Book Review

Endocrinology and Metabolism in the Elderly

N Engl J Med 1993; 329:68July 1, 1993

Article

Endocrinology and Metabolism in the Elderly
Edited by John E. Morley and Stanley G. Korenman. 567 pp., illustrated. Boston, Blackwell Scientific, 1992. $124.95. ISBN: 0-86542-148-X

This book appears to have two goals. The first is to supply physicians with useful information that allows them to recognize common endocrine conditions in older patients and special problems in the diagnosis and treatment of diseases in this population. The second goal is to provide an up-to-date summary of geriatric endocrine and metabolic research.

The first goal is addressed in the chapters focusing on growth hormone, thyroid, and adrenal disorders in the elderly. Vitamin D, parathyroid conditions, and bone metabolism are considered in depth, with special attention given to osteoporosis and Paget's disease. The attention then shifts to gonadal endocrine aspects of aging, with very practical and informative chapters on sexual function in elderly men and women. Extended attention is given to menopause, including the role of estrogen deficiency in the cardiovascular complications of older women and the possible benefits of estrogen-replacement therapy. A final clinical section deals with diabetes, hyperlipidemia, and nutrition.

The overview of relevant endocrine and metabolic research is introduced in an excellent presentation of theories of biologic aging, by Samuel S. Murray. Problems of central nervous system function in aging are included, along with such topics as Alzheimer's disease, memory loss, and depression. There is extensive coverage of research on the central nervous system effects of neuropeptides and peptides and in the field of psychoneuroimmunology. The reader is left with a realization of the research potential of these subjects, but confused about how the many intriguing effects observed in whole animals or isolated brain or cellular systems apply to human memory or immune function. The practical application of the new research in these two areas lies in the future, when the maze of isolated experimental findings will be replaced by more testable unifying concepts applicable to humans.

The editors of this book have recruited an impressive list of authors. Nevertheless, the book has the weakness of all multiauthored books -- great variation from chapter to chapter. Some chapters include much information that should be familiar to all primary care physicians, whereas others present comprehensive reviews in a somewhat uncritical fashion that may confuse some readers. A more basic philosophical problem has to do with whether or not endocrinology and metabolism in the elderly can be separated from the broader field of endocrinology in adults. The changes in endocrine function described in this book do not begin at some arbitrary age designated as “elderly.”

William H. Daughaday, M.D.
Washington University School of Medicine, St. Louis, MO 63110