Endocrine and Aging Flashcards Preview

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Flashcards in Endocrine and Aging Deck (20)
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1
Q

4 factors that can influence hormone levels?

A

Altered synthesis levels.
Altered effect on end organ.
Altered feedback.
Complicated by disease, diet, meds, exercise, etc.

2
Q

Do hormone aberrations present with “classic” symptoms seen in younger patients?

A

No, not always.

3
Q

4 normal -pause’s of aging?

A

Menopause - E2
Andropause (or, “manopause”) - T
Adrenopause - DHEA
Somatopause - GH

4
Q

What’s the take-home point about the slide with all the graphs of hormone levels at different ages?

A

Everything kind of tapers of slowly - except for estrogen, which has a dramatic drop-off at menopause.
(T and DHEAS peak in 20’s…)

5
Q

Did giving everybody estrogen at menopause turn out to be a bad idea? 3 bad things that happened?

A

Yes, increased:
Breast cancer
Strokes
Coronary artery disease

6
Q

Review: What 2 things did ERT help?

A

Decreased colorectal cancer and hip fractures.

7
Q

Might estrogen alone be less bad, in ERT?

A

Mayyyyybe. May be ok to give in low dose to peri menopausal women (who are younger and have low absolute risk for heart disease)

8
Q

What kind of pattern does T secretion follow?

A

Diurnal - it peaks in the morning.

Older men have lower levels throughout the day

9
Q

Bad things about T replacement?

A

BPH
Prostate cancer
Gynecomastia
(sleep apnea and CVD, maybe)

10
Q

How does the diurnal rhythm of cortisol change as people age?

A

More nocturnal secretion, which coincides with less REM sleep.
(I don’t think causation is proven here)

11
Q

Is impaired glucose tolerance a normal part of aging?

A

Yes. Diabetes rates go up, too.

12
Q

How is the distribution of TSH levels different in older people?

A

Distribution is shifted to the right.
We’re not sure if this means people are really hypothyroid, or that they just have a different set point.
(treatment is reasonable when benefits outweigh risks)

13
Q

Bad thing associated with high free T4?

A

Atrial fibrillation.

i.e. this is a risk of overtreating hypothyroidism

14
Q

What’s a way that hypothyroidism presents more in older people vs. younger?

A

With weight loss and anorexia.

- Recognizing hyperthyroidism and hypothyroidism is harder in old people–> “non- classical” presentation

15
Q

4 age associated hormonal drop-off’s?

A
  • Estrogen
  • Testosterone
  • DHEAS
  • IGF-1
16
Q

4 age associated increases?

A
  • Nocturnal cortisol
  • Glucose intolerance
  • Subclinical hypothyroidism
  • Type 2 diabetes
17
Q

“Normal aging” looks a lot like what?

A

Symptoms of cortisol excess/hyperactivity

  • Decrease in physical performance, walking speed
  • Decreased bone density, immunity
  • Increased depression, blood pressure
  • Decreased bone mass, cognitive function, memory
18
Q

What’s a way that hyperthyroidism presents more in older people vs. younger?

A

Apathy and anorexia

- Recognizing hyperthyroidism and hypothyroidism is harder in old people–> “non- classical” presentation

19
Q

How is homeostatic set point different in old age than youth? What 2 things change?

A

Set point is actually the SAME

  • What changes is ability to handle stressors
  • Inability to handle glucose loads as well
  • Inability to bring down high cortisol levels
20
Q

What is the log linear inverse relation between TSH and T4?

A
  • Small changes in T4 lead to LARGER changes on TSH
  • Also there is a wide variation in people’s “set points”–> for the same free T4 levels they can have VERY different TSH