ABSTRACT:The increasing prevalence of metabolic syndrome (MS) with age in older men has been linked with decreasing testosterone levels. Interestingly, while testosterone levels decline with age, estradiol (E2) levels remain relatively stable, resulting in a decreased testosterone:E2 ratio. Because E2 levels tend to be elevated in morbid obesity, insulin resistance, and diabetes, it is reasonable to hypothesize that high E2 levels are associated with MS in older men. We studied the relationship of total and free E2 with MS after adjustment for multiple confounders, including age, BMI, smoking, alcohol consumption, physical activity, interleukin-6 (IL-6), fasting insulin, and testosterone. Men 65 years or older (age range, 65-96; n 5 452) had complete data on E2, testosterone, fasting insulin, sex hormone-binding globulin, IL-6, and albumin. Concentrations of free E2 and free testosterone were calculated using the mass action equations. MS was defined according to Adult Treatment Panel III (ATP-III). Participants with MS had significantly higher serum free and total E2 (P , .001) (P 5 .003). After adjusting for confounders, including age, smoking, alcohol consumption, physical activity, log(IL-6), and log(insulin), participants with higher log(total E2) (odds ratio [OR], 2.31; 95% confidence interval [95% CI], 1.39-4.70; P 5 .02) and higher log(free E2) (OR, 2.69; 1.38-5.24; P , .001) had an increased risk of having MS. Log(free E2) (P 5 .04) maintained significant correlation with MS, even after further adjustment for BMI. In older men, high E2 is independently associated with MS. Whether confirmed in other studies, assessment of E2 should be also considered in older men. Whether changes in this hormonal pattern play a role in the development of MS should be further tested in longitudinal studies.

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ADR are a common cause of hospital admission in elderly patients and are often associated with adverse outcomes. Our data underline the need of appropriate strategies aimed at identifying high-risk patients and avoiding potentially preventable drug toxicities.

The data of the present study suggest a positive effect of physical exercise on bone metabolism in patients with adrenal incidentaloma.

A 65-year-old man with a history of arterial hypertension presented with a persistent cough for 3 months. He was a former smoker who had quit 15 years ago; there was no family history of aneurysm or connective tissue disease. Physical examination revealed decreased breath sounds and dullness at the left middle-lower lung. A chest X-ray showed a large mediastinal mass consistent with a markedly enlarged aortic profile, without inflammatory alterations of the lung parenchyma (Panel A). Thoraco-abdominal contrastenhanced computed tomography revealed a large aneurysm of the aorta extending from the isthmus to the aorto-iliac bifurcation, configuring a thoraco-abdominal aneurysm