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Changes in pituitary function with ageing and implications for patient care

Nature Reviews Endocrinology volume 9, pages 205–215 (2013)Cite this article

Subjects

Abstract

The pituitary gland has a role in puberty, reproduction, stress-adaptive responses, sodium and water balance, uterine contractions, lactation, thyroid function, growth, body composition and skin pigmentation. Ageing is marked by initially subtle erosion of physiological signalling mechanisms, resulting in lower incremental secretory-burst amplitude, more disorderly patterns of pituitary hormone release and blunted 24 h rhythmic secretion. Almost all pituitary hormones are altered by ageing in humans, often in a manner dependent on sex, body composition, stress, comorbidity, intercurrent illness, medication use, physical frailty, caloric intake, immune status, level of exercise, and neurocognitive decline. The aim of this article is to critically discuss the mechanisms mediating clinical facets of changes in the hypothalamic–pituitary axis during ageing, and the extent to which confounding factors operate to obscure ageing-related effects.

Key Points

  • Growth hormone responses to most, but not all, stimuli decline markedly with ageing

  • Adrenocorticotropic hormone–cortisol dynamics change with age in a sex-related fashion

  • Water and electrolyte homeostasis is precarious in ageing

  • TSH tends to rise with age, especially in women

  • Gonadotropins increase more in women during ageing than in men

  • Multiple factors co-determine ageing effects on pituitary hormones

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Figure 1: Human thyrotropic axis in ageing.
Figure 2: Adrenocorticotropic hormone secretion in ageing individuals.
Figure 3: Effects of ageing on water balance.
Figure 4: Ageing-related effects on prolactin secretion.

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Acknowledgements

The author thanks J. Smith of the Endocrine Research Unit, Mayo Clinic, for support of manuscript preparation. Supported in part via AG019695, DK073148, AG029362, AG031763 and DK050456 (Metabolic Studies Core of the Minnesota Obesity Center) from the National Institutes of Health (Bethesda, MD). The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institute on ageing or the National Institutes of Health. Certain cited studies were supported by the National Center for Research Resources and by Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCTS).

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    Johannes D. Veldhuis

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Hypothalamo-pituitary secretory reserve in aging (DOC 54 kb)

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Veldhuis, J. Changes in pituitary function with ageing and implications for patient care. Nat Rev Endocrinol 9, 205–215 (2013). https://doi.org/10.1038/nrendo.2013.38

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