Journal of Geriatric Research

Among the elderly population, type 2 diabetes is a growing issue, and a bigger extent of recently analysed diabetics is older. Manifestations of endocrine disease in older patients may also be mistakenly attributed to worsening of comorbid illnesses or medications by clinicians (e.g., exacerbations of congestive heart failure, atrial fibrillation. Finally, it is increasingly common for endocrine “disorders” in older persons to present with only biochemical abnormalities in the absence of appreciable symptoms (e.g., asymptomatic mild hypercalcemia secondary to primary hyperparathyroidism or subclinical hypothyroidism or hyperthyroidism).Older patients with endocrine disorders often suffer from multiple chronic medical conditions (or “multimorbidity”) that can complicate and confound clinical manifestations, evaluation, and management. The presence of concomitant comorbidities, medications used to treat these conditions, and changes in nutritional status may affect and confuse the biochemical evaluation of endocrine disorders (e.g., alterations in thyroid function tests by non-thyroidal illness, so-called euthyroid sick syndromes, or alterations in sex hormone binding globulin, SHBG, by illness, medications or aging that lower total testosterone levels but may not affect free testosterone levels). In order to minimize drug toxicity, polypharmacy, and iatrogenic disease in geriatric patients, hormone treatment should generally be initiated at low doses and increased gradually with careful monitoring to achieve the lowest dosage needed to achieve the desired therapeutic benefits without adverse effects.