and American approaches to the treatment of psoriatic disease, which allow you to quickly achieve long-term remission of the disease without harm to health. Remission, as understood by Medicenter’s dermatologists, is a complete absence of skin rashes for a period from several months to several years.

Competent use of modern drugs and an individual approach to therapy make it possible, without leaving St. Petersburg, to achieve an effect comparable to the treatment of psoriasis at the Dead Sea resorts.

After examination, diagnosis and diagnosis, the dermatologist will choose the most suitable treatment regimen for you:

Treatment of stable forms of psoriasis without hormones, cytostatics and other agents that suppress the immune system.
Individual course of systemic therapy for progressive forms of psoriasis.
Local therapy of psoriatic disease using hardware techniques.

The cost depends on the components of the individual treatment regimen.

735,815,990,817,841,1318

Hello. Thank you for the well-coordinated work of the staff of the Medical Center. Has applied with signs of acute respiratory infections. 1. At the reception, they described in sufficient detail the rules of attachment and conditions of admission in the absence of attachment under the OMS policy. 2. Excellent work of the treatment room, as well as m / brother, who carries out the collection of smears at home.3. My therapists: Polovodova E.A. and Artyukh L.Yu. Thank you for everything!
4. Excellent work of the call-center and personal account is just SUPER!

I would very much like the review to be found by everyone who is mentioned. Thank you!

Nikolaev Arseny Vitalievich

03.09.2020

13:34
medi-center.ru

Good afternoon! I would like to thank the traumatologist Riahi Aymena for his professionalism and high responsibility in his work! Damaged ligaments, for the first time in my life, I was very worried.At the very first visit, I received qualified help and recommendations for a speedy recovery. I am a very curious person and I was pleasantly pleased with the fact that I was able to get answers to all my questions related to stretching (like an injury), materials for fixing the leg, etc. This is a very important quality of a doctor when he can explain processes from his sphere in a professional, but at the same time understandable language for a common man in the street.
Thank you MediCenter for your attitude towards recruiting!

I want to express my deep gratitude to Agamurat Ozarmamedovich Dzhoraev, in Murino on Okhtinskaya alley.The child had a dislocation of the elbow joint, he did everything very quickly, put it in place, found an approach to the crying child !!
Thanks to your center for excellent doctors !!!

I liked everything. The doctor I visited took my question responsibly.

The main task for medical institutions still remains to gain the trust of people (patients) by providing medical care (service) through highly qualified medical personnel.I am a mother of three children and a six-month-old granddaughter with us. Service by polyclinics for compulsory medical insurance is getting worse and worse every year (in particular, our neighborhoods Murino, Devyatkino, Kuzmolovo, Toksovo ..). In paid medical centers, prices are of course varied, but the residents of the new Murino, who pay extra money in a lifetime mortgage with an existing compulsory medical insurance policy, is not serious! For the first time we turned for help to the Medical Center at 18 Okhtinskaya Alleya Street on a commercial basis, with a nose injury in our youngest daughter (4 years old).I want to note that they did not take extra money, namely, a qualified traumatologist determined a bruise, and not a possible fracture, thereby saving us from exposing the child to X-rays. Later I was very happy that this very center accepts citizens under compulsory medical insurance. I wrote a statement and brought the necessary package of documents to the reception. The staff of the center with good nature and understanding accepted my documents for one child, then for the second … but also not quite at certain hours … something was not enough ….we are all employees of the state. Thanks to Tashkina Marina Sergeevna, Fanchenkova Ekaterina Viktorovna and Petrochenko Olga Aleksandrovna – to this day they are greeted with good nature and always try to find the most convenient time to visit the doctor, for example, for two children at once. Blood tests are carried out in “magically” comfortable chairs with a lot of necessary questions (for example: do you feel bad from the sight of blood, etc.) the girl was (did not recognize the name).Passing the road to narrow specialists through the therapist Sultang Valeria Dmitrievna, I did not doubt her competence for a second, even despite her young age. An individual approach, moderate severity and insistence on the indispensable adoption of certain measures in relation to my health problem – allowed me to tune in to the positive. Difficulties arose with visiting an endocrinologist (the appointment was at a different address of the center) and a gynecologist (dense recording), and the situation was urgent, one might say to tears! And here I am in the office of the head of the department, Natalya Yuryevna Stepanova! Huge gratitude and deep bow for the useful use of time with a full-fledged appointment with a cardiologist in her person, the necessary recommendations from endocrinology, and for simple human communication and understanding !!! Thanks to Natalya Yurievna, for more than two months I have been living a different life with a pressure of 110/80, and by the way, I suffered from high blood pressure of 190/140 for more than 15 years, and the various drugs that doctors prescribed to me reduced my blood pressure only to 140/100, and then for a while …Thank you for the appointment of gynecologist Eskenderova Gyulyushak Abdulaevna! I would never have thought what the problem was, and that the previously prescribed drug was simply useless. Separately, I would like to thank Sidorkin Vladimir Alexandrovich (ENT) – I have not observed such a thorough examination either on myself or on children. I came with a hoarse voice that hindered my professional activity for almost two months! Pediatrician Abakumova Olga Nikolaevna turned out to be a very sensitive, attentive, tactful doctor – the necessary advice, expensive and (probably) unnecessary medications were not prescribed.My girls suffered from chickenpox without experiencing severe malaise and itching (one of them is 12 years old) and it was Olga Nikolaevna who came to our house twice, one doctor – the trust of the children! Undoubtedly, she wrote in detail and a lot, do not think that before I came across some charlatans or I swagger. In one place and such a good-natured attitude of almost all the staff! Very often and sharply we can get sick and one … and another at once, and then there are children !!! My family, and I have no doubt that many are very lucky to have such a MEDICENTER nearby! Such conscientious service must be sought! ACCEPT the words of Gratitude, special thanks, low bow and heartily from my large family! You all carry a certain mission, health to people and do an excellent job with the main task – WE TRUST YOU !!!

Hello! I went to the emergency room today on Polikarpova with an incomprehensible pain in my leg.From the work of the administrator to the work of the doctor, everything is at the highest level: the staff is polite, attentive and with a good sense of humor. The doctor inquired in detail, carried out diagnostics and told in detail what problem I had and what to do next. Prescribed treatment. No arrogance and gloominess (as is usually the case in other hospitals). I turned to strangers, and parted as good friends. Thank you Medicenter! Now only to you!

Summary endocrine system: Endocrine System (for Teens) – Nemours KidsHealth

17.1 An Overview of the Endocrine System – Anatomy and Physiology

Learning Objectives

Neural and Endocrine Signaling

Interactive Link

Structures of the Endocrine System

Other Types of Chemical Signaling

Career Connection

Endocrinologist

15.1A: Overview of the Endocrine System

Key Points

Key Terms

The Endocrine System

Key Endocrine Glands

Overview of Endocrinology

Overview of Endocrinology

Chapter 35 – An Overview of the Endocrine System – BIO 140 – Human Biology I – Textbook

An Overview of the Endocrine System

Microscope Slides of Endocrine Glands

Chapter 13 – Endocrine Glands

Pituitary

Thyroid

Parathyroid

Thyroid-Parathyroid-Thymus

Adrenal Glands

Pancreatic Islets

Endocrine System and Syndromes | Lab Tests Online

What Does the Endocrine System Do? (Endocrine System and Exercise)

Endocrinology, endocrinologist services

The functional state of the endocrine system and bone mineral density in the long-term period after combined treatment of malignant brain tumors in childhood and young age | Golounina

endocrine disorders – Russian translation – Linguee

List of contraindications for donating blood and its components

Health risk assessment from foodborne pesticides that disrupt the endocrine system

Medical specialists

Prices for services

Our clinics in St. Petersburg

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