The accurate diagnosis of endocrine dysfunction in the elderly requires a high index of suspicion. Signs and symptoms of hormone deficiency or excess may be absent. When such signs and symptoms are present, coexisting malnutrition or chronic disease may often make their interpretation difficult.
Hormone measurements and provocative tests must also be interpreted with respect to age. Some hormones, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH), have clear gender-specific age-related changes. Others such as thyroid-stimulating hormone (TSH) show more subtle and variable alterations in what is considered normal with age. Provocative tests may give a blunted or altered response. Measurements of bound hormone may be less reliable due to alterations in serum proteins and hormone binding. Clearance rates are often affected by age due to changes in renal or hepatic metabolism, peripheral utilization, and even posttranslational changes in hormone processing. Finally, therapy needs to be adjusted for age and coexisting disease.
Potential side effects of therapies such as testosterone are increased and will affect the risk-to-benefit assessment of treatment and determination of optimal dose. Essential replacement, such as with thyroid hormone, should be initiated at a low dose and gradually increased to full dosage with careful monitoring of patient response and potential adverse reactions. With these precautions in mind, every effort should be made to diagnose and treat endocrine abnormalities even in the elderly debilitated patient, as this will improve quality of life.
Generalized aging is intimately coupled with widespread progressive alterations in metabolism in elderly, of which changes in endocrine function are an integral part.
