6. & 7. Ageing and endocrine manipulation Flashcards
- 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
