{"id":758,"date":"2026-03-13T11:26:12","date_gmt":"2026-03-13T08:26:12","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=758"},"modified":"2026-03-13T11:26:13","modified_gmt":"2026-03-13T08:26:13","slug":"yasli-hastada-endokrin-aciller-tani-ve-tedavide-yasa-ozgu-farkliliklar","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yasli-hastada-endokrin-aciller-tani-ve-tedavide-yasa-ozgu-farkliliklar\/","title":{"rendered":"Ya\u015fl\u0131 Hastada Endokrin Aciller: Tan\u0131 ve Tedavide Ya\u015fa \u00d6zg\u00fc Farkl\u0131l\u0131klar"},"content":{"rendered":"\n<p><strong>Edit\u00f6r:&nbsp;<\/strong><a>Prof.Dr.Mehmet Ali Aslaner<strong>&nbsp;<\/strong><\/a><strong>Yazar:&nbsp;<\/strong>Uzm.Dr.<strong>&nbsp;<\/strong>Kudret Selki<\/p>\n\n\n\n<p><strong>Giri\u015f<\/strong><\/p>\n\n\n\n<p>Acil servis ba\u015fvurular\u0131nda geriatrik pop\u00fclasyonun giderek artan oran\u0131, hekimleri \u00e7ok daha karma\u015f\u0131k ve atipik hastal\u0131k prezentasyonlar\u0131 ile kar\u015f\u0131 kar\u015f\u0131ya b\u0131rakmaktad\u0131r.&nbsp;Ya\u015flanma s\u00fcreciyle birlikte organ sistemlerinde meydana gelen fizyolojik regresyon ve stres yan\u0131t\u0131ndaki zay\u0131flama, literat\u00fcrde &#8220;homeostenoz&#8221; kavram\u0131 ile tan\u0131mlanmakta olup; bu durum ya\u015fl\u0131 hastan\u0131n akut patolojilere kar\u015f\u0131 kompanzasyon yetene\u011fini dramatik \u00f6l\u00e7\u00fcde azaltmaktad\u0131r.&nbsp;Endokrinolojik aciller, bu fizyolojik rezerv kayb\u0131n\u0131n, komorbiditelerin ve e\u015flik eden polifarmasinin en belirgin yans\u0131malar\u0131n\u0131n g\u00f6r\u00fcld\u00fc\u011f\u00fc klinik tablolar\u0131n ba\u015f\u0131nda gelmektedir<sup>1,2<\/sup>.<\/p>\n\n\n\n<p>Sa\u011fl\u0131kl\u0131 ya\u015fl\u0131larda \u00f6nemli endokrin fonksiyonlar genellikle iyi korunsa da, endokrin bozukluklar s\u0131kl\u0131kla atipik ve spesifik olmayan belirtilerle ortaya \u00e7\u0131kar ve genellikle ba\u015fka t\u0131bbi durumlar i\u00e7in yap\u0131lan taramalar s\u0131ras\u0131nda tesad\u00fcfen saptan\u0131r.Gen\u00e7 pop\u00fclasyonda belirgin otonomik hiperaktivite veya spesifik \u015fikayetlerle kendini g\u00f6steren hiperosmolar krizler, tiroid f\u0131rt\u0131nas\u0131 veya adrenal yetmezlik gibi hayat\u0131 tehdit eden tablolar; ya\u015fl\u0131 hastalarda s\u0131kl\u0131kla a\u00e7\u0131klanamayan deliryum, d\u00fc\u015fme, senkop veya letarji gibi olduk\u00e7a silik ve nonspesifik semptomlarla kendini g\u00f6stermektedir<sup>1,3<\/sup>.&nbsp;Bu yaz\u0131da, geriatrik hastalarda en s\u0131k kar\u015f\u0131la\u015f\u0131lan endokrin acillerin tan\u0131s\u0131nda, maskelenen klasik bulgular ele al\u0131nm\u0131\u015f ve h\u00fccresel ya\u015flanma, azalan b\u00f6brek\/kardiyak rezervler g\u00f6z \u00f6n\u00fcne al\u0131narak acil servis res\u00fcsitasyonunda dikkat edilmesi gereken ya\u015fa \u00f6zg\u00fc tedavi stratejileri \u00f6zetlenmi\u015ftir.<\/p>\n\n\n\n<p><strong>Ya\u015flanma S\u00fcrecinde Endokrin Sistemdeki Fizyolojik ve Farmakolojik De\u011fi\u015fiklikler<\/strong><\/p>\n\n\n\n<p>Ya\u015flanma, hipotalamik-hipofizer aks\u0131 ve dolay\u0131s\u0131yla t\u00fcm endokrin sistemi karma\u015f\u0131k mekanizmalarla etkiler.&nbsp;Ya\u015flanmayla birlikte baz\u0131 endokrin organlar hipoaktif duruma gelirken, baz\u0131lar\u0131nda da hiperaktif durum g\u00f6r\u00fclebilir.&nbsp;Bu hormonal de\u011fi\u015fimler; sarkopeni, bili\u015fsel bozukluklar, ateroskleroz, osteoporoz ve k\u0131r\u0131lganl\u0131k gibi ya\u015fl\u0131l\u0131k sorunlar\u0131n\u0131n temelinde yer al\u0131r<sup>2<\/sup>. Acil klinik tablolar\u0131 \u015fekillendiren ba\u015fl\u0131ca sistemik ve farmakolojik de\u011fi\u015fiklikler \u015funlard\u0131r:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>S\u0131v\u0131-Elektrolit ve Su Metabolizmas\u0131:<\/strong>\u00a0Ya\u015flanma ile b\u00f6bre\u011fin suyu atma ve idrar\u0131 konsantre etme kapasitesi azal\u0131r, bu da hastay\u0131 hem hiponatremiye hem de hiperozmolariteye yatk\u0131n hale getirir.\u00a0Ya\u015fl\u0131larda ozmotik de\u011fi\u015fikliklere kar\u015f\u0131 hipotalamik osmoresept\u00f6r duyars\u0131zl\u0131\u011f\u0131 geli\u015fir ve susama cevab\u0131 azal\u0131r.\u00a0Ayn\u0131 zamanda vazopressin d\u00fczeylerinin artmas\u0131 ya\u015fl\u0131lar\u0131 hiponatremiye yatk\u0131n hale getirirken, artan atrial natri\u00fcretik peptid nokt\u00fcriye neden olur<sup>4,5<\/sup>.<\/li>\n\n\n\n<li><strong>Karbonhidrat Metabolizmas\u0131:<\/strong>\u00a0Ya\u015fla ili\u015fkili ins\u00fclin direnci geli\u015fir ve buna ba\u011fl\u0131 olarak kanda ins\u00fclin d\u00fczeyleri artar.\u00a0Bu durum ya\u015fl\u0131lar\u0131 hipertansiyona, d\u00fc\u015f\u00fck yo\u011funluklu lipoproteinlerde art\u0131\u015fa ve y\u00fcksek yo\u011funluklu lipoproteinlerde d\u00fc\u015f\u00fc\u015fe e\u011filimli hale getirir<sup>6-9<\/sup>.<\/li>\n\n\n\n<li><strong>Hipofiz ve B\u00fcy\u00fcme Hormonu Aks\u0131:<\/strong>\u00a0Hipofizde ya\u015fa ba\u011fl\u0131 mikrovask\u00fcler de\u011fi\u015fiklikler ve fibrozis g\u00f6r\u00fcl\u00fcr; bu durum hormonlar\u0131n sal\u0131n\u0131m miktar\u0131n\u0131 ve sirkadiyen ritimlerini bozar.\u00a0B\u00fcy\u00fcme hormonu 40&#8217;l\u0131 ya\u015flardan itibaren azalmaya ba\u015flar ve ins\u00fclin benzeri b\u00fcy\u00fcme fakt\u00f6r\u00fc-1 d\u00fczeyleri d\u00fc\u015fer<sup>10<\/sup>.<\/li>\n\n\n\n<li><strong>Tiroid Aks\u0131:<\/strong>\u00a0Normal ya\u015flanma s\u00fcrecinde tiroid stim\u00fclan hormon ve T4 seviyeleri genellikle de\u011fi\u015fmezken, tiroksinin klirens h\u0131z\u0131 azald\u0131\u011f\u0131 i\u00e7in serbest T4 seviyeleri sabit kal\u0131r.\u00a0Ancak \u00fcretiminin azalmas\u0131na ba\u011fl\u0131 olarak aktif hormon olan serbest T3 d\u00fczeyleri d\u00fc\u015fer<sup>11-13<\/sup>.<\/li>\n\n\n\n<li><strong>Adrenal Aks:<\/strong>\u00a0Kortizol klirensi ya\u015fla birlikte azald\u0131\u011f\u0131 i\u00e7in bazal kortizol seviyeleri ya\u015flanmadan belirgin \u015fekilde etkilenmez.\u00a0D\u0131\u015far\u0131dan verilen\u00a0adrenokortikotropik hormona (ACTH) kar\u015f\u0131 adrenal kortizol yan\u0131t\u0131 azal\u0131r, ancak bask\u0131lay\u0131c\u0131 testlerde deksametazon kortizol\u00fc gen\u00e7ler kadar etkin bask\u0131layamaz.\u00a0Adrenal bezlerden salg\u0131lanan dehidroepiandrosteron s\u00fclfat hormonu ise dramatik bir \u015fekilde d\u00fc\u015ferek 80&#8217;li ya\u015flarda gen\u00e7likteki seviyesinin %20&#8217;sine iner<sup>2,14<\/sup>.<\/li>\n\n\n\n<li><strong>Kalsiyum Metabolizmas\u0131:<\/strong>\u00a0Ba\u011f\u0131rsaklardan kalsiyum emiliminin azalmas\u0131 ve D vitamini seviyelerindeki d\u00fc\u015f\u00fc\u015fe tepki olarak parathormon d\u00fczeyleri yakla\u015f\u0131k %30 oran\u0131nda artar (kompansatuvar mekanizma); bu tablo osteoporozu h\u0131zland\u0131r\u0131r<sup>14<\/sup>.<\/li>\n\n\n\n<li><strong>Otonomik ve Farmakolojik Fakt\u00f6rler:<\/strong>\u00a0Otonomik sinir sistemindeki de\u011fi\u015fikliklere ba\u011fl\u0131 olarak ya\u015fl\u0131larda adrenerjik yan\u0131t k\u00f6relir.\u00a0Ek olarak, ya\u015fl\u0131 hastalar\u0131n s\u0131kl\u0131kla maruz kald\u0131\u011f\u0131 polifarmasi\u00a0\u00a0endokrin krizlere kar\u015f\u0131 olu\u015fmas\u0131 beklenen klasik fizyolojik yan\u0131tlar\u0131 ciddi \u015fekilde maskeler<sup>14<\/sup>.<\/li>\n<\/ul>\n\n\n\n<p><strong>Endokrin Aciller<\/strong><\/p>\n\n\n\n<p><strong>1. Glukoz Metabolizmas\u0131 Acilleri<\/strong><strong><sup>7-9,15,16<\/sup><\/strong><strong><\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda glukoz metabolizmas\u0131 acillerinin y\u00f6netimindeki en kritik prensip, kat\u0131 glisemik kontrolden ziyade hastan\u0131n fonksiyonel durumuna g\u00f6re hedeflerin bireyselle\u015ftirilmesi ve \u00f6l\u00fcmc\u00fcl olabilen hipoglisemiden kesinlikle ka\u00e7\u0131n\u0131lmas\u0131d\u0131r.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Maskelenmi\u015f Hipoglisemi:<\/strong>\u00a0Ya\u015fl\u0131 diyabetik hastalar\u0131n acil tedavisindeki birincil hedef hipoglisemiden ka\u00e7\u0131nmakt\u0131r. Kognitif problemler, hatal\u0131 ins\u00fclin kullan\u0131m\u0131, yetersiz beslenme ve azalan b\u00f6brek klirensi nedeniyle ya\u015fl\u0131larda hipoglisemi geli\u015fme ve fark edilmeme riski \u00e7ok daha y\u00fcksektir. Ya\u015fl\u0131larda otonom n\u00f6ropati ve adrenerjik yan\u0131tlar\u0131n k\u00f6relmesi nedeniyle, hipogliseminin klasik otonomik uyar\u0131c\u0131 semptomlar\u0131 (terleme, \u00e7arp\u0131nt\u0131, titreme) kaybolur (maskelenmi\u015f hipoglisemi). Hastalar acil servise genellikle do\u011frudan n\u00f6roglikopenik semptomlarla (deliryum, konf\u00fczyon, fokal n\u00f6rolojik defisitler veya koma) getirilirler.<\/li>\n\n\n\n<li><strong>Hiperosmolar Hiperglisemik Durum (HHD):<\/strong>\u00a0Ya\u015fl\u0131 pop\u00fclasyonda diyabetik ketoasidoza (DKA) k\u0131yasla \u00e7ok daha s\u0131k g\u00f6r\u00fclen, daha sinsi ilerleyen ve mortalite oran\u0131 (%10-20) \u00e7ok daha y\u00fcksek olan bir tablodur. Tan\u0131; kan \u015fekerinin\u00a0<a>&gt;<\/a>600 mg\/dl, ozmolaritenin &gt;320 mOsm\/kg olmas\u0131, a\u011f\u0131r dehidratasyon bulunmas\u0131 ve keton olmamas\u0131 ile konur. Ya\u015fl\u0131larda susama hissinin azalmas\u0131 ve ketozis kaynakl\u0131 kusmalar\u0131n olmamas\u0131 nedeniyle sinsi bir ba\u015flang\u0131\u00e7 g\u00f6sterir; s\u0131v\u0131 kayb\u0131 (ortalama 8-10 litre) hastay\u0131 uyarmadan \u00e7ok a\u011f\u0131r bir seviyeye ula\u015f\u0131r.\n<ul class=\"wp-block-list\">\n<li><em>Acil Y\u00f6netim:<\/em>\u00a0Tedavideki en kritik nokta s\u0131v\u0131 ve elektrolit replasman\u0131d\u0131r. Ancak ya\u015fl\u0131larda s\u0131kl\u0131kla e\u015flik eden komorbid kalp ve b\u00f6brek yetmezli\u011fi nedeniyle agresif s\u0131v\u0131 res\u00fcsitasyonu, iyatrojenik vol\u00fcm y\u00fcklenmesine ve akut pulmoner \u00f6deme yol a\u00e7abilir. Bu nedenle s\u0131v\u0131 a\u00e7\u0131\u011f\u0131 kapat\u0131l\u0131rken mutlaka fizik muayene ve ultrasonografi (USG) gibi y\u00f6ntemlerle s\u0131k\u0131 takip yap\u0131lmal\u0131d\u0131r.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>DKA ve Laktik Asidoz:<\/strong>\u00a0\u0130ns\u00fclin eksikli\u011fi ve enfeksiyon gibi tetikleyici fakt\u00f6rlerin varl\u0131\u011f\u0131nda ya\u015fl\u0131 tip 2 diyabetiklerde de DKA geli\u015febilir. Ya\u015fl\u0131larda laktik asidoz e\u015flik etme riskinin y\u00fcksekli\u011fi, atipik kar\u0131n a\u011fr\u0131s\u0131 veya sadece bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131 ile geli\u015f, tan\u0131y\u0131 zorla\u015ft\u0131ran fakt\u00f6rlerdir. Ayr\u0131ca ya\u015fl\u0131 hastalarda b\u00f6brek fonksiyonlar\u0131nda azalma veya kalp\/akci\u011fer hastal\u0131\u011f\u0131na ba\u011fl\u0131 doku hipoksisi mevcutsa, metformin kullan\u0131m\u0131na ba\u011fl\u0131 olarak a\u011f\u0131r laktik asidoz (kan laktat &gt;5 mmol\/l, pH &lt;7.3) tablosu geli\u015febilece\u011fi ak\u0131lda tutulmal\u0131d\u0131r.<\/li>\n<\/ul>\n\n\n\n<p><strong>2. Tiroid Bezi Acilleri<\/strong><strong><sup>11-13<\/sup><\/strong><strong><\/strong><\/p>\n\n\n\n<p>Tiroid krizleri, ya\u015fl\u0131 hastalarda klasik bulgular\u0131n tamamen z\u0131tt\u0131 bir klinik yelpazede kar\u015f\u0131m\u0131za \u00e7\u0131kabilir ve bu durum tan\u0131da ciddi gecikmelere yol a\u00e7ar.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Apatetik Tirotoksikoz (Tiroid F\u0131rt\u0131nas\u0131):<\/strong>\u00a0Ya\u015fl\u0131lar\u0131n yakla\u015f\u0131k \u00fc\u00e7te birinde hipertiroidinin klasik hiperaktivite, anksiyete, terleme ve tremor gibi bulgular\u0131 g\u00f6r\u00fclmez. Bunun yerine klinik tablo; a\u00e7\u0131klanamayan letarji, belirgin kilo kayb\u0131, proksimal kas g\u00fc\u00e7s\u00fczl\u00fc\u011f\u00fc ve yeni geli\u015fen atriyal fibrilasyon (AF) veya diren\u00e7li kalp yetmezli\u011fi ile giden &#8220;apatetik tirotoksikoz&#8221; \u015feklinde ortaya \u00e7\u0131kar. Gen\u00e7lerden farkl\u0131 olarak ya\u015fl\u0131larda tan\u0131da mutlaka ciddi kardiyak de\u011ferlendirme yap\u0131lmal\u0131d\u0131r.\n<ul class=\"wp-block-list\">\n<li><em>Acil Y\u00f6netim:<\/em>\u00a0Tedavide beta-bloker (\u00f6rn. propranolol) kullan\u0131m\u0131 temel ta\u015flardan biri olsa da, dekompanse kalp yetmezli\u011fi ve bronkospazm riski olan ya\u015fl\u0131larda bu ajanlar \u00e7ok dikkatli titre edilmelidir. Ayr\u0131ca dehidratasyon durumundaki hastalarda intraven\u00f6z kristalloid inf\u00fczyonu ve inaktif T4 formun T3\u2019e d\u00f6n\u00fc\u015f\u00fcm\u00fcn\u00fc \u00f6nlemek i\u00e7in hidrokortizon tedavisi de \u00f6nerilir.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Miks\u00f6dem Komas\u0131:<\/strong>\u00a0S\u0131kl\u0131kla uzun s\u00fcreli hipotiroidisi olan ya\u015fl\u0131larda araya giren bir pn\u00f6moni, so\u011fu\u011fa maruziyet veya ila\u00e7 kullan\u0131m\u0131 (\u00f6rn. amiodaron, lityum) ile tetiklenir. Hipotermi, a\u00e7\u0131klanamayan bradikardi, hiponatremi ve mental durum de\u011fi\u015fikli\u011fi triad\u0131 ile karakterizedir ve bu atipik tablo ya\u015fl\u0131larda s\u0131kl\u0131kla sepsis ile kar\u0131\u015ft\u0131r\u0131labilir.\n<ul class=\"wp-block-list\">\n<li><em>Acil Y\u00f6netim:<\/em>\u00a0\u0130ntraven\u00f6z levotiroksin replasman\u0131 tedavinin merkezinde yer alsa da, tiroid hormonu miyokard\u0131n oksijen t\u00fcketimini art\u0131r\u0131r. Sessiz iskemisi olan ya\u015fl\u0131larda y\u00fcksek doz replasman akut miyokard enfarkt\u00fcs\u00fcn\u00fc veya \u00f6l\u00fcmc\u00fcl aritmileri tetikleyebilece\u011finden, ilaca her zaman \u00e7ok d\u00fc\u015f\u00fck dozlarda ba\u015flanmal\u0131 (&#8220;Start low, go slow&#8221; prensibi) ve doz yava\u015f\u00e7a art\u0131r\u0131lmal\u0131d\u0131r.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"868\" height=\"396\" src=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2026\/03\/image.png\" alt=\"\" class=\"wp-image-759\" srcset=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2026\/03\/image.png 868w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2026\/03\/image-300x137.png 300w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2026\/03\/image-768x350.png 768w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2026\/03\/image-585x267.png 585w\" sizes=\"(max-width: 868px) 100vw, 868px\" \/><figcaption class=\"wp-element-caption\"><strong>\u015eekil\u00a01. Geriatrik Tiroid Replasman\u0131nda &#8221;Start Low, Go Slow&#8221; Prensibi<\/strong><\/figcaption><\/figure>\n\n\n\n<p><strong>3. Adrenal Aciller<\/strong><strong><sup>14,17,18<\/sup><\/strong><strong><\/strong><\/p>\n\n\n\n<p>Adrenal korteks disfonksiyonlar\u0131 ya\u015fl\u0131larda genellikle sinsi ilerler, ancak stres fakt\u00f6rleri ile kar\u015f\u0131la\u015f\u0131ld\u0131\u011f\u0131nda h\u0131zla ya\u015fam\u0131 tehdit eden krizlere d\u00f6n\u00fc\u015febilir.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Akut Adrenal Kriz (Adrenal Yetmezlik):<\/strong>\u00a0Ya\u015fl\u0131larda adrenal yetmezli\u011fin en yayg\u0131n nedeni, otoimm\u00fcn hastal\u0131klardan ziyade uzun s\u00fcreli iatrojenik glukokortikoid tedavisinin aniden kesilmesidir. Ya\u015fl\u0131larda kortizol klirensi azald\u0131\u011f\u0131 i\u00e7in bazal kortizol seviyeleri genellikle normal s\u0131n\u0131rlarda kal\u0131r; ancak akut stres an\u0131nda (enfeksiyon, cerrahi) beklenen kortizol yan\u0131t\u0131 yetersiz kalabilir.\n<ul class=\"wp-block-list\">\n<li><em>Ya\u015fa \u00d6zg\u00fc Fark:<\/em>\u00a0Klasik hiperpigmentasyon veya spesifik bulgular g\u00f6r\u00fclmeyebilir. Hastalar acil servise genellikle a\u00e7\u0131klanamayan diren\u00e7li \u015fok (vazopress\u00f6rlere yan\u0131ts\u0131z hipotansiyon), derin letarji, a\u00e7\u0131klanamayan hiponatremi ve hiperkalemi tablosu ile getirilir.<\/li>\n\n\n\n<li><em>Acil Y\u00f6netim:<\/em>\u00a0Hemodinamik instabilite varl\u0131\u011f\u0131nda, tan\u0131sal testlerin (ACTH stim\u00fclasyon testi) sonu\u00e7lar\u0131 beklenmeden derhal ampirik intraven\u00f6z hidrokortizon tedavisine ba\u015flanmal\u0131d\u0131r.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><strong>4.&nbsp;<\/strong><strong>Hipofiz Acilleri: Akut Hipopit\u00fcitarizm<\/strong><strong><sup>10<\/sup><\/strong><strong><\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131l\u0131kta hipofiz bezinde meydana gelen mikrovask\u00fcler de\u011fi\u015fiklikler ve interstisyel fibrozis, hormonal sal\u0131n\u0131m amplit\u00fcdlerini ve sirkadiyen ritimleri bozarak hastay\u0131 yetmezlik tablolar\u0131na yatk\u0131n hale getirir.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Etiyoloji ve Risk Fakt\u00f6rleri:<\/strong>\u00a0Ya\u015fl\u0131 pop\u00fclasyonda akut hipopit\u00fcitarizmin en s\u0131k nedenleri kafa travmalar\u0131 ve &#8220;bo\u015f sella&#8221; sendromudur.\u00a0\u00d6zellikle hemorajik serebrovask\u00fcler olaylar, hipofiz yetmezli\u011fi i\u00e7in kritik bir risk fakt\u00f6r\u00fcd\u00fcr; subaraknoidal kanama ge\u00e7iren hastalar\u0131n %30-35&#8217;inde hipopit\u00fcitarizm geli\u015fti\u011fi bildirilmi\u015ftir.<\/li>\n\n\n\n<li><strong>Klinik Prezentasyon:<\/strong>\u00a0Ya\u015fl\u0131larda hipofiz yetmezli\u011fi bulgular\u0131 hem hasta hem de hekim taraf\u0131ndan s\u0131kl\u0131kla &#8220;ya\u015flanman\u0131n do\u011fal bir sonucu&#8221; olarak g\u00f6r\u00fcl\u00fcp hafife al\u0131nd\u0131\u011f\u0131 i\u00e7in tan\u0131 s\u0131kl\u0131kla gecikir.\u00a0Acil serviste bu tablo genellikle kilo alma, a\u00e7\u0131klanamayan halsizlik, diren\u00e7li hipotansiyon ve so\u011fuk intolerans\u0131 gibi nonspesifik belirtilerle kar\u015f\u0131m\u0131za \u00e7\u0131kar.<\/li>\n\n\n\n<li><em>Acil Y\u00f6netim ve Tan\u0131:<\/em>\u00a0Adrenal yetmezlik \u015f\u00fcphesinde sabah kortizol d\u00fczeyinin &lt;4 mcg\/dl olmas\u0131 tan\u0131y\u0131 kesinle\u015ftirirken, &gt;18 mcg\/dl olmas\u0131 d\u0131\u015flamaktad\u0131r.\u00a0Ya\u015fl\u0131larda ins\u00fclin tolerans testi riskli kabul edildi\u011fi i\u00e7in tan\u0131 a\u015famas\u0131nda &#8220;K\u0131sa ACTH (Synacthen) testi&#8221; tercih edilmelidir.\n<ul class=\"wp-block-list\">\n<li><em>Kritik Uyar\u0131:<\/em>\u00a0Acil serviste hem tiroid hem de adrenal yetmezli\u011fi bir arada saptanan ya\u015fl\u0131 hastalarda, tiroid hormonu replasman\u0131ndan \u00f6nce mutlaka hidrokortizon tedavisi ba\u015flanmal\u0131d\u0131r. Aksi takdirde, artan metabolik h\u0131z adrenal krizi tetikleyebilir.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><strong>5.<\/strong><strong>&nbsp;Elektrolit ve Su Metabolizmas\u0131 Bozukluklar\u0131<\/strong><strong><sup>4,5,18<\/sup><\/strong><strong><\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131larda endokrin disfonksiyonlar (\u00f6zellikle hipofizer veya adrenal kaynakl\u0131 olanlar) acil servise s\u0131kl\u0131kla sadece izole elektrolit bozukluklar\u0131 \u015feklinde yans\u0131r.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Hiponatremi ve Uygunsuz ADH Sendromu (SIADH):<\/strong>\u00a0Hiponatremi, acil servise ba\u015fvuran ya\u015fl\u0131larda en s\u0131k kar\u015f\u0131la\u015f\u0131lan ve mortalitenin ba\u011f\u0131ms\u0131z bir belirleyicisi olan elektrolit anormalli\u011fidir. En s\u0131k nedeni SIADH&#8217;t\u0131r. Ya\u015fl\u0131lar\u0131n s\u0131kl\u0131kla kulland\u0131\u011f\u0131 polifarmasi rejimi (\u00f6zellikle tiyazid grubu di\u00fcretikler ve SSRI grubu antidepresanlar\u0131n e\u015fzamanl\u0131 kullan\u0131m\u0131) hiponatremi riskini 13,5 kata kadar art\u0131rmaktad\u0131r. D\u00fc\u015fmelerin, senkoplar\u0131n ve akut kognitif de\u011fi\u015fikliklerin gizli nedeni s\u0131kl\u0131kla hiponatremidir.<\/li>\n\n\n\n<li><strong>Hipernatremi:<\/strong>\u00a0Azalm\u0131\u015f susama hissi ve k\u0131s\u0131tl\u0131 mobiliteye ba\u011fl\u0131 olarak suya ula\u015famama, ya\u015fl\u0131larda sessiz ve derin bir dehidratasyona yol a\u00e7ar. Acil serviste bu hastalar\u0131n s\u0131v\u0131 res\u00fcsitasyonu planlan\u0131rken, ozmotik demiyelinizasyon sendromu gibi kal\u0131c\u0131 n\u00f6rolojik hasarlar\u0131 engellemek i\u00e7in serum sodyumunun d\u00fczeltilme h\u0131z\u0131 dikkatle ayarlanmal\u0131 ve 24 saatte 8-10 mEq\/L&#8217;den fazla d\u00fc\u015f\u00fcr\u00fclmemelidir.<\/li>\n<\/ul>\n\n\n\n<p><strong>6.Kalsiyum Metabolizmas\u0131 Acilleri<\/strong><strong><sup>1,2,17<\/sup><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Hiperkalsemi Krizi:<\/strong>\u00a0Ya\u015fl\u0131larda hiperkalseminin en s\u0131k g\u00f6r\u00fclen iki temel nedeni primer hiperparatiroidi ve malignite ili\u015fkili hiperkalsemidir. Acil serviste letarji, ciddi kas g\u00fc\u00e7s\u00fczl\u00fc\u011f\u00fc, kognitif bozukluk ve EKG de\u011fi\u015fiklikleri (k\u0131sa QT mesafesi) ile prezente olur.\n<ul class=\"wp-block-list\">\n<li><em>Acil Y\u00f6netim:<\/em>\u00a0Hiperkalsemi krizinin temel tedavisi agresif intraven\u00f6z hidrasyon ve loop di\u00fcretikleridir; ancak kalp yetmezli\u011fi olan ya\u015fl\u0131 hastalarda bu &#8220;agresif hidrasyon&#8221; ciddi bir iyatrojenik pulmoner \u00f6dem ikilemi yarat\u0131r. Bu hastalarda hidrasyon yak\u0131ndan takip edilmeli ve diren\u00e7li vakalarda bisfosfonatlar veya denosumab gibi anti-rezorptif ajanlar tedaviye eklenmelidir.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><strong>Tablo\u00a01. Gen\u00e7 Eri\u015fkin ve Geriatrik Hastalar\u0131n Endokrin Acil Prezentasyonlar\u0131 Aras\u0131ndaki Farklar<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Endokrin Acil<\/strong><\/td><td><strong>Gen\u00e7 Eri\u015fkin Prezentasyonu<\/strong><\/td><td><strong>Geriatrik Prezentasyon<\/strong><\/td><td><strong>Kritik Acil Servis N\u00fcans\u0131<\/strong><\/td><\/tr><\/thead><tbody><tr><td><strong>Hipoglisemi<\/strong><\/td><td>Terleme, \u00e7arp\u0131nt\u0131, titreme (Adrenerjik yan\u0131t)<\/td><td>Deliryum, konf\u00fczyon, inme taklit\u00e7isi fokal defisitler (N\u00f6roglikopeni)<\/td><td>Beta-bloker kullan\u0131m\u0131 adrenerjik uyar\u0131lar\u0131 maskeler; &#8220;maskelenmi\u015f hipoglisemi&#8221;ye dikkat!<\/td><\/tr><tr><td><strong>HHD<\/strong><\/td><td>Polidipsi, poli\u00fcri, orta derece dehidratasyon<\/td><td>Derin dehidratasyon (8-10L), sinsi ba\u015flang\u0131\u00e7, koma<\/td><td>Agresif s\u0131v\u0131 y\u00fcklemesi kalp yetmezli\u011fini tetikleyebilir; fizik muayene veya USG takibi \u015fartt\u0131r.<\/td><\/tr><tr><td><strong>Tirotoksikoz<\/strong><\/td><td>\u00c7arp\u0131nt\u0131, anksiyete, hipertiroidi bulgular\u0131<\/td><td><strong>Apatetik Form:<\/strong>&nbsp;Letarji, kilo kayb\u0131, yeni AF, kalp yetmezli\u011fi<\/td><td>Propranolol dozunda bronkospazm ve dekompanse kalp yetmezli\u011fi riski.<\/td><\/tr><tr><td><strong>Miks\u00f6dem Komas\u0131<\/strong><\/td><td>Belirgin miks\u00f6dem \u00f6demi, uyku hali<\/td><td>Hipotermi, bradikardi, hiponatremi (Sepsis ile kar\u0131\u015fabilir)<\/td><td>T4 replasman\u0131 sessiz miyokard iskemisini tetikleyebilir; &#8220;Start low, go slow&#8221;.<\/td><\/tr><tr><td><strong>Adrenal Kriz<\/strong><\/td><td>Hiperpigmentasyon, kar\u0131n a\u011fr\u0131s\u0131, \u015fok<\/td><td>Diren\u00e7li \u015fok, a\u00e7\u0131klanamayan hiponatremi ve hiperkalemi<\/td><td>Tan\u0131 testlerini beklemeden ampirik Hidrokortizon ba\u015flanmal\u0131d\u0131r.<\/td><\/tr><tr><td><strong>Hipopit\u00fcitarizm<\/strong><\/td><td>Spesifik hormon eksikli\u011fi bulgular\u0131<\/td><td>Halsizlik, kilo alma, hipotansiyon (Ya\u015fl\u0131l\u0131k belirtisi san\u0131labilir)<\/td><td>Tiroid replasman\u0131ndan \u00f6nce mutlaka steroid tedavisi verilmelidir.<\/td><\/tr><tr><td><strong>Hiperkalsemi<\/strong><\/td><td>Kemik a\u011fr\u0131s\u0131, ta\u015flar, abdominal yak\u0131nmalar<\/td><td>Letarji, bili\u015fsel bozukluk, EKG&#8217;de k\u0131sa QT<\/td><td>Agresif hidrasyon vs. ya\u015fl\u0131 kardiyak rezervi dengesi g\u00f6zetilmelidir.<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n<p><strong>Sonu\u00e7 ve Acil Servis Y\u00f6netimi \u0130\u00e7in &#8220;Alt\u0131n Kurallar&#8221;<\/strong><\/p>\n\n\n\n<p>Geriatrik pop\u00fclasyonda endokrin aciller, sessiz ve atipik prezente olma e\u011filimindedir. Gen\u00e7 hastalarda hayat kurtaran standart tedavi algoritmalar\u0131, ya\u015fl\u0131 hastalardaki homeostenoz g\u00f6z \u00f6n\u00fcne al\u0131nmadan uyguland\u0131\u011f\u0131nda iyatrojenik komplikasyonlara yol a\u00e7abilir.<\/p>\n\n\n\n<p>Acil t\u0131p prati\u011finde geriatrik endokrin acillerin y\u00f6netimi i\u00e7in iki temel &#8220;alt\u0131n kural&#8221; ak\u0131lda tutulmal\u0131d\u0131r:<\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li><strong>Atipik Semptomlar \u0130\u00e7in D\u00fc\u015f\u00fck E\u015fik:<\/strong>\u00a0A\u00e7\u0131klanamayan deliryum, d\u00fc\u015fme, senkop veya genel durum bozuklu\u011fu ile acile getirilen her ya\u015fl\u0131 hastada parmak ucu kan \u015fekeri ve sodyum\/kalsiyum d\u00fczeylerinin h\u0131zla de\u011ferlendirilmesi zorunludur.<\/li>\n\n\n\n<li><strong>&#8220;Start Low, Go Slow&#8221; (D\u00fc\u015f\u00fck Doz Ba\u015fla, Yava\u015f \u0130lerle):<\/strong>\u00a0\u0130ntraven\u00f6z tiroid hormonu replasman\u0131ndan, diyabetik acillerdeki s\u0131v\u0131 ve ins\u00fclin res\u00fcsitasyonuna kadar t\u00fcm endokrin kriz y\u00f6netimlerinde; end-organ rezervleri, komorbiditeler ve polifarmasi dikkate al\u0131narak tedaviye d\u00fc\u015f\u00fck dozlarda ba\u015flanmal\u0131 ve monit\u00f6rizasyon e\u015fli\u011finde yava\u015f\u00e7a titre edilmelidir.<\/li>\n<\/ol>\n\n\n\n<p><strong>Referanslar<\/strong><\/p>\n\n\n\n<p>1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;De Bray A, Tomas J, Gittoes N, Hassan-Smith Z. Management of endocrine conditions at the end of life.&nbsp;<em>British Journal of Hospital Medicine.&nbsp;<\/em>2020;81(5):1-9.<\/p>\n\n\n\n<p>2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Karan MA. Geriatri ya\u015f grubunda endokrin ve imm\u00fcn sistemlerdeki fizyolojik de\u011fi\u015fiklikler. In: Eri\u015fim; 2020.<\/p>\n\n\n\n<p>3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Senguldur E, Selki K. Today&#8217;s Problem Tomorrow&#8217;s Crisis: A Retrospective, Single-Centre Observational Study of Nonagenarians in the Emergency Department.&nbsp;<em>Cureus.&nbsp;<\/em>2024;16(11):e73460-e73460.<\/p>\n\n\n\n<p>4.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Cowen LE, Hodak SP, Verbalis JG. Age-associated abnormalities of water homeostasis.&nbsp;<em>Endocrinology and Metabolism Clinics.&nbsp;<\/em>2013;42(2):349-370.<\/p>\n\n\n\n<p>5.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Soiza RL, Cumming K, Clarke JM, Wood KM, Myint PK. Hyponatremia: special considerations in older patients.&nbsp;<em>Journal of clinical medicine.&nbsp;<\/em>2014;3(3):944-958.<\/p>\n\n\n\n<p>6.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus Statement By The American Association of Clinical Endocrinologists And American College Of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm&#8211;2016 Executive Summary.&nbsp;<em>Endocr Pract.&nbsp;<\/em>2016;22(1):84-113.<\/p>\n\n\n\n<p>7.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Munshi M, Nathan D, Schmader K, Mulder J. Treatment of type 2 diabetes mellitus in the older patient.&nbsp;<em>UpToDate Nathan D, Schmader KE, Mulder JE, Eds Waltham, MA, UpToDate Inc.&nbsp;<\/em>2019.<\/p>\n\n\n\n<p>8.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Satman \u0130 \u0130\u015e, Akal\u0131n S, et al; T . EMD Diabetes Mellitus \u00c7al\u0131\u015fma ve E\u011fitim Grubu. TEMD Diabetes Mellitus ve Komplikasyonlar\u0131n\u0131n Tan\u0131, Tedavi ve \u0130zlem K\u0131lavuzu-2016. 8th ed. . In: Matbaas\u0131 B, ed.2016.<\/p>\n\n\n\n<p>9.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Sonne DP, Hemmingsen B. Comment on American Diabetes Association. Standards of Medical Care in Diabetes\u20142017. Diabetes Care 2017; 40 (Suppl. 1): S1\u2013S135.&nbsp;<em>Diabetes care.&nbsp;<\/em>2017;40(7):e92-e93.<\/p>\n\n\n\n<p>10.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Curt\u00f2 L, Trimarchi F. Hypopituitarism in the elderly: a narrative review on clinical management of hypothalamic\u2013pituitary\u2013gonadal, hypothalamic\u2013pituitary\u2013thyroid and hypothalamic\u2013pituitary\u2013adrenal axes dysfunction.&nbsp;<em>Journal of Endocrinological Investigation.&nbsp;<\/em>2016;39(10):1115-1124.<\/p>\n\n\n\n<p>11.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Papaleontiou M, Cappola AR. Thyroid-stimulating hormone in the evaluation of subclinical hypothyroidism.&nbsp;<em>Jama.&nbsp;<\/em>2016;316(15):1592-1593.<\/p>\n\n\n\n<p>12.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Ruggeri R, Trimarchi F, Biondi B. Management of endocrine disease: l-thyroxine replacement therapy in the frail elderly: a challenge in clinical practice.&nbsp;<em>European Journal of endocrinology.&nbsp;<\/em>2017;177(4):R199-R217.<\/p>\n\n\n\n<p>13.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Stott DJ, Rodondi N, Kearney PM, et al. Thyroid hormone therapy for older adults with subclinical hypothyroidism.&nbsp;<em>New England Journal of Medicine.&nbsp;<\/em>2017;376(26):2534-2544.<\/p>\n\n\n\n<p>14.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;G\u00fcndo\u011fdu A. T\u00fcrkiye Endokrinoloji ve Metabolizma Derne\u011fi (TEMD).&nbsp;<em>Diyabetes mellit\u00fcs ve komlikasyonlar\u0131n\u0131n tan\u0131, tedavi ve izlem klavuz.&nbsp;<\/em>2013;6:216.<\/p>\n\n\n\n<p>15.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society.&nbsp;<em>The Journal of Clinical Endocrinology &amp; Metabolism.&nbsp;<\/em>2013;98(5):1845-1859.<\/p>\n\n\n\n<p>16.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline.&nbsp;<em>The Journal of Clinical Endocrinology &amp; Metabolism.&nbsp;<\/em>2019;104(5):1520-1574.<\/p>\n\n\n\n<p>17.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Modawal A, Ansari S, Fazili S. Management of Geriatric endocrine disorders.&nbsp;<em>Comprehensive therapy.&nbsp;<\/em>2004;30(1):10-17.<\/p>\n\n\n\n<p>18.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Morley JE. Dehydration, hypernatremia, and hyponatremia.&nbsp;<em>Clinics in geriatric medicine.&nbsp;<\/em>2015;31(3):389-399.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Edit\u00f6r:&nbsp;Prof.Dr.Mehmet Ali Aslaner&nbsp;Yazar:&nbsp;Uzm.Dr.&nbsp;Kudret Selki Giri\u015f Acil servis ba\u015fvurular\u0131nda geriatrik pop\u00fclasyonun giderek artan oran\u0131, hekimleri \u00e7ok daha karma\u015f\u0131k ve atipik hastal\u0131k prezentasyonlar\u0131 ile&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":760,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10020,10055,10018],"class_list":["post-758","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-endokrin","tag-geriatri"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/758","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=758"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/758\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/760"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=758"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=758"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=758"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}