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Age differences in the characteristics of the circadian rhythm in circulating radioimmunoassayable aldosterone were studied on nine 20 to 26 year-old and ten 70 to 78 year-old women and ten 23 to 26 year old and ten 70 to 80 year old men in Würzburg, West Germany. These diurnally active-nocturnally resting subjects were sampled every 3 hours for 15 hours. A classical analysis of variance and a multivariate analysis of rhythm characteristics revealed major effects of age exerted on the circadian aldosterone amplitude in women (p = 0.003) but not in concomitantly sampled men. These observations complement the study of circadian and circannual rhythms in 8 young adults (15-21 years), 10 mature adults (29-36 years) and 10 post-menopausal (44-59 years) North American women, sampled at 100 minute intervals for 24 hours, once in each season, and document that the adrenocortical aldosterone-producing system remains rhythmic with at least two frequencies up to the late decades of human life, although in women it may be characterized by a reduction in the extent of spectral change after 70 years of age.

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Nine 20- to 26-year-old and ten 70- to 78-year-old diurnally active, nocturnally resting women in Würzburg, Federal Republic of Germany, gave blood at 0700, 1000, 1300, 1600, 1900, and 2200 for radioimmunoassay of aldosterone. Single and population-mean cosinors were applied. A multivariate analysis of circadian rhythm characteristics revealed effects of age on the amplitude (p = .003) but not the mesor of aldosterone in women (i.e., the age effect could only be detected at certain circadian times but not at others). No change with age was found for concomitantly sampled men. Statistically significant interactions among circadian time, age, and sex (p = .001) establish the adrenocorticopause in women and suggest that it may occur earlier in women than in men, in keeping with similar results on serum cortisol in the same subjects. This phenomenon awaits scrutiny from the viewpoint of its bearing on longevity and life quality. These results also indicate the importance of assessing chronobiological characteristics.

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We compared the excretory pancreatic function of a healthy young population (n = 18, mean age 31.8 years) with that of a healthy older people (n = 18, mean age 58.7 years) using a modified secretin-pancreozymin test which comprised short infusion of secretin, injection of pancreozymin, and repetition of this procedure immediately after the end of the collection period following the first stimulation. Secretion rate and bicarbonate following secretin, lipase, amylase and secretin rate following pancreozymin were significantly lower in the old than in the young after first and second stimulation. Trypsin was lower in the old than in the young following repeat stimulation. Trypsin was the only substance which was produced in smaller quantities after the second stimulation than after the first, i.e. pancreatic fatigue was demonstrable in the older age group.

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Iron is necessary for every of organic life. The depot forms of the iron are Haemosiderin and Ferritin. Comparisons of the serum ferritin with the body iron contents measured through quantitative phlebotomy, intestinal iron absorption and bone marrow puncture showed extremely significant correlations. Since there are often lower serum iron levels to be found in elderly persons and the hypoferric anemia is the most important cause of it, the question of the valency for the serum ferritin analysis arises. Two groups of young and old persons were examined. Their age ranged between 20 and 30 as well as 60 and 90 years. It showed an increase of the serum ferritin level depending on the age. There are also sexual distinctions. The added immunoglobulin determination in older patients does not lead to a better interpretation of the investigated serum ferritin value. The analysis of the serum ferritin is of great importance in young patients as well as for some illnesses, but becomes problematic in old patients because of the increasing number of disturbing factors.

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The effect of the decapeptide cerulein on exocrine pancreatic function was compared with pancreozymin by means of intraindividual double stimulation. 100 ng/kg bw/45 min of synthetic cerulein led to a greater enzyme excretion than 2 U/kg bw pancreozymin. This increase in enzyme secretion was independent of whether the pancreas function was normal or disordered. In the selected experimental procedure, cerulein increased the excretion of enzymes (chymotrypsin, trypsin, lipase, amylase) whether it was infused in connection with or before an injection of pancreozymin. Cerulein can therefore completely replace pancreozymin in the diagnosis of pancreatic function.

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Patients with fatty liver of grades I and II were re-examined by liver biopsy after a 10 years' interval. Only two patients showed improvement in the original findings. In each case up to about half of the material for investigation showed an unchanged stage of fatty liver or a deterioration. In the group with an unchanged clinical picture of grade II fatty infiltration and in the cases with a tendency to deteriorate, an accumulation of etiological factors was noted. Extensive histories proved that the patients had not altered their living habits in the past 10 years. This means that the prognosis of fatty liver with regard to regression of an originally established stage is very unfavorable, because the patients' understanding seems not to be very great.

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The insulin-hypoglycemia-test seems to be an appropriate instrument for the examination of the hormonal ability to adapt, even at old age, whereby especially accurate control is necessary. Although older patients of our policlinic show lower basic cortisol- and HGH-values, the increase of catecholamines, cortisol and HGH is not diminished, thus demonstrating a satisfying stress-adaptability. We relate the fact, that in literature the basic cortisol- and HGH-levels are also found to be mostly normal, to the different criteria in the selection of patients.

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The primary goal of all regulatory processes is to preserve the internal steady state. We summarize the elapsing mechanisms with the definition "adaptation". Statements about that without considering the vigilance are impossible. Adaptation and vigilance are closely related to each other. If the verified "Pirazetam" (Normabrain) influences the vigilance, it should be possible to proof changes in the adaptation, which according to hormonal results in insulin hypoglycemia might be registered. The behavior of cortisol ahd STH are the same before and after medication, however a significant higher noradrenalin secretion can be traced after treatment. This effect is rated as a positive influence of the medication on the suprarenal medulla, which on the contrary is regarded as a prolonged part of the brain.

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Morphological and functional peculiarities appear with increasing age. Senile changes often cause the well known clinical picture and complications to appear different phenomenologically and in their course. Thus particular tonic conditions of the esophagus are found, the senile ulcer is typical and even the small and large intestines show characteristic findings. Finally, according to age care must be taken in diagnostic and therapeutic measures, otherwise slight iatrogenic damage may occur. Age consequently presents a risk through organic and functional changes which must be allowed for in all our classifications and observations.

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Today are multiple illnesses, pertaining the internal maladies (illnesses), almost a regularity. You differentiate between combination-illnesses, which represent primarily dependent illnesses and associated illnesses independent from each other. In the following summary illnesses are mentioned, which according to present information, appear more often together or cancel each other out. Of special interest are such procedures, by which a second disorder to the one existing can appear. The patient will experience a change in his illness. The appearance of a so called second sickness is especially to be observed in such organs as liver, gallbladder and pancreas. The study of multiple illnesses is more meaningfull, because statements for the basic research can be met and next to these more aetiologic or pathogenic associated questions lead to the next step, to the clinical symptoms which experience a change, and further to certain therapeutic considerations and consequences. Finally also the prognostic statements change.

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There are multiple relations between neurotic abnormal behavior and the incidence of functional vegetativ disorders and there are also correlations between such dysfunctions and blood sugar homoiostasis. In patients with functional vegetative dysorders and neurotic behavior we performed a glucose tolerance test and compared the results to a control group. In the group of patients with vegetative dysfunction and neurotic tendencies the oral glucose tolerance test was abnormal in 68.4 p.c. as compared to 21.3 p.c. in the control group. Several insulin antagonists which play a role in stress responses are discussed in the interpretation of these surprising results.

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Adaptation processes in an acute stress situation were investigated an compared in young and elderly subjects. Insulin hypoglycemia was used to provoke stress. The behavior of the blood sugar after administration of 0.1 U/kg old insulin shows a marked hypoglycemic state after 30 minutes, both in the young and in the older subjects. The rise into the normal range occurs considerably quicker in the young than in the elderly. Adrenaline excretion is distinctly lowered in older people. Measurement of hydrocortisone excretion also shows a lower reaction level and a delayed onset in the elderly. Growth hormone analysis shows a smaller production in advanced age. It is consequently established that adaptation potential decreases in old age.

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