INTRODUCTION

Although the majority of endocrine diseases present in the elderly patient population with classic symptoms and signs, a substantial minority of patients come to medical attention with subtle or atypical findings. Such presentations require a low threshold in the physician for consideration of endocrine diagnoses. The pituitary–adrenal cortex and pituitary–thyroid endocrine axes remain very much intact over the life span and, therefore, the diagnostics of endocrine disorders in these topical areas remain much as they are in young individuals. Virtually all of the endocrinopathies may have their presentations obscured in the elderly patient population by concomitant nonendocrine disorders that are severe and that distract attention from the possibility of endocrinopathy. Finally, treatment of endocrine diseases in the elderly is often more complex than in younger patients. This results from concomitant nonendocrine illness. Polypharmacy for such conditions complicates dosing of endocrine drugs and increases risks of complications of drug therapy in the older endocrine patient. For example, hypoglycemia in the management of the older diabetic patient occurs in the contexts of metabolic bone disease with attendant increased risk of fractures with falls and of coronary artery disease. Extreme care is required in the development of therapeutic regimens for older endocrine patients so that treatment achieves a satisfactory, albeit compromised, balance between benefit and risk.

PARATHYROID DISEASE AND OTHER DISEASES OF CALCIUM METABOLISM

Primary Hyperparathyroidism

Clinical Features

Primary hyperparathyroidism is a common and subtle endocrinopathy over the life span.