Search Results

Today, the problem of old age masks what it means to grow old. Skeletal fragility has become part of what it means to be an older woman in Western culture. Today, the ageing female body is defined in terms of its bone mineral density, an exact figure derived from the interrogation of female bones, using dual energy X-ray absorptionetry screening machines. This chapter illustrates the history of the reduction of women to their bodies including menopause and osteoporosis. The media and many intelligent people talk about the advisability of medicating ageing women's bodies. There are two models of women's bodies: the hormonal and the mineral. The industry of hormone replacement therapy (HRT), was built on the ‘hormonal body’ model. With the evident failure of this model, medical attention turned to the mineral version. The essential deficiency from which older women now suffer is no longer failing hormones, but flaky bones.

Since the introduction of combination antiretroviral therapy, clinicians have seen a sharp decrease in the incidence of many HIV-associated comorbidities, and patients with access and adherence to combination antiretroviral therapy are living longer and healthier lives. However, the frequency of endocrine, metabolic, cardiovascular, renal, dermatological, neoplastic, hepatic, renal, pulmonary, and gastrointestinal multimorbid medical conditions remains very significant and in some cases is increasing. Although the incidence of particular HIV-associated comorbidities such as cytomegalovirus (CMV) retinitis has declined considerably, it remains a significant source of distress and suffering for persons with AIDS. This chapter is not intended to provide a lengthy discourse on each topic addressed, but rather be a general overview that will give the reader a basic working knowledge of multimorbid medical conditions and enhance the understanding of associated psychiatric complications and psychological distress. For a summary of these conditions and their respective features and treatment, see Table 10.1. HIV and AIDS have been associated with a wide spectrum of endocrine abnormalities that underscore the complex relationships between immunological, endocrinological, and psychological systems. Endocrinopathies are great mimickers of psychiatric disorders, manifesting in some cases as disturbances of mood, sleep, appetite, thought process, energy level, or general sense of well-being. Endocrinopathies may present insidiously or abruptly, in either case with potentially tragic consequences when misdiagnosed as psychopathology. Prompt recognition of reversible alterations in endocrine function is essential to prevent unnecessary morbidity and mortality. An understanding of the complex interactions between endocrine and psychological systems may improve recognition and treatment of endocrinopathies, diminish suffering, and enhance quality of life and longevity in persons with HIV and AIDS. Many studies have demonstrated alterations in adrenal function in patients with HIV and AIDS. Associated infections and tumors, as well as direct invasion of the adrenal glands by the virus, partly explain these changes. Patients are also commonly prescribed drugs that alter steroid synthesis or metabolism; for example, ketoconazole decreases steroid synthesis, megesterol acetate suppresses pituitary secretion of corticotropin, and rifampin increases p450 activity, leading to increased metabolism of cortisol.