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  • ADA American Diabetes Association
  • BG Blood glucose
  • BMD Bone mineral density
  • BMI Body mass index
  • CHF Congestive heart failure
  • CRHCorticotropin-releasing hormone
  • CVD Cardiovascular disease
  • DHEA Dehydroepiandrosterone
  • DPP IV Dipeptidyl peptidase IV
  • FFA Free fatty acids
  • GFR Glomerular filtration rate
  • GIP Glucose insulinotropic peptide
  • GLP1Glucagon-like peptide 1
  • GLUT Glucose transporter
  • HHNS Hyperglycemic hyperosmolar nonketotic syndrome
  • IGT Impaired glucose tolerance
  • LH Luteinizing hormone
  • LHRH Luteinizing hormone–releasing hormone
  • NHANES National Health and Nutrition Examination Survey
  • NPH Neutral protamine Hagedorn
  • NSAIDS Nonsteroidal anti-inflammatory drugs
  • OGTT Oral glucose tolerance test
  • PTH Parathyroid hormone
  • RANK-L Receptor activator of nuclear factor kappa B ligand
  • SERM Selective estrogen receptor modulator
  • SIADH Syndrome of inappropriate antidiuretic hormone
  • T3 Triiodothyronine
  • T4 Thyroxine
  • TLI Therapeutic lifestyle intervention
  • TSH Thyroid-stimulating hormone
  • UKPDS United Kingdom Prospective Diabetes Study

Individuals over age 65 comprise the fastest-growing segment of the United States population; each day this group increases by more than 1000 people. This increase has led to a remarkable situation—of all the people who have ever lived to the age of 65, more than two-thirds are still alive. Thus, it is becoming increasingly important for the endocrinologist to understand how endocrine physiology and disease may differ in the elderly.

Before considering specific endocrinologic conditions in the elderly, however, it is worthwhile to review some general principles that account for many of the age-related changes in disease presentation in the elderly. First, aging itself—in the absence of disease—is associated with only a gradual and linear decline in the physiologic reserve of each organ system (Figure 23–1). Because the reserve capacity of each system is substantial, age-related declines have little effect on baseline function and do not significantly interfere with the individual's response to stress until the eighth or ninth decade. Second, because each organ system's function declines at a different physiologic rate and because 75% of the elderly have at least one disease, endocrine dysfunction in the elderly often presents disparately, with initial symptoms derived from the most compromised organ system. For example, hyperthyroidism in an elderly patient with preexisting coronary and conduction system disease may present with atrial fibrillation and a slow ventricular response, whereas in another equally hyperthyroid patient with a prior stroke, it may present with confusion or depression; neither patient may tolerate hyperthyroidism long enough for the classic thyroid-related manifestations (eg, goiter) to become apparent. Third, elderly patients often have multiple diseases and take many medications that may mimic or mask the usual presentation of endocrine disease.

Figure 23–1

Influence of age on physiologic function in humans. (Reproduced, with permission, from Shock NW. Discussion on mortality and measurement. In: Strehler BL, et al, eds. The Biology of Aging: A Symposium. American Institute of Biological Sciences; 1960.)

The prevalence of thyroid disease in the elderly is approximately twice that in younger individuals, with hypothyroidism ranging from 2% to ...

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