Abstract
Age-related increases in ACTH and cortisol secretion, and decreases in DHEA/DHEAS, are unlikely to contribute significantly to the aging phenotype. In comparison, decreased renin secretion with age results in a 50% reduction in plasma aldosterone by age 70, and may explain the tendency for increased natriuresis, hyponatremia, and hyperkalemia in the elderly.
Autoimmune adrenalitis is a relatively uncommon cause of adrenal insufficiency (AI) after age 60. The presentation of AI in older individuals is insidious and is associated with decreased functional capacity, increased risks for cardiovascular and infectious diseases, and more frequent adrenal crises. There are no specific age-related recommendations for diagnosis and replacement therapy with mineralocorticoids and glucocorticoids (GCs), although comorbidities, polypharmacy, and cognitive status should be assessed.
Cushing’s syndrome in the elderly is most often due to excess GC treatment and, when sustained, can exert deleterious consequences on mood/affect, cognition, bone, muscle, visceral, fat, cardiometabolic function, and cutaneous fragility. Ectopic ACTH secretion is the commonest cause of endogenous hypercortisolemia in old age.
There is insufficient information related to primary hyperaldosteronism and aging, both in regard to specific criteria for diagnostic screening and confirmation, and to clinical and treatment guidelines.
Pheochromocytoma diagnosis in older adults is uncommon, although a quarter of all tumors are detected in patients over 60years of age, possibly due to blunted adrenergic manifestations in the elderly.
Adrenal incidentaloma found are detected by imaging in up to 10% of older adults. Most are benign, nonfunctioning, adrenocortical, tumors. Endocrine function and malignancy potential should be evaluated as in younger adults.
Adrenocortical cancer is a rare, aggressive disease, usually diagnosed between the 5th and 7th decades of life. Radical resection by open adrenalectomy is the only potential curative treatment.
Minimally invasive, laparoscopic surgical techniques have greatly improved the safety of adrenal gland surgery, particularly in elderly patients.