6. & 7. Ageing and endocrine manipulation Flashcards
(27 cards)
- why is life expectancy higher now?
- by 2050, how many ppl are expected to be above age of 60?
- elderly patients have disproportionately higher prevalence of (2) dysfunction
- bc of antibiotics!
- 1 in 5 people –> 2 billion people over the age of 60
- endocrine and metabolic dysfunction
what are examples of endocrine and metabolic dysfunctions in elderlies? (7)
- hypopituitarism
- hypothyroidism
- hypoparathyroidism
- hypoinsulinism
- adrenal insufficiency
- various forms of hypogonadism
- endocrine malignancies
which hormones (4 each) decrease with age for men and women?
WOMEN:
- estrogen –> decrease post menopause
- DHEA decreases
- IGF-1 decreases
- intact PTH decreases (sharp decrease after 40)
MEN:
- testosterone decrease
- DHEA decrease
- IGF-1 decreases
- intact PTH decreases (sharp decrease after 40)
increase or decrease of diabetes incidence with age?
increase!
do women or men have more tendency of developing osteoporosis?
- intervention?
women! almost 5x more than men
- estrogen inhibits osteoclast activity and promotes osteoclast apoptosis –> menopause = decrease in estrogen!
- intervention = replace hormones!
what are some examples of hormone replacement therapy:
1. first one to ever exist?
2. to reduce symptoms of menopause?
3. to give life improvement for senior people ish also for what?
4. for hypothyroidism
- insulin treatment for type 1 and insulin-dependant T2D
- estrogen or estrogen/progesterone –> most common! and most information on
- growth hormone or IGF1 in adults –> also for adult manifestation of GH deficiency –> leads to CV risk and reduced bone health
- inconsistent data on their benefits: not sure about dosage and regimen - thyroid hormone: levothyroxine (L-T4) replacement
- hypothyroidism presents multiple clinical symptoms –> severe cases: myxedema, cold intolerance and coma
Menopause:
- about 90% of women at which age?
- follicular waves starting in utero eventually reduces oocyte pool to about ________ by the age of ______ –> where there’s a bigger increase/decrease
- THEN rate of follicular atresia increases/decreases (if remained the same, then enough eggs to about what age?)
- mechanism known? would be useful to extend what?
- age 51
- 25 000 by age of 37.5 –> bigger decrease
- atresia increases! –> if remained, then enough eggs until age 71
- mechanism unknown but useful to extend reproductive lifespan
- do all women need hormone replacement therapy post menopause? why?
- what are symptoms of menopause? (6) –> constant?
- symptoms can be treated with what? –> caveat?
- solution?
- no! almost 75% of women don’t need HRT as they may not have or may not be bothered by menopausal symptoms!
- vasomotor symptoms (hot flashes! sweating and palpitations), urogenital atrophy, osteoporosis, psychosocial symptoms (insomnia, fatigue), short term memory changes, depression
- symptoms kind of die off –> homeostasis for new normal
- can be treated with estrogen –> estrogen alone can increase risk for endometrial and breast cancer (+ extended menses)
- solution: add progesterone!
- what does progesterone do? as a HRT?
- are long term effects of HRT in perimenopausal women known?
- risk of no treatment?
- progesterone promotes conversion of estradiol to estrone in target cells –> estrone has a lower affinity to estrogen receptors and thus MAY diminish cancer risk
- long term effects are unknown! –> still open question: dosage, treatment, ethnicities
*even birth control pills: nobody takes them forever, long term effects are unknown - however, without treatment, bone loss is about 1-2% per year –> increased risk of bone fractures with age = strong justification for HRT
*misfolding of Tau proteins can lead to Alzheimer’s/ cognitive degeneration
- study showed that females had higher or lower tau compared with age-matched males?
- in females, what (2) were associated with increased tau vulnerability?
- females had higher tau compared with age-matched males
- in females, earlier age at menopause AND late initiation of HT were associated with increased tau vulnerability!
*thus, earlier menopause = increased tau = increase risk of Alzheimer’s
what are 2 reasons to promote HRT for post-menopausal women?
- what are reasons to not do it?
- no HRT = lots of bone loss = increased risk of bone fractures with age
- no HRT associated with increased tau vulnerability = increased risk of Alzheimer’s disease
- long term effects are unknown, still dont have clear answers for how much, at what time to start, what regimen…
- what are the effects of testosterone HRT in men? (4)
- decrease fat mass
- increase muscle mass/activity (= increase metabolism)
- slight advantage in bone mineral density
- no difference in physical function
what are the effects of GH HRT in men?
- 2 significant differences
- 4 non sig differences
- rigorous study?
*after 6 months of GH treatment
- only significant different was in lean mass and fat mass
- weight, bone mineral content, skin thickness, muscle strength were all not significantly different
- only 26 participants + probs only 1 ethnic group…
- define doping
- derivation from what word?
- term became current when?
- use and abuse of performance enhancing substances in elite sport
- from Dutch word “dop”, an alcoholic beverage that Zulu warriors used prior to battle
- at the start of 20th century in reference to illegal drugging of race horses! first use of doping ish as we know it today
history of doping
- Egyptians slaves
- Greek athletes
- Slaves of Incas
- marathoners and cyclists
- cyclists
- Egyptians slaves: were fed elixirs (khat leaves) stimulant to work harder for longer hours
- Greek athletes ate supposedly energy boosting substances prior to activity/sports
- Slaves of Incas: worked better after chewing coca leaves –> enhance working capabilities
- marathoners and cyclists: used strychnine (acethylcholine antagonist) –> increase muscle contractions
- cyclists: used caffeine, cocaine and even alcohol for advantage
history of doping:
- 1928:
- 1935:
- WW2:
- 1966:
- 1968:
- 1974:
- 1976:
- 1979:
- 1928 – IAAF (now WAF) banned doping (use of stimulants)
- 1935: Isolation of testosterone with subsequent creation of artificial anabolic steroids
- WW II: concentration camp survivors given testosterone + nandrolone (endogenous testosterone metabolite) to enhance recovery from starvation
- 1966: FIFA (soccer) & UCI (cycling) introduce drug testing at championships
- 1968: drug testing first used in Olympic Games
- 1974: reliable test for anabolic steroids introduced
- 1976: IOC bans anabolic steroids
- 1979: testing for illegal drugs by IOC begins (off and in season testing)
what are 5 motivations for use of doping?
- peer pressure and acceptance (need for grandeur)
- role models
- social support
- pressure from coaches/parents/ advisors/ government (Russia: state sponsored doping)
- perfectionism
*Marion Jones confessed taking drugs for Sydney Olympics (3 gold, 2 bronze)
prevalence of doping
- estimated ___% of high school athletes, college and professional
- which 4 sports, suspected the most
- what other (3) non-athletic category of people suspected?
- 2/3 of which teams
- ________ dollar industry!
- 11%
- olympic swimmers, cyclists, sprinters and weightlifters
- 50% of Hollywood actors > age 40 + musicians, baby boomers… –> for youthful image
- 2/3 of 1998 tour de France teams
- billion dollar industry!
*ie people write books about how to never test positive
name 7 categories of performance enhancing drugs + examples ish
- stimulants: caffeine, amphetamines, cocaine
- build muscle/bone: anabolic steroids, beta-2 agonists, hCG, IGF-1, insulin
- relaxants: alcohol, beta-blockers, cannabinoids
- mask pain: narcotics, ACTH, cortisone, local anesthetics
- increase O2 delivery: EPO, blood doping, artificial O2 carriers
- reduce weight (for weight classes or to dilute urine): diuretics
- mask drug use: diuretics, epitestosterone, plasma expanders, secretion inhibitors
which classes of drugs are these drugs part of:
1. diuretics
2. ACTH
3. EPO
4. cocaine
5. beta-blockers
6. hCG
7. epitestosterone
8. anabolic steroids
- diuretics: reduce weight OR mask drug use
- ACTH: mask pain
- EPO: increase O2 delivery
- cocaine: sitmulants
- beta-blockers: relaxants
- hCG: build muscle/bone
- epitestosterone: mask drug use
- anabolic steroids: build muscle/bone
- caffeine = what? –> ______ metabolite
- exerts effects via (2)
- enhanced (2)
- beneficial for what kind of events?
- banned?
- legal limit?
- side effects (6)
- methylxanthine: purine metabolite (adenine, guanine)
1. increase in cAMP by inhibition of phosphodiesterase (breaks down cAMP to AMP)
2. translocation of calcium into cytoplasm for more neuro-muscular availability - enhanced nervous (mood) and cardiovascular functions –> active feeling
- endurance events, like cycling
- large doses banned by IOC and NCAA
- 15 ug/mL –> equal to 6-8 cups of coffee at 1 sitting, with testing within 2-3 hours
- insomnia, irritability, nervousness, tachycardia, arrythmias and possible death
beta-blockers:
- medically used for (5)
- usually, heightened arousal –> what are produced –> effect (2)?
- non-selective beta blockers (name) –> block what –> reducing (3)
- commonly used in which sports?
- used to reduce blood pressure, migraine headaches, heart arrhythmia, alcohol withdrawal and anxiety
- during heightened arousal, epi and norepinephrine are produced and released –> heart rate and blood pressure increase
- Propranolol: block beta-receptors in cardiac muscles –> reducing anxiety, jitters, and slows heart rate = calm down
- used in sports that require a steady hand –> golf, archery, bowling, pool, biathlon, rifle shooting…
- what is the normal function of GH? (2)
- what are 2 ways to “drug yourself” with GH?
- banned? –> how to test?
- side effects? (6)
- normal function is growth and development of every system, including bone and muscle
1. indirect manipulation (ie stimulate GH axis by GHRH, vasopressin (helps GH release))
2. direct manipulation (ie inject GH or IGF) - banned by NCAA and IOC
- no urine test available (detectable in blood) but no way to say if endogenous or exogenous + can withdraw usage prior to games to achieve “normal” blood levels
- acromegaly (may be irreversible) + peripheral neuropathy (bc GH promotes increased glu) + coronary artery disease & cardiomyopathy + diabetes + hypothyroidism + arthritis
Florence Joyner (Flojo) = fastest woman in the world
- suspected what abuser?
- world record for 100m and 200m from 1988 Olympics still stands
- died at age 38
suspected steroid/GH abuser
