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Endocrinology and the elderly patient

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As we get older, physiological, hoemostatic and endocrine systems become less able to function sussessfully. This ican be made worse by factors such as polypharmacy and frailty

Veröffentlicht in: Gesundheit & Medizin
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Endocrinology and the elderly patient

  1. 1. Diabetes & Endocrinology In the ageing patient
  2. 2. Endocrinology and Ageing • Overview • Thyroid disease • Adrenal function • Hypogonadism • Bone disease • Diabetes
  3. 3. Hormones • Ageing causes changes in many hormonal axes • Concomitant disease and polypharmacy are common in the elderly population, with frequent secondary effects upon the endocrine system. • Example – fluid and electrolyte homeostasis; • Impaired GFR, reduced sensitivity to circulating hormones • Reduced ability to concentrate urine, more prone to sodium imbalance and dehydration
  4. 4. Thyroid disease • Thyroid disease is twice as common in the elderly as in younger patients • Changes in thyroid tests with ageing; • TSH secretion remains pulsatile, loss of physiological nocturnal rise • T4 – overall unchanged • T3 – 10-50% decrease, occurs at an earlier age in females • Thyroid antibodies; increasing prevalence with age • Radio-iodine uptake is unchanged • Nodular thyroid disease is more common with age
  5. 5. Patterns of thyroid dysfunction
  6. 6. Thyroid disease • Sick euthyroid disease is more common in the elderly due to frequent concurrent non-thyroidal illness Metabolic process Increase Decrease TSH secretion Amiodarone Sertraline St. John’s Wort Glucocorticoids Dopamine agonists Phenytoin Paroxetine T4 synthesis Amiodarone Lithium Amiodarone Lithium Binding proteins Oestrogen Clofibrate Heroin Glucocorticoids Androgens Carbamazepine T4 metabolism Anti-convulsants Rifampicin T4/T3 binding in serum Heparin Salicylates Frusemide
  7. 7. Adrenal function • Cortisol secretion very similar throughout life • Dynamic testing shows a prolonged release of ACTH and cortisol to stress • DHEAS levels decline with age but physiological relevance is not established • Those with known adreno-cortical insufficiency need to have a low threshold for following their ‘sick day’ rules. • Aldosterone – reduced renal sensitivity, reducing circulating levels. May result in isolated mineralocorticoid deficiency (DTA with hyponatraemia, hyperkalaemia, hyperchloraemia and normal AG acidosis – more come with DM patients)
  8. 8. Hypogonadism • Many men remain potent and fertile until their death • However, sexual acitivity, libido and potency decline gradually and progressively from midlife onwards.
  9. 9. Hypogonadism • Symptoms of Hypogonadism and normal ageing overlap; • Reduced lean body mass • Impaired muscle function • Increased fat mass • Reduced libido / virility • Reduced overall well- being • Normal ranges of testosterone in men of different ages have not yet been well established
  10. 10. Testosterone • Free testosterone levels decline slowly over time – significant variation between individuals • Normal range (10- 30nmol/l) • 2 x 9AM testo <8 should prompt further investigation • LH/FSH may be low because of other disease • ED in the elderly • Multiple causes • Vascular disease • Medications • Neuropathy • Psychogenic
  11. 11. Bone health • Osteoporosis • Vitamin D deficiency • Primary hyperparathyroidism
  12. 12. Diabetes mellitus • Progressive nature of the underlying disease • Sensitivity to medication side effects and compliance • Cognitive and physical ability to self manage diabetes ie. CBG monitoring and self-injection • Importance of balancing good glycaemic control versus symptoms and quality of life • End of life diabetes care • Glycaemic management during enteral feeding of stroke patients • Management of diabetes in nursing homes • Associated depression, social issues, limited daily means and co-existent health problems
  13. 13. Many thanks •Any questions?