T1 L12 Endocrinology of ageing

Question 1

What is somatopause?

Answer 1

Decrease in growth hormone secretion with age

Question 2

What is adrenopause?

Answer 2

Decrease in androgen secretion with age

Question 3

What has a greater effect than hormonal influence on age?

Answer 3

Genetic
Environmental
Psychological
Co-morbidities

Question 4

What shared symptoms do hypogonadism, GH deficiency and ageing cause?

Answer 4

Increased fat mass
Increased visceral fat
Sarcopaenia
Decreased bone mineral density
Decreased quality of life / mood
Increased risk of cardiovascular disease

Question 5

Describe how weight changes with age

Answer 5

Increases from the mid 30s until it plateaus between 50 and 70
Lean body mass decreases by 6-8% per decade from mid-30s

Question 6

Describe how diet changes with age

Answer 6

Decreased total energy intake

Increased protein intake

Question 7

Describe how insulin and glucose concentration change with age

Answer 7

Increased insulin resistance

Decreased peripheral glucose uptake

Question 8

What are the 4 cardiovascular risk factors in metabolic syndrome?

Answer 8

Visceral obesity
Dyslipidaemia
Hyperglycaemia
Hypertension

Question 9

Describe oestrogen levels pre and post-menopausal

Answer 9

Pre-menopausal: cycling

Post-menopausal: very low, constant levels

Question 10

What is the average age of menopause?

Answer 10

50 ± 2 years

Genetics are a strong predictor for the age of menopause

Question 11

What are the symptoms of menopause?

Answer 11

Hot flushes

Night sweats

Question 12

What morbidity is associated with the menopause?

Answer 12

Increased risk of osteoporosis
Increased risk of coronary heart disease
Increased risk of sexual dysfunction

Question 13

What are the benefits of post-menopausal HRT?

Answer 13

Treatment reduces symptoms

Decreases risk of osteoporosis and fractures during use

Question 14

What are the risks of post-menopausal HRT?

Answer 14

Increased risk of venous thromboembolism
Increased risk of breast cancer
Increased risk of endometrial cancer - this is prevented if the HRT includes progesterone

Question 15

Describe the relationship between the male gonadal axis and age

Answer 15

Decrease in testosterone concentration with age

At 75 years, the mean concentration of testosterone is 2/3 what it was at 25 years

Question 16

Describe the effect of clinical hypogonadism

Answer 16

Decreased sexual function
Increased osteoporosis
Decreased muscle strength

Question 17

What is the effect of testosterone treatment on bones?

Answer 17

Increased bone mineral density

No evidence that it decreases the risk of fractures

Question 18

Why doesn’t testosterone treatment decrease the risk of bone fractures?

Answer 18

Fractures also depend on muscle strength and stability

Question 19

What is the effect of testosterone treatment on body composition?

Answer 19

Increased lean body mass
Decreased fat mass
Increased muscle strength with supra-physiological dose

Question 20

What are the risks of testosterone treatment?

Answer 20

Prostate (benign prostatic hypertrophy / cancer)
Erythropoiesis
Possible cardiovascular risk

Question 21

Describe the relationship between the GH - IGF1 axis and age

Answer 21

Decrease in integrated GH concentration as age increases

Decreased IGF1 concentration with increasing age

Question 22

What happens to body composition when GH treatment is given?

Answer 22

Increased lean body mass

Decreased fat mass

Question 23

What are the potential risks of GH treatment?

Answer 23

Increased risk of cancer in the prostate, colon and breast

Increased risk of T2DM

Question 24

What are the side effects of GH treatment?

Answer 24

Soft tissue oedema
Arthralgias
Carpal tunnel syndrome

Question 25

Describe the relationship between cortisol and ageing

Answer 25

Higher trough levels with increasing age Phase advance of diurnal rhythm (trough and peak occurs earlier) Average levels of cortisol increase

Question 26

Describe the relationship between DHEA and ageing

Answer 26

Decreases with age

Question 27

What is an increase in DHEA associated with?

Answer 27

Increased quality of life Increased bone mineral density Decreased cognitive decline Decreased coronary heart disease

Question 28

Describe the relationship between the thyroid axis and ageing

Answer 28

Increase in TSH with age T4 remains the same Decrease in peripheral T4 to T3 conversion with age Decrease in T3 concentration with age

Question 29

What are the potential risks of giving T4 treatment?

Answer 29

Increased risk of osteoporosis and atrial fibrillation | Increased risk in elderly with atherosclerotic coronaries

Question 30

What happens with insulin and glucose in starvation / anorexia nervosa?

Answer 30

Decrease in insulin Decrease in glucose Increase in insulin sensitivity

Question 31

Where is leptin produced?

Answer 31

White adipose tissue | Leptin concentration correlates with BMI and body fat

Question 32

What is the consequence of a decreased leptin concentration?

Answer 32

Increased food intake Decreased energy expenditure Decreased fertility

Question 33

What happens to oestrogen / testosterone in starvation / AN?

Answer 33

Decrease in LH and FSH Decrease in oestrogen / testosterone Decrease in fertility (hypothalamic amenorrhoea) Osteoporosis

Question 34

What is kisspeptin?

Answer 34

Central mediator KISS1 neurons are highly response to oestrogen Metabolic influences on reproduction are mediated by leptin via the kisspeptin system (puberty, reproduction)

Question 35

What happens to cortisol levels in starvation / AN?

Answer 35

Decrease

Question 36

What is the relationship between thyroid function and starvation / AN?

Answer 36

TSH and T4 on lower limit of normal Decreased T4 conversion to T3 --> decreased T3 Increased T4 conversion to reverse T3 --> increased reverse T3 (inactive) Lower basal metabolic rate Conserve energy