Hormone Replacement

One of the major health concerns for older persons is their potential risk for serious cardiovascular events, a risk that rises dramatically with increasing age.1,2 For example, the average annual rate of first major cardiovascular events rises from 7 per 1000 men at ages 35-44 years to 68 per 1000 men at ages 85-94; comparable rates occur in women 10 years later in life.3

Coronary heart disease (CHD) is more prevalent in the elderly, with over 83% of cardiovascular disease deaths in the United States occurring in individuals age 65 years or older.4 Individuals in the sixth decade of...

To the Editor:
I read with interest the article, “Osteoporosis in Elderly Men,”1 written by Neil Baum, MD. The initial background information is pertinent and raises awareness of the growing problem of osteoporosis in men, and a number of preventive and management strategies are suggested. The case presented in the article is a 66-year-old man with a history of prostate cancer that was initially treated with radiation therapy. After a recurrence of cancer, he was treated with luteinizing hormone-releasing hormone agonist and anti-androgen therapy, which is an important risk factor...

CASE PRESENTATION
A 66-year-old male had a routine physical examination. He had a moderately enlarged benign prostate gland. The prostate-specific antigen (PSA) was 7.7, and the ratio of free/total PSA was 9% (normal > 25%). A prostate biopsy revealed multiple cores of adenocarcinoma of the prostate, Gleason score 3 + 4. He was treated with I-125 brachytherapy plus 20 Gy of external beam therapy to the periprostatic tissue, and the PSA nadir was 0.7 ng/mL 6 months after the radiation therapy. However, 6 months later the PSA increased to2.7, and repeat PSA testing demonstrated progr...

CASE PRESENTATION
A 69-year-old male is seen for an annual examination. He reports to his physician that he has a decrease in his libido, a decrease in the rigidity of the penis during sexual intimacy as well as rapid detumescence, a loss of energy, and is falling asleep after meals. The physical exam reveals a 3/4” loss of height since that recorded at his last examination, and decreased hair on his arms and legs. He has a minimally enlarged benign prostate gland. The serum testosterone was 220 ng/dL. The luteinizing hormone (LH) and prolactin levels were normal. Prostate-specific ...

Significant alterations in the hormonal milieu occur in the aging population.1,2 In women, these changes are predictable and well recognized, and include a constellation of somatic and psychological symptoms due to a decline in circulating estrogenic hormones, called menopause. In contradistinction to menopause, the changes in the hypothalamic-pituitary-gonadal (HPG) axis in men are highly variable and are not seen in all men. These manifestations often may go unrecognized. These changes in the hormonal milieu in men are known by a collective term, male climacteric, or andropause. Andropaus...

CME ARTICLE

FULL DISCLOSURE POLICY AFFECTING CME ACTIVITIES
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following: Dr. Miller has indicated that he has not received financial support for consultat...

According to the Centers for Disease Control and Prevention (CDC), by the year 2020 about 60 million Americans will be affected by arthritis. It is a leading cause of disability in developed countries. It limits the physical capability and independence of affected individuals and causes high stress levels for caregivers.

Although the diagnosis of arthritis includes a wide spectrum of more than 100 disorders, osteoarthritis (OA) by definition is a failure of joint cartilage due to “wear and tear.” By age 75, nearly 85% of the U.S. population has clinical or radiographic features ...

Case Presentation

A 77-year-old woman lost consciousness while stepping out of an automobile. She had previously been feeling well and had been playing cards earlier in the day with friends. She quickly became alert, but while awaiting the ambulance and during the ambulance ride to the hospital, she developed recurrent syncope. Heart rates in the 20s to 30s were recorded and were unresponsive to atropine and epinephrine. Brady-arrhythmia persisted in the emergency room, associated with nausea and vomiting. The patient was intubated. She had no signs of congestive heart failure on exa...