When I first started in geriatric medicine, one of the common theories of aging was that of a biological "endocrine" clock that gradually wound down. Although endocrine changes have since been found to take a lesser role in the aging process, they are still crucial for understanding health and disease in elderly individuals. The most important and common of the endocrine disorders remains diabetes mellitus, and the majority of cases occur in elderly individuals. The simple-minded approach to diabetes mellitus (lower the sugar) which prevailed when I was a medical student has been replaced with the understanding that comprehensive risk factor identification and management is necessary for good outcomes. This, of course, has made the management of diabetes mellitus more complex, and Dr. David Lau helps clarify many of the issues in his article this month. The last few years also have seen a dramatic expansion in the drugs available for controlling hyperglycemia, as well as a better understanding of the benefits of various combination regimes. Dr. Baines summarizes this information in this issue's Drugs & Aging column, while Dr. D'Arcy Little's review of non-pharmacological therapies for diabetes serves as a reminder that comprehensive diabetes management cannot be obtained simply by using a prescription pad.
The recent report from the Women's Health Initiative concerning the risks and benefits of postmenopausal hormone replacement make Dr. Marla Shapiro's article particularly pertinent. With my interest in dementia, I am still waiting for further results to clarify any possible benefits of estrogen in preventing dementia (already shown to be of no value in treating established dementia). My guess is that estrogen will not prove beneficial in that sphere, either.
One only has to watch Viagra commercials on television to understand how important male sexual functioning is to a sizeable portion of the population, and endocrinologists and geriatricians have long struggled over the meaning of testosterone levels in elderly men. Drs. Carrier and Rehman review the effects of aging on the gonads in our regular Biology of Aging series, while Dr. Jay Lee gives us some practical pointers in his article on the management of androgen decline in aging men. Furthermore, the President of the Canadian Andropause Society provides a complementary article that presents both the facts and the remaining questions about the andropause.
Rounding off our endocrine disorder theme this issue is a review of thyroid nodule evaluation by Dr. Jeremy Freeman. Having experienced the value of proper evaluation of thyroid nodules among my own family and friends, I can personally attest to the importance of this article.
We also have our usual collection of articles on various age-related themes. Among them, a group from the Hamilton branch of the Regional Geriatric Programs of Ontario (David Jewell, Irene Turpie, Chris Patterson, David Lewis and Julia Baxter) enlighten us with "A one minute survey of learning needs for regional geriatric program central personnel". I am sure it would take more than one minute to learn the extent of my personal ignorance!
Enjoy this issue.
