Lecture 15B Endocrine management

Question 1

Metabolic syndrome

Answer 1

1. Common (incidence 26 per 1000) multifactorial syndrome of aging; associated with abdominal obesity.
2. Varies among racial and ethnic groups.
3. Primary risk factors: Abdominal obesity; insulin resistance; physical inactivity; hormonal imbalance (e.g., increased cortisol).

Question 2

Metabolic syndrome - diagnosis

Answer 2

• Abdominal obesity* plus two of the following:
  1. BP over 129/94 or taking antihypertensives.
  2. Plasma triglyceride level over 149 mg/dL, or taking medication.
  3. HDL-C (“good cholesterol”) level below 40 mg/dL in men, below 50 mg/dL in women, or taking medication.
  4. Fasting glucose above 99 mg/dL.

Question 3

Metabolic syndrome - management

Answer 3

Focus on root causes:

1. Reduce risk factors and maintain a therapeutic lifestyle.
2. Nutritional management.
3. Slow, moderate weight loss.

Question 4

Hyperthyroidism

Answer 4

1. Primary hyper-secretion of thyroid hormones (T₃ and T₄).
2. Thyroid hormone is stimulatory - increases sympathetic nervous system activity.
3. Causes: Multi-nodular and uni-nodular toxic goiter (90% of thyroid nodules in older adults are benign); Graves’ disease; thyroiditis.

Question 5

Hyperthyroidism - signs and symptoms in older adults

Answer 5

1. Atrial fibrillation - most common.
2. Tachycardia.
3. Fatigue.
4. Tremors.
5. Nervousness.
6. Heat intolerance.

Question 6

The most common sign of hyperthyroidism in older adults is _

Answer 6

Atrial fibrillation.

Question 7

Goiter

Answer 7

Chronic enlargement of the thyroid gland.

Question 8

Graves’ disease

Answer 8

1. Autoimmune disease resulting in diffuse goiter and hyperthyroidism.
2. Other symptoms include exophthalmos, heat intolerance, and anxiety.

Question 9

Thyroid storm

Answer 9

A life-threatening syndrome consisting of fever, severe tachycardia, altered mental status, dehydration, and irritability.

Question 10

Weight loss over the previous 3-6 months, serum albumin levels, fatigue, tachycardia, and dysphagia are all focus areas relevant to the assessment of _

Answer 10

Hyperthyroidism.

Question 11

Between hyperthyroidism and hypothyroidism, _ is more common among older adults.

Answer 11

Hypothyroidism (16-21% vs. 2.5-6% for hyperthyroidism).

Question 12

In hypothyroidism, the thyroid gland may be absent (surgically removed), small, or large, depending on _

Answer 12

The cause of the disorder.

Question 13

Drugs that may cause hypothyroidism in older adults

Answer 13

1. Lithium carbonate.
2. Amiodarone.
3. Iodine (deficiency).

Question 14

Hypothyroidism - signs and symptoms

Answer 14

Usually atypical, subclinical, and often misattributed to the normal aging process:

1. Fatigue.
2. Cold intolerance.
3. Weight gain.
4. Muscle cramps.
5. Confusion.

Question 15

Depression, fatigue, TSH levels, and weight gain are all focus areas relevant to the assessment of _

Answer 15

Hypothyroidism.