Diagnosis and management of endocrine disease in the geriatric population is challenging, with calcium, thyroid, pituitary and adrenal disorders being particular areas of concern. Hypercalcemia should prompt a workup for both parathyroid hormone (PTH) and non-PTH mediated etiologies. While primary hyperparathyroidism is most common in the seventh decade of life, secondary hyperparathyroidism is most common in the setting of vitamin D deficiency and chronic kidney disease. The latter may progress to tertiary hyperparathyroidism, particularly in individuals with renal disease and on hemodialysis. Hypercalcemia in the setting of a suppressed PTH, in contrast, should prompt a workup for underlying malignancy. Thyroid disease may be functional or structural. Management of both overt and subclinical hypo-/hyperthyroidism must take into account symptomatology and risk factors (including underlying cardiac and bone disease), and individualized treatment goals are important. Incidental radiographic findings are more common in the elderly, and appropriate clinical, radiographic, and biochemical correlation are necessary to optimize individual care.