Dysfunction of the endocrine glands can occur at any point in the life cycle. Although many endocrine diseases will present with classic signs and symptoms, atypical presentation of hormonal dysregulation can make diagnosis in the elderly particularly challenging. Normal physiologic changes associated with aging, as well as medical comorbidities and medications, may all cloud the identification of endocrine dysfunction in this complicated population. As such, the diagnosis of endocrinopathies in the elderly population requires a careful medical history, detailed physical exam, rational biochemical workup, and, if necessary, directed imaging. The management of endocrine disorders can be equally complex. Many endocrine disorders are treated with medications that may complicate an already-lengthy list, causing unwanted side effects or even drug–drug interactions. If therapy includes possible surgical referral, careful assessment of the risk–benefit ratio and candidacy of the elderly patient is imperative. Endocrine guidelines have been designed to assist the clinician with accurate diagnosis and therapeutic decision-making; however, guidelines cannot supplant the need for patient-centered care in this vulnerable population in whom disorders of the endocrine glands fail to adhere to “textbook” scenarios.