Effects of Age and Diet on Endocrine Function Flashcards
1
Q
Effects of age on endocrine function
- look at … status
- …/… levels
- … axis i.e. menopause, ‘andropause’
- GH-IGF system - what is this?
- … levels
- DHEA
- … function
A
- look at nutritional status
- Insulin/glucose levels
- Gonodal axis i.e. menopause, ‘andropause’
- GH-IGF system - growth hormone / IGF system
- Cortisol levels
- DHEA - dehydroepiandrosterone
- Thyroid function
2
Q
Effects of diet on endocrine function
- Starvation
- … Nervosa
- …/glucose levels
- L… levels
- … axis
- GH-IGF system - what is this
- C… levels
- … function
A
- Starvation
-
Anorexia Nervosa
- insulin/glucose levels
- leptin levels
- Gonodal axis
- GH-IGF system - Growth hormone IGF system
- Cortisol levels
- Thyroid function
3
Q
Different perspectives on age, diet and endocrine function
- Evolutionary perspective is what?
- Hormonal function:
- …pause exists
- ‘andropause’
- ‘somatopause’
- ‘adrenopause’
- Hormonal function:
- Cultural perspective is what?
- Anti-aging results in … google hits
- Pharma perspective is what?
A
- Evolutionary perspective
- We are outliving our natural lifesan
- Hormonal function:
- menopause
- ‘andropause’
- ‘somatopause’
- ‘adrenopause’
- Cultural perspective is what?
- Anti-aging results in 3,000,000 google hits
- Pharma perspective is what?
- enourmous market - especially compared to endocrine market for testosterone / GH
4
Q
Is 80 the new 60?
“Just because that happens doesnt mean that it’s health or inevitable … there must be a supplement or hormone that I can take to counteract it”
who said this?
A
healthy 76 yo compaining of loss of flexibility (yoga expert)
5
Q
‘Medicalisation’ - Aging and endocrine function
- Increased … expectancy may not equate to increased … expectancy
- ‘Usual ageing’ what does this mean?
- physiological?
- pathological?
- optimal?
- Hormonal influence
- dwarfed by other influences, what are these? (4)
- Balance of … and … of treatment
- risks - esp … risk in elderly
- … - GH/testo not … active
- … involved
A
- Increased life expectancy may not equate to increased health expectancy
- Usual ageing
- physiological?
- pathological?
- optimal?
- Hormonal influence
- dwarfed by other influences, what are these? (4)
- Genetic
- Environmental
- Psychosocial
- Co-morbidities
- Balance of benefit and harm of treatment
- risks - esp cancer risk in elderly
- hassle - GH/testo not orally active
- Costs involved
- dwarfed by other influences, what are these? (4)
6
Q
Association and Causation - Aging and endocrine function
- Similar ‘phenotypes’ between …/… deficiency and aging
- Increased … mass, increased … fat
- Sarco…
- Decreased bone … density
- Decreased …/mood
- Increased risk of … disease
- BUT:
- Phenotypes are non-… and high …
A
- Similar ‘phenotypes’ between Hypogonadism/GH deficiency and aging
- Increased fat mass, increased visceral fat
- Sarcopaenia
- Decreased bone mineral density
- Decreased QOL/mood
- Increased risk of CV disease
- BUT:
- Phenotypes are non-specific and high prevalence
7
Q
Age: Nutritional status
- Weight
- increases from mid-…s
- Plateau after age of … onwards
- Lean body mass
- declines by approx …-…% / decade from mid …s
- Diet
- trend towards (decrease or increase?) intake total energy and protein with increasing age
A
- Weight
- increases from mid-30s
- Plateau after age of 50-70
- Lean body mass
- declines by approx 6-8% / decade from mid 30s
- Diet
- trend towards decreased intake total energy and protein with increasing age
8
Q
Age: Insulin/glucose
- As you get older what happens to levels of insulin and glucose?
- What happens to insulin resistance?
- What happens to peripheral glucose uptake?
- Increased prevalence of … syndrome with increased age
A
- As you get older what happens to levels of insulin and glucose? insulin and glucose levels increase
- What happens to insulin resistance? - increases
- What happens to peripheral glucose uptake? - decreases
- Increased prevalence of metabolic syndrome with increased age
9
Q
Metabolic syndrome
- ‘Constellation of closely associated … risk factors’
- These are … (4)
- … resistance is the underlying pathophysiological mechanism
A
- ‘Constellation of closely associated CV risk factors’
- These are … (4)
- Visceral obesity
- Dyslipidaemia
- Hyperglycaemia
- Hypertension
- These are … (4)
- Insulin resistance is the underlying pathophysiological mechanism
10
Q
This graph shows that the prevalence of … syndrome goes up by age
A
metabolic syndrome
11
Q
What axis is shown?
A
Gonadal axis
12
Q
Age: Menopause
- Menopause means what?
- Oestrogen levels:
- Pre-menopausal: there is a …
- Post-menopausal: levels are … meaning levels of LH and FSH are … - why?
- ? What causes menopause
- Average age of menopause is roughly … with a standard deviation of 2 years
- Symptoms of menopause include … (2)
- Symptoms median duration is … years
- Morbidity:
- Increased chance of osteo… increased CHD - what is this? increased sexual …
- Oestrogen levels:
A
- Menopause means ovarian failure
- Oestrogen levels:
- Pre-menopausal: there is a cycle
- Post-menopausal: levels are very low meaning levels of LH and FSH are constantly high - why? - because of the lack of negative feedback
- ? What causes menopause - brain and ovary are ‘pacemakers’
- Average age of menopause is roughly 50 with a standard deviation of 2 years
- Symptoms of menopause include hot flushes, night sweat
- Symptoms median duration is 7 years
- Morbidity:
- Increased osteoporosis increased CHD (coronary heart disease)increased sexualdysfunction
- Pre-menopausal: there is a cycle
- Oestrogen levels:
13
Q
Age: Menopause - Post-Menopausal HRT
- Hormone replacement therapy
- Initial observational studies showed benefits (… user bias)
- Some subsequent RCTs showed what?
- However, ratio depends on
- other risk factors
- … of woman and … of use
- greater risk if >…yrs, >…yrs post-MP
- … of HRT (oestrogen, progestogen, route)
A
- Hormone replacement therapy
- Initial observational studies showed benefits (healthy user bias)
- Some subsequent RCTs showed no benefits and increased risks
- However risk:benefit ratio depends on
- other risk factors
-
age of woman and duration of use
- greater risk if >60yrs, >10yrs post-MP
- Type of HRT (oestrogen, progestogen, route)
14
Q
Post-menopausal HRT
- Benefits
- Treatment of menopausal symptoms
- decreased risk of … / fracture risk
- for … of treatment only
- Risks
- increased risk of venous …-…
- increased … cancer risk (esp >5yrs)
- increased … cancer if unopposed oestrogen is used
A
- Benefits
- Treatment of menopausal symptoms
- decreased osteoporosis / fracture risk
- for duration of treatment
- Risks
- increased risk of venous thrombo-embolism - particularly smokers
- increased breast cancer risk (esp >5yrs)
- increased endometrial cancer - if use unopposed oestrogen used
15
Q
Post-menopausal HRT - goals of treatment
- Goals have shifted back:
- from … (to prevent disorders associated with post-menopausal oestrogen deficiency, like osteoporosis)
- To … of menopausal …
- … term, … effective dose, … menopausal women
A
- from replacement (to prevent disorders associated with post-menopausal oestrogen deficiency, like osteoporosis)
- To treatment of menopausal symptoms
- short term, lowest effective dose, younger menopausal women
16
Q
Male Gonadal Axis
- Gradual testosterone … with increased age
- Wide range of … at all ages
- @ 75 years, mean testosterone is …/… that @ 25years
- … association between libido / erectile dysfunction and testosterone
- Testosterone prescriptions increased by …% over the past decade
A
- Gradual testosterone decrease with increased age
- Wide range of normality at all ages
- @ 75 years, mean testosterone is 2/3 that @ 25years
- Poor association between libido / erectile dysfunction and testosterone
- Testosterone prescriptions increased by 500% over the past decade
17
Q
What does this figure illustrate?
A
The gradual decline in testosterone with age
18
Q
What is this table showing?
A
Testosterone range for 95% of healthy men
19
Q
Age - Male Gonodal Axis
- Clinical hypo…
- … sexual function
- … risk of osteoporosis
- … muscle strength
-
Questions
- are some features of ageing secondary … deficiency
- Would treatment be beneficial or risky?
A
- Clinical hypogonadism
- decreased sexual function
- increased risk of osteoporosis
- decreased muscle strength
-
Questions
- are some features of ageing secondary androgen deficiency
- Would treatment be beneficial or risky?
20
Q
Testosterone treatment in older men
- Are there improvements in sexual function?
- most erectile dysfunction in older age is …
- drugs like sildenafil (‘…’) may work
- Little or no evidence of benefit or insufficient data that testosterone improves… (3)
- Potential risks
- … (benign prostatic hypertrophy / cancer)
- … (increased haematocrit)
- ? … risk (MI/strokes)
A
- There are small improvements in sexual function
- most erectile dysfunction in older age is atherosclerotic
- drugs like sildenafil (‘viagra’) may work
- Little or no evidence of benefit or insufficient data
- physical function, including energy & vitality
- cognitive function
- mood/QOL
- Potential risks
- prostate (benign prostatic hypertrophy / cancer)
- erythropoeisis (increased haematocrit)
- ? CVS risk (MI/strokes)
22
Q
What are these quotes discussing treatment of?
A
Testosterone treatment in older men
23
Q
What axis is shown here?
A
GH-IGF-1-axis
24
Q
GH-IGF-1-Axis - age
- … integrated GH with increased age, … IGF-1 with increased age
- Wide variation in … range
A
- decreased integrated GH with increased age, decreased IGF-1 with increased age
- Wide variation in normal range
27
Q
What is this quote discussing?
A
Growth hormone
28
Q
What axis is this?
A
Hypothalamic-pituitary-adrenal axis
29
Q
Effects of age on cortisol levels
- … trough levels cortisol with increased age
- … average levels with increased age
- phase advance of … rhythm
- time at trough and peak both earlier or later?
A
-
Increased trough levels cortisol with increased age
- increased average levels with increased age
- phase advance of diurnal rhythm
- time at trough and peak both earlier
31
Q
DHEAS is an … androgen
A
DHEAS is an adrenal androgen
32
Q
What happens to levels of DHEA with age?
A
Declining levels with age
38
Q
What axis is shown?
A
Thyroid axis
43
Q
Central mediator: kisspeptin
- A … secretagogue - at the apex of the reproductive axis in the hypothalamus
- KISS1 neurons highly responsive to …, implicated in both + and - central feedback of sex steroids on GnRH production
- Metabolic influences on reproduction:
- mediated by …: permissive effect
- via the kisspeptin system
- puberty and reproduction
A
- A GnRH secretagogue - at the apex of the reproductive axis in the hypothalamus
- KISS1 neurons highly responsive to oestrogen, implicated in both + and - central feedback of sex steroids on GnRH production
- Metabolic influences on reproduction:
- mediated by leptin: permissive effect
- via the kisspeptin system
- puberty and reproduction
44
Q
What does this show the permissive effect of?
A
Permissive effect of leptin on kisspeptin
46
Q
Starvation/AN: cortisol
- Left (Individual data) = fed state
- Right (Individual data) = fasting state
- What happens to cortisol in fasting state?
A
- In fasting state - starvation - stress response - increased cortisol pulses - loss of diurnal trough - get increased pulsatility of cortisol
