Atypical presentation of endocrine disorders in the elderly

Endocrine disorders affecting the elderly present a continuing challenge to the clinician. Often confused with normal age-related changes or age-prevalent disease, disorders such as thyrotoxicosis, hyperglycemia, and hypercalcemia often go undetected until late in their course, if at all. Non-specific and atypical presentations make the diagnosis even more difficult and a low threshold for obtaining laboratory testing is advised. Thyrotoxicosis may present with only anorexia, weight loss, and cardiac dysfunction. Hyperglycemia often remains undetected; long-term sequelae, however, may impair function and result in problems such as neuropathy, postural instability, and nephropathy--conditions often dismissed as consequences of old age. Hypercalcemia may not present with the classic findings of renal colic, GI pathology, and skeletal disease. An acute confusional state with or without volume depletion appears to be a more frequent presentation during later life.