Primary hyperparathyroidism (PHPT) is a common endocrine disease that occurs with multiple profiles in which no classical manifestation. Diagnosis revolves around routine measurement of serum calcium and parathyroid hormone more than in half cases. The understanding of clinical presentation, epidemiology and management tactics of patients with hyperparathyroidism has significantly changed by virtue of the use of biochemical calcium screening.

The successful diagnosis and treatment are possible with the cooperation of a multidisciplinary team of endocrinologist, endocrine surgeon, radiologist, nuclear medicine physician and pathomorphologist.

The only radical method of treatment is the surgical removal of abnormal parathyroid glands. In this regard, there is necessary to improve the parathyroid glands imaging algorithms.

Early treatment of hyperparathyroidism allows to avoid severe damage to the bones, kidneys, heart, other organs, improving the quality of life and reducing the incidence of disability.

For a systematic literature review, more than 100 articles published from 2000 to the present time were used, on following resources: PubMed, Embase, SciSearch, Scopus, Cochrane Databases, Research Gate, Google Scholar. Including recommendations from the American Association of Endocrinologists and Endocrine Surgeons (AACE/AAES), European Society of Nuclear Medicine (EANM), European Society of Endocrinologists (ESE), Russian Association of Endocrinologists (RAE) and several other organizations.

The main goal of this review is to summarize and present relevant information and a new look on preoperative imaging techniques, methods of intraoperative navigation, surgery, control quality of treatment in patients with primary hyperparathyroidism.

Background: Bariatric surgery methods have proven to be most effective in treating obesity. Weight regain (WR) is often found after various types of bariatric surgery. The clinical significance of WR is not clearly defined.

Aims: to assess the dynamics of body weight and determine the amount of clinically significant WR based on the study of carbohydrate metabolism and blood pressure in patients with obesity after performing sleeve gastrectomy (SG) and gastric bypass (GB).

Materials and methods: 68 patients with obesity after SG (40) and GB (28) were observed for 3 years. Body mass index (BMI), percentage of excess BMI lost (% EBMIL), WR, glycated hemoglobin, blood pressure were evaluated.

Results: A comparable efficiency (EBMIL more than 50%) of the SG and the GB was at the nadir point. % EBMIL over 50% was achieved in 78.8% of patients after SG and 80.0% of patients after GB. WR more than 15% was associated with a significant increase in systolic blood pressure. Clinically significant WR in the SG group was detected in 32.5% of patients, in the GB group – in 17.2% of patients (p > 0.05).

Conclusion: WR of more than 15% was associated with a significant increase in systolic blood pressure in patients with obesity after SG and GB, which makes it possible to consider WR of more than 15% clinically significant. A clinically significant WR 36 months after surgery was detected in 32.5% of patients after SG and 17.2% of patients after GB.

Background: Papillary thyroid cancer (PTC) course and outcome very much depend on prognosis factors. One of the most significant factors is extrathyroidal extension (ETE), which can be local or extensive. In the view of some authors, tumor grow beyond the thyroid capsule is associated with high risk locoregional and distant metastasis, which increase disease recurrence and reduce survival. Some others do not see influence of minimal ETE on disease prognosis, so we need more trials to clarify the role of ETE in PTC.

Aims: To evaluate the ETE role in development of metastasis in PTC patients.

Materials and methods: The study includes 233 patients with PTC who receive treatment in RSCRR. 185 patients had clinical N0 stage, 48 patients were with verified N1a–1b. All patients with cN0 underwent thyroidectomy with central neck dissection, patients with N1 – thyroidectomy combined with different neck dissections, also superior mediastinal lymphadenectomy if required. Within combination treatment the radioiodine therapy was carried out. The histology evaluated thyroid capsule involvement and lymph node metastasis. Data processing was carried out in a Microsoft Access database, a one-factor dispersion analysis was used for the analysis of the quantitative signs, and a χ-square criterion was used for qualitative ones. Multifactor analysis was done in SPSS20 program.

Results: Thyroid capsule extension was detected in 111 cases (47.6%), from which 92 were microscopic. 122 patients did not have ETE. The frequency of lymph node metastasis with or without ETE was 62.2% and 35.8% respectively, which is significantly more often (р = 0.000, χ2 = 21.342). In microscopic and macroscopic extension regional metastasis were 56.5% and 94.7%, distant metastasis – 1.1 and 21% respectively. Statistically significant, the ETE was more prevalent in non-encapsulated tumor cases (р = 0.000, χ2 = 15.122), and if the tumor size was more than 1cm (р = 0.026, χ2 = 7.293). Only 41% of patients with cN0 had ETE, and patients with N1 – 72.9%, which is statistically significant (р = 0.000, χ2 = 14.235).

Conclusion: ETE is a predictor of PTC metastasis. The presence of ETE requires the necessity to apply the more aggressive treatment of PTC including thyroidectomy with central neck dissection and radioiodine therapy. Gross ETE significantly increases the risk of regional together with distant metastasis.

Primary aldosteronism is characterized by hypertension and accounts for about 10% of hypertensive patients. Hyperkalemia and renal disease post adrenalectomy has been described in the literature. We present а case of primary aldosteronism with long standing hypertension (more than 10 years) with severe hypokalemia (1.9 mmol/l). Post unilateral adrenalectomy he had reduction in the blood pressure and became eukalemic. However, after 8 weeks of adrenalectomy patient developed hyperkalemia and increased serum creatinine, which resolved with fludrocortisone and attempt to discontinue fludrocortisone resulted in hyperkalemia and rising creatinine.

Screening of developing post-operative hyperkalemia should be actively considered in high-risk patients: older age, longer duration of hypertension, higher levels of aldosterone and severe hypokalemia before surgery, impaired estimated glomerular filtration rate and long-term treatment with spironolactone.