1.
Diabetes &
Endocrinology
In the ageing patient

2.
Endocrinology and Ageing
• Overview
• Thyroid disease
• Adrenal function
• Hypogonadism
• Bone disease
• Diabetes

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.
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.
Patterns of thyroid dysfunction

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.
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.
Hypogonadism
• Many men remain potent and fertile until their death
• However, sexual acitivity, libido and potency decline gradually
and progressively from midlife onwards.

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.
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.
Bone health
• Osteoporosis
• Vitamin D deficiency
• Primary
hyperparathyroidism

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.
Many thanks
•Any questions?