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Steroid use in the elderly. Guidelines for avoiding adverse effects.

F E Kaiser, R P Doe

    Postgraduate Medicine
    |July 1, 1984
    PubMed
    Summary
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    Aging affects adrenal function, impacting steroid prescribing for seniors. While glucocorticoids remain stable, androgens may decline, necessitating careful steroid use in the elderly.

    Area of Science:

    • Endocrinology
    • Geriatrics
    • Pharmacology

    Background:

    • Aging influences adrenal gland function, affecting hormone production and clearance.
    • Steroid therapy in elderly patients requires careful consideration of age-related physiological changes.

    Purpose of the Study:

    • To review the effects of aging on adrenal function relevant to steroid prescribing.
    • To discuss the implications of age-related changes in glucocorticoid and androgen metabolism.
    • To highlight safety and efficacy considerations for steroid use in the elderly.

    Main Methods:

    • Literature review of studies on aging, adrenal function, and steroid pharmacology.
    • Analysis of physiological changes associated with aging impacting hormone levels and clearance.
    • Evaluation of risk/benefit factors for steroid use in geriatric populations.

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    Main Results:

    • Glucocorticoid production and clearance changes in aging are balanced, maintaining normal levels.
    • Hypothalamic-pituitary-adrenal axis response to stress is not significantly altered by aging.
    • Androgen levels may decrease due to "adrenopause," with mechanisms and clinical relevance requiring further research.
    • Elderly patients, especially those of asthenic build, may require lower steroid doses due to reduced muscle mass and plasma volume.

    Conclusions:

    • Steroid therapy can be safe and effective in the elderly when prescribed carefully.
    • Physicians should consider age-related adrenal function changes when managing steroid treatment in older adults.
    • Further research is needed to understand the phenomenon of "adrenopause" and its clinical implications.