As people with pituitary disorders like acromegaly grow older, they face unique challenges due to the complex interplay between aging and hormonal changes. In a recent interview with WAPO, Dr. Sandra Aleksic, Assistant Professor of Medicine at the Albert Einstein College of Medicine in New York, shed light on how hormones evolve with age and how this affects those living with pituitary conditions. Her expertise, spanning endocrinology and geriatrics, offered valuable insights especially relevant to the acromegaly community.
Dr. Aleksic began by explaining how hormone levels shift naturally with age. In women, menopause marks a sharp drop in estrogen around age 50, while men experience a more gradual decline in testosterone. Growth hormone (GH) and its related protein, IGF-1, peak during adolescence and begin to decline in early adulthood, which is part of the normal aging process. Other hormones, like thyroid and antidiuretic hormone (ADH), also show changes: thyroid function slightly decreases with age, possibly offering protective effects, while ADH levels tend to rise. Additionally, the cortisol rhythm—usually high in the morning and low at night—shifts earlier in the day with age, making the evening drop less pronounced.
These age-related hormonal shifts become particularly significant in people with pituitary disorders, where symptoms can overlap with normal aging. In older adults, pituitary hormone deficiencies (hypopituitarism) often present with subtle signs like fatigue, low libido, or altered fat distribution—symptoms that might be dismissed as typical aging. Diagnosing and treating these conditions requires careful attention to age-adjusted hormone levels, medication interactions, and overall health.
Hormone replacement therapy in older adults with pituitary disorders must be approached with caution. Dr. Aleksic recommends lower, carefully tailored doses to minimise risks such as high blood pressure, diabetes, and osteoporosis. For example, thyroid hormone replacement should begin with low doses, increasing gradually, while glucocorticoids should be administered at the lowest effective dose. Growth hormone therapy, though controversial in older adults, may still be appropriate for some under age 80 if closely monitored. Sex hormone replacement varies by gender—estrogen therapy is typically tapered off after menopause, while testosterone can continue in older men at reduced levels. Special care is also required with desmopressin (a synthetic form of AVP), as older adults are more sensitive to it.
New research is helping inform these treatments. The TRAVERSE study showed that transdermal testosterone replacement did not increase cardiovascular risk in older men with low testosterone, although it did raise concerns about blood clots and kidney issues. Meanwhile, the ERCUSYN registry provided a deeper look at how Cushing’s syndrome presents differently in older adults—less classic symptoms, larger pituitary tumors, and lower surgery rates—highlighting the importance of age-specific treatment strategies.
For people with acromegaly, aging can bring added health burdens. Dr. Aleksic noted increased rates of diabetes, hypertension, heart enlargement, and sleep apnea in older adults. Frailty and cognitive decline may also be more common in this group. Joint pain and vertebral fractures are frequent issues, although data is still emerging on how these compare to younger individuals with acromegaly.
To enhance quality of life and longevity, Dr. Aleksic emphasised the importance of a holistic approach. Older adults living with pituitary conditions should focus on maintaining physical function through a balanced exercise program—combining aerobic, strength, balance, and flexibility training. Managing cardiovascular risk through a healthy diet, weight control, and medications is crucial. Mental and emotional well-being also plays a key role, with strategies like stress reduction, social connection, and good sleep hygiene contributing to better outcomes.
With more people being diagnosed later in life due to better imaging and more effective treatments, the number of older adults living with pituitary conditions is growing. Dr. Aleksic’s advice serves as an important reminder that while hormones may decline with age, thoughtful treatment and a proactive lifestyle can support a longer, healthier life.
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