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Endocrin betegségek időskorban

2009.12.21

Endocrin betegségek időskorban

 

Az endocrin rendszernek jelentős kapacitása van, az öregedés lényeges eltérést nem okoz.

ACTH, TSH-elválasztás napi ritmusa megmarad, a stimulációs és szupressziós próbákban a hypotalamus, hypophysis mellékvese tengely működése a fiatalkorival megegyező.

FSH

LH szintje a férfiakban emelkedik, a humán choriogonadotropinra hGC testosteron válasz csökken, azonban a testeronszint nem változik.

GH (növekedési hormon) termelése kis mértékben csökken, ezzel együtt csökken az inzulin like growth factor-1 és /IGF/-szintje. A GH és IGF-1 anabolikus hatására minden életkorban szükség van, hiánya felnőttnél izom, zsír arány és a regionális zsír elosztás megváltozásával jár, idős korban pedig az alacsonyabb testosteron szinttel társulva az izomzat tömegének, erejének csökkenését okozza.

ADH secretioja változatlan, az osmoticus stimulusra adott ADH válasz a fiatalkorinak legalább 2,5-szerese.

A renin és aldosteron-szint csökken.

Az atrialis natriureticus faktor szintje emelkedik

A szomjúságérzés csökken.

Mindezek elektrolitzavarok kialakulására hajlamosítanak.

Thyrexin secretioja és clearence kissé csökken, se- szintje nem változik.

A mellékvesék tömege a cortisol scretio korral csökken, de a lebontás is csökken, a cortisol-szint változatlan.

 

A mellékvese dehydroepiandrosteron (DHEA) secretioja a negyedik évtizedtől fokozatosan negyedére, felére csökken.

 

Hypophysis betegségei: hormontermelő adenoma gyakorisága csökken. Hormont nem (inaktív alegységet azonban gyakran termelő) cromophob adenoma transcranialis feltárásból műthető.

Hypophysis hypofunctios kórképeinek kezelése során pajzsmirigy és mellékvese hormon szint feltárása célszerű, sexualsteroid substitutio fiataloktól eltérően nem szükséges. Nők és férfiak esetében gondolni kell az osteoporosis megelőzésére.

 

Hypothyreosis

 

Hashimoto-thyreoiditis

Anaplasticus pajzsmirigy carcinoma

Differentialt pajzsmirigy carcinoma

Sick euthyreoid syndroma (egyéb betegséghez társuló pajzsmirigy hormonszint eltérés), euthyreoid állapot, alapbetegséget kell kezelni

 

Mellékpajzsmirigy betegség: Hyperparathyreosis

Legtöbbször nem a panaszok alapján, hanem emelkedett Se Ca szint véletlenszerű észlelés nyomán derül ki, 60 éves kor felett 10-szer gyakoribb, mint fiatalon.

 

Primer hypoparathyreosis: ritka

Só és víz háztartás endocrin szabályozása

 

Hyponathaemia. Az ADH túltermelés syndroma esetén gyakori, pl. endocrin kórkép (Addizon, hypothyreosis) központi idegrendszeri traumák, infectio, bronchus carcinoma.

Hypernatraemia relative ritkán fordul elő.

Hyporeninaemia hypoaldosteronismus olyan idős diabeteseken jelentketik, akiknek enyhe veseelégtelensége is van.

 

Pajzsmirigy betegségei: nagyban függ az adott terület lakosságának jódellátásától.

 

Struma nodosa: meleggöb, forrógöb, hedeggöb, suprassio esetén TSH értéke 0,5-1 u/l között legyen.

 

Hyperthyreosis

 

Graves-Basedow kór (apáthiás, thyreotoxicosis)

Therápia: Béta-blokkoló, thyreostaticum (metothyrin)

Radiojód kezelés

 

 

Mellékvese betegségei:

Hyperfunctios kórképek ritkák, váratlanul magas cortisol-szint, hypercorticismusra utaló tünetek nélkül latens depresszióra utal, relesing faktor szintjén van zavar.

 

Vesebetegek idős korban

 

 

  1. A vese strukturális és funkcionális változásai:

  2. A vese tömege korral 230-270 grammról 180-200 grammra csökken

  3. A glumerulusok száma 70 éves korral 30 %-kal csökken

  4. Csökken a tubulusok hossza és térfogata, helyüket kötőszövet foglalja el és enyhe gyulladásos jelek figyelhetők meg, melyek az ischaemia következményei

  5. A nagy és középnagy artériák rugalmassága, az art. Renalisban gyakran alakul ki szűkület

  6. Csökken a vesekéreg ill. a vese vérellátása

  7. 40. életévtől a GFR évenként általában 1 ml/perc értékkel csökken

  8. A tubularis funkciók is beszűkülnek, idősek esetében só és vízháztartásra fokozottan figyelni kell – idős korban a szervezet víztartama 85 éves korban férfiaknál 65 %-ről 50 %-ra, a nőknél 54 %-ról 45 %-ra csökken. Az intracellularis víztér csökken, idősek exsiccosisra hajlamosak, nincs szomjúságérzetük. Víz deficit az alábbi képlet segítségével számítható ki:

VD=testsúly x 0,55 x (PNa-140)

 

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