Endocrine and Aging

Question 1

4 factors that can influence hormone levels?

Answer 1

Altered synthesis levels.
Altered effect on end organ.
Altered feedback.
Complicated by disease, diet, meds, exercise, etc.

Question 2

Do hormone aberrations present with “classic” symptoms seen in younger patients?

Answer 2

No, not always.

Question 3

4 normal -pause’s of aging?

Answer 3

Menopause - E2
Andropause (or, “manopause”) - T
Adrenopause - DHEA
Somatopause - GH

Question 4

What’s the take-home point about the slide with all the graphs of hormone levels at different ages?

Answer 4

Everything kind of tapers of slowly - except for estrogen, which has a dramatic drop-off at menopause.
(T and DHEAS peak in 20’s…)

Question 5

Did giving everybody estrogen at menopause turn out to be a bad idea? 3 bad things that happened?

Answer 5

Yes, increased:
Breast cancer
Strokes
Coronary artery disease

Question 6

Review: What 2 things did ERT help?

Answer 6

Decreased colorectal cancer and hip fractures.

Question 7

Might estrogen alone be less bad, in ERT?

Answer 7

Mayyyyybe. May be ok to give in low dose to peri menopausal women (who are younger and have low absolute risk for heart disease)

Question 8

What kind of pattern does T secretion follow?

Answer 8

Diurnal - it peaks in the morning.

Older men have lower levels throughout the day

Question 9

Bad things about T replacement?

Answer 9

BPH
Prostate cancer
Gynecomastia
(sleep apnea and CVD, maybe)

Question 10

How does the diurnal rhythm of cortisol change as people age?

Answer 10

More nocturnal secretion, which coincides with less REM sleep.
(I don’t think causation is proven here)

Question 11

Is impaired glucose tolerance a normal part of aging?

Answer 11

Yes. Diabetes rates go up, too.

Question 12

How is the distribution of TSH levels different in older people?

Answer 12

Distribution is shifted to the right.
We’re not sure if this means people are really hypothyroid, or that they just have a different set point.
(treatment is reasonable when benefits outweigh risks)

Question 13

Bad thing associated with high free T4?

Answer 13

Atrial fibrillation.

i.e. this is a risk of overtreating hypothyroidism

Question 14

What’s a way that hypothyroidism presents more in older people vs. younger?

Answer 14

With weight loss and anorexia.

- Recognizing hyperthyroidism and hypothyroidism is harder in old people–> “non- classical” presentation

Question 15

4 age associated hormonal drop-off’s?

Answer 15

• Estrogen
• Testosterone
• DHEAS
• IGF-1

Question 16

4 age associated increases?

Answer 16

• Nocturnal cortisol
• Glucose intolerance
• Subclinical hypothyroidism
• Type 2 diabetes

Question 17

“Normal aging” looks a lot like what?

Answer 17

Symptoms of cortisol excess/hyperactivity

• Decrease in physical performance, walking speed
• Decreased bone density, immunity
• Increased depression, blood pressure
• Decreased bone mass, cognitive function, memory

Question 18

What’s a way that hyperthyroidism presents more in older people vs. younger?

Answer 18

Apathy and anorexia

- Recognizing hyperthyroidism and hypothyroidism is harder in old people–> “non- classical” presentation

Question 19

How is homeostatic set point different in old age than youth? What 2 things change?

Answer 19

Set point is actually the SAME

• What changes is ability to handle stressors
• Inability to handle glucose loads as well
• Inability to bring down high cortisol levels

Question 20

What is the log linear inverse relation between TSH and T4?

Answer 20

• Small changes in T4 lead to LARGER changes on TSH
• Also there is a wide variation in people’s “set points”–> for the same free T4 levels they can have VERY different TSH