From the Guidelines
Elevated cortisol in an elderly person is a significant concern that requires immediate medical evaluation to prevent serious health complications, including accelerated bone loss, muscle weakness, and cognitive impairment, as highlighted in the 2021 guideline update on Cushing's disease management 1. The potential consequences of elevated cortisol levels in elderly individuals are multifaceted, affecting various bodily systems and significantly impacting quality of life and independence. Key concerns include:
- Accelerated bone loss, which increases the risk of fractures, with vertebral fractures occurring in 30–50% of patients with hypercortisolism, as noted in the study on bone disease in Cushing's syndrome 1.
- Muscle weakness, impaired glucose tolerance or diabetes, hypertension, and compromised immune function, all of which can be exacerbated by the age-related physiological changes in elderly individuals.
- Cognitive impairment, mood changes, and sleep disturbances, which can further diminish the quality of life and independence of elderly patients. Given the severity of these potential complications, it is crucial to rapidly normalize cortisol levels in elderly patients with severe hypercortisolism, using treatments such as osilodrostat, metyrapone, ketoconazole, or etomidate, as recommended in the 2021 guideline update 1. Regular monitoring of cortisol levels through blood, urine, or saliva tests is also essential to ensure that treatment is effective and to make any necessary adjustments. Additionally, conventional osteoporosis treatments, such as bisphosphonates, vitamin D, and calcium, may be beneficial in preventing further bone loss in patients with persistent hypercortisolism 1.
From the Research
Significance of Elevated Cortisol in Elderly Persons
Elevated cortisol levels in elderly persons can have significant health implications. Some of the key points to consider include:
- Elevated cortisol levels are associated with an increased risk of mortality, hypertension, and diabetes mellitus (DM) in older persons 2
- High cortisol levels can also lead to osteoporosis, susceptibility to infections, and depression 2
- In elderly men, high salivary morning cortisol levels are associated with a higher mortality risk, while in elderly women, high salivary evening cortisol levels are associated with a higher mortality risk 2
- Elevated cortisol levels can also contribute to the development of metabolic syndrome, which is characterized by abdominal obesity, hypertension, and insulin resistance 3
Health Implications of Elevated Cortisol
The health implications of elevated cortisol levels in elderly persons are numerous and can include:
- Increased risk of chronic diseases such as hypertension, DM, and chronic obstructive pulmonary disease (COPD) 2
- Osteoporosis and increased risk of fractures 2
- Susceptibility to infections and depression 2
- Metabolic syndrome and its associated health risks 3
- Cushing's syndrome, a condition characterized by elevated cortisol levels, can also lead to a range of health problems, including hypertension, diabetes, and osteoporosis 4, 5
Management of Elevated Cortisol Levels
Management of elevated cortisol levels in elderly persons typically involves addressing the underlying cause of the elevation. This can include:
- Treatment of Cushing's syndrome, which may involve surgery, medication, or radiation therapy 4, 6
- Management of metabolic syndrome, which may involve lifestyle changes such as diet and exercise, as well as medication to control blood pressure, cholesterol, and blood sugar levels 3
- Treatment of underlying conditions such as hypertension, DM, and COPD 2
- Consideration of novel therapeutic approaches, such as 11β-HSD1 inhibition, which may help to reduce cortisol levels and alleviate symptoms of metabolic syndrome 3