Enhancing endocrine education: for medical students by medical students

Vaishali Limbachia is an intercalating medical student at Norwich Medical School, University of East Anglia (UEA). Vaishali has completed four years of the course enter their final year in September 2021. Last year, Vaishali became Secretary of UEA Endocrinology Society and in November 2020 became an Endocrine Ambassador for the Society for Endocrinology. In this guest blog, Vaishali shares what the UEA Endocrinology Society has been up to so far, and the importance of supporting and encouraging students in endocrinology.

*pictured Vice President, Vaishali Limbachia (left), and President of UEA Endocrinology Society, Milly Green (right).

First, I would like to introduce our society. We are a society run by medical students, for medical students. The committee consists of 4th year, intercalating, and 5th year medical students. Guided by the President, we organise revision sessions for medical students currently learning diabetes and endocrinology, in addition to other events that aim to raise interest in endocrinology. We also run social media pages, keeping our members informed of our society news and events, as well as Society for Endocrinology activities. To further engage with our members, weekly diabetes and endocrinology exam-style, multiple-choice questions are created by the committee members and posted on our social media pages.

Each academic term we have organised and delivered a teaching session on diabetes and on endocrinology. The aim of these sessions is to revise content from the medical school curriculum, which at Norwich Medical School, is taught in year 3. The presentation slides used for lectures are constructed by committee members. It can be challenging to cover a module worth of content in a couple of hours. The sessions are taught by medical students who have undergone diabetes and endocrinology teaching, placements and exams, so are able to provide useful tips.

On top of the teaching sessions, we organise and run mock objective structured clinical examinations (OSCEs), aiming to give medical students a practice run. We design 6 stations, for example a diabetic foot examination and communication skills station, to give members a realistic experience of the summative OSCE. Each committee member runs one station to keep that station consistently delivered. At the end of each station, we feedback verbally to students. In addition, we provide a marking scheme, which we constructed for written feedback, so students can see where marks were given. This allows students to gauge their learning needs in preparation for their summative OSCE. These mock exams are highly subscribed and the feedback is very positive.

This year I organised our first Diabetes and Endocrinology Careers Event, targeted at medical students. Three consultants kindly volunteered their time to speak at the event. Each spoke about their motivating force that led them to choose this specialism, their professional journey, what their day-to-day life is like and shared top tips for medical students. This was followed by an opportunity to ask questions. Speakers shared highly interesting patient cases, showing how the specialism involves detective work and how endocrinology impacts multiple systems. Each speaker’s professional journey was very different, emphasising how there is more than one path to follow. Many useful tips were shared, for example getting involved in research, and opportunities at the Society for Endocrinology. It was a highly inspiring and informative event, that I personally enjoyed, and the feedback was positive, with the only suggestions for improvement being they wished it was longer! I found the event reinforced my passion for specialising in diabetes and endocrinology in the future.

I have had a fantastic year working with great colleagues, who share an interest in diabetes and endocrinology, in organising events and sharing our interests with other students. Next academic year, I will fortunately continue being a part of this brilliant society and assume the role of Vice President of UEA Endocrinology Society. I look forward to working with the new committee members, putting on more events and continuing to share Society for Endocrinology activities and opportunities to members.

Find out more and apply to become an Endocrine Ambassador.

Please email ambassadors@endocrinology.org if you have any questions.


Meet Daniel Drucker the Society’s 2020 Transatlantic Medal winner

Dr Daniel Drucker is a clinical researcher involved in the development of treatments for diabetes, obesity and intestinal disorders at the University of Toronto Lunenfeld-Tanenbaum Research Institute. He also holds the Canada Research Chair in Regulatory Peptides and the Banting and best Diabetes Centre-Novo Nordisk chair in Incretin biology. He will be giving his Society Transatlantic Medal Lecture during SfE BES Online 2020. In this interview he tells us a little about his research and career.

Tell us about your research and lab in Toronto

I have a medium-sized lab of 8 people, where we use molecular biology and mouse physiology to study peptide hormone action. Whenever possible, we also try and extend our findings to humans, using available tissues, or occasionally, by carrying out small clinical trials. The lab has carried out basic research leading to two new treatments for type 2 diabetes and one new therapy for short bowel syndrome.

Tell us about your career path

I was very fortunate to learn molecular biology under the tutelage of Joel Habener in Boston. I returned to Toronto and was guided to adopt transgenic and knockout mice, which proved to be wise counsel. I think I am most proud of my dozens of trainees and their success. We also take pride in being extremely careful-that sounds trite, but we are generally not as concerned about being first, rather, we are very focused on making sure the data and observations are as correct as they can be. This article includes some of my career highlights in discovery, characterization, and clinical development of glucagon-like peptides.

What inspired you to choose endocrinology as a career?

I had a great role model, Gerard Burrow, who was an enthusiastic mentor, and head of endocrinology. At the same time, endocrinology was appealing since one could understand many of the disorders, and there were multiple treatments available to correct endocrine deficiencies or hormone excess states.

What do you enjoy most about your work?

I like the ability to ask questions, carry out experiments, and then scrutinise the answers. Watching trainees mature as scientists is also very enjoyable. Finally, having the good fortune to see basic science translated into new medicines is a privilege and extremely rewarding.

What are you presenting during your Medal Lecture at SfE BES Online 2020?

My presentation, ‘Incretins and Cardiometabolic Disease-An Inflammatory Perspective’ will examine how inflammation underlies many of the common endocrine disorders in metabolism, from type 2 diabetes to heart disease, to the complications of obesity and fatty liver. Gut peptides, exemplified by GLP-1, attenuate inflammation in many organ systems. I will describe how GLP-1 might work, and highlight many unanswered questions, surrounding the anti-inflammatory actions of GLP-1.

What do you think about the move to virtual meetings?

Virtual meetings allow for a broader and larger global audience, and enable us to continue to share data and concepts. I suspect that many of us still miss the social and personal interactions, and we will be keen to return to many of the in person meetings once this is feasible.

What do you think are the biggest challenges in your field?


What do you think will be the next major breakthrough in your field?

I am hopeful that stem cell therapy will solve many challenges and mature to allow for true beta cell replacement therapy for people with type 1 diabetes.

Any words of advice for aspiring endocrinologists?

Have fun, find a good environment, choose mentors that are supportive, and don’t take yourself too seriously!

You can hear Dr Daniel Drucker’s Medal Lecture “Incretins and Cardiometabolic Disease-An Inflammatory Perspective” on Wednesday 18 November at 15:55 GMT.

If you haven’t already, register for SfE BES Online now!


Video advice for adrenal insufficiency patients

Kerrie Grounds, Lead Endocrine Specialist Nurse (ESN) at the Royal Liverpool University Hospital (RLUH) and her team have produced an educational video for patients with adrenal insufficiency. Here she explains what inspired them to create this invaluable and informative patient resource.

Kerrie Grounds adrenal crisis video image

I work with a team of fabulous, dedicated ESN’s named: Amanda Hamilton, Karen Jones and Michelle Lewin. We have created a short video for all our patients with adrenal insufficiency to access via the internet. This video provides education regarding steroid replacement therapy; sick day rules and demonstrates how to prepare and administer the hydrocortisone emergency injection should this be required in the event of an adrenal crisis. We feel this information is vital for improving quality of life for all patients with adrenal insufficiency and urge you to share the video.

Why did we create the video?

Prior to the COVID-19 pandemic, we commenced group education sessions for all our patients with adrenal insufficiency to deliver education regarding their steroid replacement, sick day rules and hydrocortisone emergency injection training. We ensured that at the end of each session everybody received their emergency injection prescription/ancillaries/travel letter/ sharps bin and patient information support pack, including surgical guidelines /steroid treatment card/medic alert identification etc. These sessions have been well received and the feedback has been very positive. It was delivered in a relaxed environment and I think the tea/coffee and biscuits also helped!

Then COVID-19 arrived! A very difficult and scary time for everyone involved and our main aim was to ensure all our adrenal insufficiency patients had access to an emergency injection. We have over 300 patients at present under our ESN team that we review. As we had to suspend our group education sessions, we created a letter for our patients to take to their own GP’s to prescribe the emergency hydrocortisone injection. Primary care played a vital role in ensuring our adrenal insufficiency patients all had access to this injection. We also sent our patient information packs, which we used to provide in our education sessions, to our patients alongside ancillaries (needles and syringes) to enable them to administer their injections, which also covered guidance from the Society for Endocrinology COVID-19 guidelines. We provided our ESN contact details and advised them to access the ADSHG Professor John Wass video regarding their emergency injection training. We tried our very best to ensure our patients received as much information as possible to protect them in the event of an adrenal crisis. We had an administration clerk, Ann Marie Brookes, whom played a vital role in assisting us with this. I will be forever grateful to my team for working together at such a difficult time.

We can honestly say that although Professor John Wass’ emergency injection video was very informative and inspired us, we felt that our patients would receive the video better if they saw familiar faces….who better to deliver this than their own ESN’s. We also wanted to cover steroid replacement during illness. Due to lockdown we were unable to provide face-to-face education sessions and we felt that creating a video was not only the best way, but the safest way forward. Our departmental manager gained funding for us to record the video, we created the script and practised it on our own and then filmed the video, all in one day. Please remember we are nurses and not actors and it was rather nerve racking for us all!

Why am I so passionate about this?

My ESN role is not just an occupation for me. I am passionate about endocrinology and have learned so much in the 8 years I have worked with the Endocrinology team, here at the RLUH. I work with a fabulous team of Endocrine/Diabetes Consultants at the RLUH and as mentioned above Endocrine Specialist Nurses. It still fascinates me every day and there is always room to learn within this role.

However I also have Addison’s disease. I was diagnosed at the age of 18 and have lived with this condition for 22 years now. I have always been a positive person and my glass is always half full. When diagnosed I weighed about six stone and had been unwell at home for three months, fading away. I could not stand up or eat anything, I was nauseous, vomiting, had headaches, the fatigue was so debilitating and it was frustrating for me and family as we did not know what was wrong. However, a positive side to that was I had a fabulous tan!. When I was eventually admitted to hospital and diagnosed with Addison’s disease I remember being so thankful to all the nurses and doctors who had helped me. This was when I realised I wanted to be able to give something back, so I trained to be an adult registered nurse and have never looked back. I can honestly say that when the ESN job post was advertised I thought I knew quite a bit about my Addison’s disease but I knew nothing! This job has literally saved my life. This is why I will always be thankful to my Endocrinology Consultants and fellow ESN’s here at the RLUH for the education and training they provided me, to be able to not only ensure I have a perfectly normal quality of life but to be able to provide specialist advice and empathy for my patients.

I know only too well the symptoms of low cortisol and adrenal crisis and I would say the fatigue is the worst symptom that we have to learn to live with. However, I am a mother to two beautiful boys and a full-time ESN. I have perfectly normal quality of life and feel blessed every day that I am able to manage my Addison’s disease.

Here is our Emergency Injection Steroid Replacement Video on the RLUH website or watch it on YouTube. Please share this widely and help to keep adrenal insufficiency patients safe and informed.

Learn more about Society for Endocrinology guidance on managing adrenal crisis, including a downloadable NHS Emergency Steroid Card.

Learn more about the adrenal glands and related diseases.


Meet the Endocrinologist: Matthew Simmonds, expert in pancreatic transplant genomics

Meet the Endocrinologist: Meet Dr Matthew Simmonds a Senior Lecturer in Biomedical Science at the University of Lincoln. His research is focused on the genetics of pancreatic transplant function and he will be presenting at the Early Career session at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, he tells us more about his work and what he is looking forward to at the SfE BES 2018 conference.

Can you tell us a little about your current position and research?

I am a Senior Lecturer at the University of Lincoln where I have been now for just over two years.  My research career has revolved around trying to identify genetic contributors to a series of autoimmune endocrine diseases including autoimmune thyroid disease and type-1 diabetes.  My current research is specifically focused on looking at genetic predictors of long-term pancreas transplant function in people with severe type 1 diabetes.

What inspired you in to this field?

The immune system is amazing and without it we would never have survived and evolved on this earth. What I find so interesting about the autoimmune endocrine diseases is how the immune system, which is meant to protect us, actually starts to attack parts of the body leading to changes in how the endocrine system works.  I am passionate about understanding how disease pathways are triggered/progress and how we can use these insights to inform better treatments for people with these different conditions.

What do you think are the biggest challenges in your field of research?

I think the major challenge within pancreas transplantation is both the number of donor organs available for transplantation into people with severe type-1 diabetes and trying to ensure that the transplanted organ remains functional throughout the recipient’s life to ensure the benefits these transplants provide, of retuning insulin production and halting/reversing secondary diabetes related complication in that person, remain for as long as possible.

What do you think will be the next major breakthrough in your field?

I think both the advances being made in using induced pluripotent stem cells, combined with gene editing, to create new beta cells, will provide unparalleled new opportunities for transplantation purposes. Combined with the decreased costs around genome and other proteomic screening for patients and our increased understanding of how genetic variation impact upon autoimmunity and transplant success this will give us new understanding of disease progression and provide better individual tailoring of therapeutics.

What will you be doing at SfE BES 2018 in Glasgow?

Well as you have asked – nothing like a bit of shameless plugging – I will be doing a talk on the Tuesday as part of the Early Careers session ‘Navigating the Academic Pathway’.  My talk is entitled ‘The lectureship route’ where I will be providing some insights into this career pathway, the challenges and benefits of this route and some tips on how to be get such a position.

What are you looking forward to at this year’s conference?

I think as an early career researcher I loved going to conferences to be able to present my work and network with others working in the field – which is the same reason I enjoy attending conferences to this day. Whilst there are lots of fantastic talks, plenaries and other sessions throughout the conference with something to suit everyone’s research interests, one thing I would suggest to early career researchers is to take time to speak to other early career researchers at the poster sessions and after their talks.  You would be surprised how much you have in common with other researchers and how random conversations at conferences can lead to new collaborations and possibly job offers in the future.

Who do you most admire and why?

 I have been really lucky to have worked with some of the most amazing researchers in diabetes and endocrinology throughout my career so far – both in the centres I have worked and through numerous collaborations. I have been very lucky to have some amazing mentors throughout the years, and think that whatever stage in your career you are at it is important to keep listening, learning and being inspired by researchers at every level.

What words of wisdom do you have for someone starting out in research?

These type of questions always make me feel old.  Joking aside, I think the best advice I can give to any early career researcher is to think about where you want your career to go but don’t be so rigid in your approach that you may miss out on some unexpected opportunities that come your way. Also listen to your gut feeling about career decisions.  Whilst is it perfectly normal to be scared to take on new challenges be it new techniques, moving into different project areas or new jobs, sometimes you instantly know if something is a good or a bad move. From my own experience I have learnt that sometimes saying no to something that is not right for you is as important as the opportunities you say yes to.

You can hear Dr Simmonds presentation, “The lectureship route” on Tuesday 20 November, as part of the Early Career: Navigating the Academic Pathway session at 16:00-17:30. Find out more about the scientific programme for SfE BES 2018.




Meet the Endocrinologist: Interview with Prof Antonio Vidal-Puig

Group Photo - June 2017

Meet Professor Antonio Vidal-Puig, endocrinologist and Society for Endocrinology Medal winner for 2017. Prof Vidal-Puig is based at the Institute of Metabolic Sciences, Cambridge University and at Addenbrooke’s Hospital, where his outstanding research, focusing on the link between obesity and associated metabolic complications, has earned him this award, to be presented the annual conference, SfE BES 2017, in Harrogate, 6-8 November 2017. Learn more about his endocrine journey in this exclusive interview.

Q: Tell us a little about your career so far and how you ended up in Cambridge.

Originally from Spain, I studied medicine and trained in endocrinology at Valencia Medical School and Granada Medical School. I held post-doctoral positions in Boston at the Massachussetts General Hospital and Beth Israel Hospital/Harvard Medical School from 1992-1999. There I had excellent mentors including Jeff Flier, Brad Lowell, David Moller and Leo Krall. This was a very intense, exciting and uncertain period, at the epicentre of major discoveries in the field of obesity. This was a period that defined my career, scientific focus, approach to science and reinforced my values. I have been developing my career in the UK, since arriving at Cambridge University in 2000, and now have an established laboratory and have become a Professor of Molecular Nutrition and Metabolism.

Q: Tell us more about your research that led to you being awarded the Society Medal

The lab is interested in why obesity results in diabetes, insulin resistance, fatty liver and ischaemic heart disease, in order to find ways of preventing these complications.

The key concept of our programme is lipotoxicity, which links obesity-related metabolic complications with the excessive accumulation of lipids outside adipose tissue, in organs including muscle, liver and heart. From the concept of lipotoxicity we have developed three main research directions:

  • understanding how the adipose tissue works, with the aim of improving its function and ensuring that lipids remain in adipose. This led to the development of our “adipose tissue expandability hypothesis”, which is now widely accepted by the scientific community
  • developing strategies to burn the excess lipids and prevent lipotoxicity through activation of brown fat
  • promoting that the quality of dietary lipids should be as healthy as possible, to prevent toxic effects.

My Medal Lecture at SfE BES 2017 will summarise our contribution to these three directions.

Q: What are you particularly looking forward to at SfE BES 2017?

I will use this conference for updating clinical aspects of my work. The presentation quality is always good and helpful. One session I am really curious about is Workshop 1: Tissue Engineering for Regenerative Medicine in Endocrinology. I think technology is essential to retain a competitive position in research and the topics presented are highly transferable and of interest. I think tissue engineering approaches to increase brown fat mass could be really helpful in preventing obesity and diabetes, I am curious about the concept and possibilities of using 3D bioprinting.

Q: What have been your career highlights so far?

I feel content about my career progression. I consider highlights to be our best pieces of research; our papers tend to be quite comprehensive and we believe they make important contributions. I think for this reason these contributions are well respected by our colleagues. Our reputation as a lab is important for us. Also as a proud introvert, I have not touted our highlights and have not needed to for our professional highlights to be widely acclaimed, however I do understand that it is important to make the public aware of their implications. Also, as a laboratory leader I know that to disseminate these highlights is important for the careers my lab members. In this respect, winning the Society for Endocrinology Medal is a highlight that reflects the quality and commitment of the present and past members of the laboratory.

At a more personal level, I admit I have an aesthetic approach to science. I enjoy understanding and identifying sophisticated mechanisms, developing models that explain reality and learning how biological systems self-regulate. I don’t think this is unusual amongst endocrinologists. Also, becoming a Professor at Cambridge University was a moment of satisfaction I shared with my colleagues and family. In some ways my career has provided me with professional freedom, which is a key value for me, beyond other motivations, such as power or fame, that I have always found energy draining and restrictive of my autonomy.

Q: What do you think are the biggest challenges in your research area right now?

I think a big challenge in my research area, and others, is how to extract value from the excessive information generated by recent technological advances. Our challenge is how to analyse this information to prioritise the types of mechanistic validation that are necessary for estimating its relevance. Also, it is not only the amount of data, but the amount of unnecessary noise coming from poor quality research that makes this task more difficult.

Q: What are your future plans for your work & career?

As you become more senior in science, you often suffer the disadvantage that your professional horizon is shorter. However, this position also has the advantage that you can be more selective in your choice of projects, with more freedom to take risks. I think my laboratory in this respect is quite entrepreneurial, we are innovating by entering new fields/technologies, which I think is important for remaining competitive.  For example, we have opened a new lab at Sanger, funded by the European Research Council to work on stem cells and adipose tissue. We are also developing two new programmes of research; one in Nanjing focused on murine models of fatty liver, and another in Bangalore focused on adipose tissue stem cell biology to model obesity and diabetes in India. These are exciting challenges that will provide opportunities for my younger associates in their future careers.

Q: Who do you most admire professionally?

I have learned a lot from many of my mentors, colleagues and trainees. In some way these experiences have shaped my values and my strong views about science and leadership. For example, I have always admired the intellectual rigour and scientific honesty of Brad Lowell. I admired the consistency and confident leadership of Jeff Flier and the legacy of Daniel Lane, who developed many academic scientists in his lab to share his cultural values and collegiality, which they now disseminate to the next generations. I find this very impressive.

Q: Any words of wisdom for aspiring endocrinologists out there?

Endocrinology is not a specialty that will make you rich, but it is a specialty where you can fulfill your intellectual scientific needs and enjoy the human aspect of practicing medicine. It is very satisfying because your patients get better and, given that treatments are required long term, an important factor in the success depends on establishing an empathetic relationship with them. You will get to know many of your patients well, from whom you will receive gratitude and a sense of meaning and fulfillment. In this respect it is a very rewarding profession.

Q: What do you think will be the next major breakthrough in your field?

I think real breakthrough with long term impact requires deep knowledge and new technologies, I have become quite sceptical about quick or easy breakthroughs that address complex problems. It is important to understand how regulatory systems operate, to learn what the adaptive changes of the organism or cell to maintain normality are, and to determine the intrinsic capacity of these systems to recover normality if the early factors of the disease are removed. For this reason, we focus on early disease events, aiming to prevent or reverse excessive damage to the homeostatic system and regain metabolic control. In this sense, we think it is as important to learn how the problem occurs as it is to learn the trigger and why it occurs. In our field I think understanding how lipids mediate disease could be used for prevention, early diagnostic and therapeutic purposes.

You can hear Prof Vidal-Puig’s Society for Endocrinology lecture on Wednesday 8 November, 15:45-16:45, and see the full scientific programme for SfE BES 2017.

Physical Activity and the Endocrine System: Oral communication prize winners

A Society Meeting Support Grant was used to fund a focused scientific meeting on physical activity and the endocrine system at Nottingham Trent University in July 2022. John Hough and Jessica Piasecki, Senior Lecturers in Exercise Physiology, Sport, Health and Performance Enhancement (SHAPE) Research Group at Nottingham Trent University organised the one-day meeting and three oral presentations were selected to win prizes at the event. Read on to learn about the prize winners and their research.

Clair Prior

The overall aim of this study, presented by self-funded PhD candidate Clair Prior, is to understand the conduct and implementation of a dietary intervention that restricts time of eating and drinking in people at risk of type 2 diabetes. Outside of Clair’s research hours, she also work for the NHS Manchester Royal Infirmary for the Major Trauma Signposting Partnership. She has previous experience in sports injuries and rehabilitation, and cardiovascular health. The project is part funded by Abbott Laboratories and Manchester Metropolitan University in collaboration with Northern Care Alliance, Newcastle University and Salford Hospital.

A protocol for time restricted eating in adults with pre-diabetes: the OFFSET study

Clair Prior1*, Christopher I Morse1, William Ollier2, Adrian H Heald3, Kelly A Bowden Davies1
1 Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Institute of Sport, Manchester Metropolitan University, Manchester, UK.
2 School of Health Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
3 Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
*Presenting Author

Introduction: Nutritional interventions play a key therapeutic role in preventing, managing, and more recently reversing Type 2 diabetes (T2D). However, over half of the people referred to the NHS Diabetes Prevention Programme do not engage. Additionally, demographics such as age, sex, ethnicity, and socio-economic status are associated with a differential response and success (Valabhji et al., 2020). More acceptable and inclusive interventions need to be developed.

Aim: To investigate the effect of a dietary intervention that restricts time of eating (time restricted eating; TRE) and drinking in people at risk of T2D.

Methods: Recruitment is inclusive based on the NIHR INCLUDE ethnicity framework (2022) and will target 34 participants, aged 18-65 years, male or female, classed as pre-diabetic (HbA1c 42-47 mmol/mol). A randomised control trial design will be used to study the effects of 12 weeks TRE (limited to a maximum 10 hrs per day; n=17) versus control (usual eating/drinking; n=17). Participants will be required to record their dietary intake as baseline, week 1, 6 and 12. Two weeks of continuous glucose monitoring (CGM) and physical activity (GENEActiv) will be obtained pre and post (i.e., study weeks -2 to 0 and 10-12). Pre and post laboratory assessments include: anthropometrics, body composition, blood pressure, fasting blood biochemistry (e,g, HbA1c, HOMA-IR) and a 2-hr oral glucose tolerance test. The primary outcome is change in mean post-prandial glycaemia (AUC) from CGM. Analysis will meet the requirements set out by international consensus (Danne et al., 2017) for 70-80% of possible CGM readings over a 2-week period.

Results: The study has been funded by Abbott Laboratories (medical device company) who supply the CGMs FreeStyle Libre 2™. Currently under ethical review. The conference provides the invaluable opportunity for peer-review comment prior to full registration of the trial and submission of the protocol manuscript.

Conclusion: A dietary intervention that specifically targets people with pre-diabetes in diverse communities is warranted. The findings may assist the development of future larger scale interventions that adopt an inclusive approach.

Reece Scott

Reece Scott is an Academic Associate at Nottingham Trent University and undertaking a part-time PhD alongside that role. His research is looking at quantifying load and how this can be used to optimise exercise regimes for an osteogenic response. The present study aimed to determine how resting periods can be used to enhance the activity of osteoblasts, which are fundamental to the bone formation process.

Intermittent loading induces an increased bone formation marker response in mice compared to continuous loading in vitro

Reece Scott1* , Cleveland Barnett1, Ruth James1, Craig Sale2, Livia Do Santos1, Ian Varley1
1 Department of Sport Science, Nottingham Trent University, Nottingham UK
2 Institute of Sport Science, Manchester Metropolitan University, Manchester, UK
*Presenting Author

Weight-bearing exercise has proven effective at inducing bone formation. Rest periods between exercise bouts may have a role in optimising bone mechanosensitivity and could be an important consideration when designing exercise regimes for osteogenic effects. It is not clear how pre-osteoblast/osteoblast activity reacts when loading intensity and duration are matched, but the mode of load application is altered.

The aim of this study was to assess the pre-osteoblast response to a loading regime with and without periods of unloading.
Mouse pre-osteoblasts were cultured under cyclic loading conditions (non-loaded, continuous, intermittent) using a Flexcell bioreactor for tension (n=3). Loading conditions were matched for duration under strain (5 hrs) and intensity of strain (5000 μS at 1 Hz). The mode of applying continuous load was 5 hrs of strain followed by 19 hrs of rest whereas intermittent loading was 1 hr of strain followed by 3 hrs 48 mins of rest every 24 hrs for 1, 3 and 12 days. ARS, ALP and P1NP analyses were performed. A one-way repeated measures ANOVA compared differences between loading conditions for ARS, ALP and P1NP for each timepoint.

There were no differences between loading conditions in ARS (p>0.235). ALP activity was greater following intermittent loading on days 1, 3 and 12 (non-loaded 0.258 ± 0.028; continuous 0.313 ± 0.031; intermittent 0.440 ± 0.054 umol/min/mL; p<0.05). P1NP was greater in the intermittent condition at day 12 (ctrl 151 ± 39; conex 121 ± 61; intex 279 ± 116 ng/ml; p<0.05) but lower at 3 day (ctrl 46 ± 12; conex 66 ± 9; intex 32 ± 9 ng/ml; p<0.05) than in the non-loaded and continuous conditions.

Intermittent loading resulted in higher ALP and P1NP activity on days 1, 3 and 12. This may be due to rest periods between the bouts of loading restoring the mechanosensitivity of the pre-osteoblasts, and thus speculatively enhancing the activation of bone formation. Our findings suggest that intermittent loading is important for re-sensitising pre-osteoblast cells and should be considered when attempting to maximise the osteogenic effects from loading.

Esther Goldsmith

Esther is a sport and exercise physiologist, working for sport and data science company, Orreco, whilst doing her professional doctorate in human performance and innovation at the University of Limerick. Esther has a particular focus in both her research and professional practice on the female athlete. Her work with USA Volleyball prior to Tokyo 2020 as part of Orreco’s Female Athlete Programme led to the project she presented at the meeting.

Ameliorating menstrual cycles symptoms – an education intervention in elite volleyball players

Esther Goldsmith1* and Georgie Bruinvels1,2
1Orreco Ltd
2University College London, London, UK
*Presenting Author

Physiological and psychological symptoms that occur as a result of hormonal changes in the menstrual cycle may negatively affect the performance of elite female athletes. The extent to which this occurs is highly variable, and may be influenced by genetics, nutrition, sleep, travel, psychological stress, and exercise training modality and load. Furthermore, dietary and lifestyle interventions have been found to be effective in reducing symptoms of premenstrual syndrome (PMS). However, athletes are rarely educated on changes that can occur during the cycle or how they can implement changes to their diet and lifestyle to mitigate against any potentially associated negative symptoms.

Aim: To evaluate the effect that menstrual-cycle specific education and minor dietary interventions can have on elite female athletes over four months of intense competition.

Twenty elite volleyball athletes, all representing the United States internationally, were given a 60 minute education presentation regarding the menstrual cycle and sports performance. Athletes were also provided with fish oil supplements and optional dietary support. Prior to the education, all athletes completed a bespoke online questionnaire to evaluate menstrual cycle history and characteristics, experience of menstrual cycle symptoms, and key aspects of their diet and lifestyle including perceived psychological stress and sleep quality, average daily fruit and vegetable intake, average weekly fish consumption and fish oil supplementation. Menstrual symptom index (MSi) was calculated in the menstrual, late follicular (mid cycle) and premenstrual phases. After 4 months, athletes repeated the questionnaire and MSi was re-calculated.

There was a significant reduction in MSi in the menstrual phase pre- and post-between time points (p <0.05); average MSi decreased by 7.1 ± 11.5. However, there was no significant change in MSi in the mid-cycle or premenstrual phases (p=0.4041 and p=0.1827 respectively). The most frequently cited symptoms pre-education were changes in mood, cravings/increased appetite, stomach cramps, and bloating; post-education the most common symptoms were changes in mood, stomach cramps, lower back pain and breast pain/tenderness.

Targeted menstrual cycle education may be beneficial in reducing female athletes’ experience of menstrual cycle symptoms during menstruation. However, symptoms are multifactorial in nature and a more longitudinal, multi-disciplinary education approach, with targeted intervention may be necessary to create behaviour change and subsequently significantly ameliorate menstrual cycle symptoms.

Organisers, John Hough and Jessica Piasecki, have written an article reflecting on its success of the Physical activity and the endocrine system 2022 meeting and the value of the Society Meeting Support Grant. Read it in the winter 2022 issue of The Endocrinologist.

Meet Peter Croucher the Society’s 2022 International Medal Lecturer

Professor Peter Croucher is the interim Executive Director of the Garvan Institute in Sydney. His main research focus is tumours that grow in the bone, such as multiple myeloma, or those that metastasise to bone, including breast and prostate cancer. In this interview he discusses his career path which led him to bone biology, the exciting developments happening in his field and gives top tips for aspiring endocrinologists.

Tell us about your career so far

I did my initial training in zoology at Cardiff University, followed by a PhD in cell biology at the medical school in Cardiff. I then spent time in Cambridge before moving to the University of Sheffield to specialise in skeletal disease. After a stint at the University of Oxford I returned to Sheffield as a Professor of bone biology and ran the department of human metabolism. Here we set up an institute called the Mellanby Centre for Bone Research. Then 10 years ago, I was approached by the Garvan Institute of Medical Research in Sydney to lead their bone programme and I’ve been there since. Over the last few years, I’ve been head of various parts of the Garvan Institute, most recently the deputy director and then in the last three months, the Interim Executive Director. It’s pretty varied and has been an adventure, which has been fun.

What drew you to specialise in bone biology?

After doing zoology, I was offered the opportunity of doing a PhD in the medical school, and I worked with Juliet Compston, who is an expert on osteoporosis.. Since then I’ve always worked in skeletal biology, or cancer of the growing bone.

. “Probably my biggest highlight has been the ability to work with some wonderful colleagues”

Tell us about your current research

One of the major projects I’m working on is trying to understand why cancers grow in the skeleton. There are a number of cancers that grow in the skeleton with –  multiple myeloma is one example, and breast and prostate cancers can also spread from primary tumours to the skeleton. We do know that once they’ve spread to the skeleton, they’re difficult to treat and often regarded as incurable, causing devastating effects to the skeleton and bone disease. We are trying to understand why tumours grow in the in the skeleton, what controls an individual tumour cell when it first arrives in the skeleton and why these cells can live in a long-term, dormant state before they get woken up to form active disease. If we can understand what holds them in a dormant state and then what causes them to wake up this will help us identify new therapeutic targets in order to eradicate these cells and stop the cancers growing in the skeleton.

What are your career highlights so far?

My highlights are typically associated with the people I have had the pleasure of working with or with scientific discoveries associated with these collaborations. A good example was the first time we saw a dormant cancer cell in a living animal, and then being able to isolate those cells to work out all the genes that control the behaviour of those cells. This was a important as it opened up the prospect of being able to tackle an important clinical challenge for the first time. However, probably my biggest highlight has been the ability to work with some wonderful colleagues; both withi the Garvan Institute but also in laboratories across the globe. It is enormously satisfying to be able to work with great colleagues to be able to tackle important scientific and clinical questions.

What are the biggest challenges your field faces?

Some of the most exciting area are new imaging approaches, for example intravital imaging, which in our case is allowing us to find very rare cancer cells and study them for the very first time in living organisms. The advent of approaches to sequence an individual’s genome, or to work out all the genes that are switched on in a particular cell are exciting new developments. Being able to analyse this data at a scale that was not previously possible is truly exciting .

“Do things that are difficult and are going to have impact”

What are the most exciting developments happening in your field?

Some of the most exciting things are imaging approaches, which allow us to find very rare cancer cells and study them for the very first time. Also data science and the advent of approaches to sequence an individual’s genome, or to work out all the genes that are switched on in a particular cell and be able to analyse that at scale that we’ve never really had until the last couple of years. I think the developments and opportunities that come with these discoveries are really important.

What’s coming up at your SfE BES lecture?

I’ll be talking about how we’ve been successful in finding very rare, dormant cancer cells in the skeleton. We’ve been using single-cell sequencing approaches to identify the genes that control dormant cancer cells and the various specialised environments where they live. I’ll also explain how this provides important insights into what controls dormancy and how we might be able to use this information to target and eradicate these cells in the future.

What advice would you give someone starting out in the field?

I would say to identify an area that you feel passionate about, then to try and address an important question that’s going to have a big impact in that area. Do things that are difficult and are going to have impact.

You can attend Professor Peter Croucher’s 2022 International Medal Lecture “Insights into the Cell and Molecular Control Pathways that Regulate Cancers in the Skeleton on Tuesday 15 November from 9:00 – 9:30am.

Take a look at the full scientific programme for SfE BES 2022.

Meet Mark McCarthy the Society’s 2022 Dale Medal Lecturer

Professor Mark McCarthy is Executive Director of Human Genetics, and a Principal Fellow at Genentech, where he leads research in human genetics to advance molecular understanding of health and disease. In this interview he tells us about his career, the people who have shaped his experience in endocrinology and what we can expect from his SfE BES lecture.
Tell us a little about your career so far

I trained in medicine at the University of Cambridge, then St Thomas’, working through medical SHO and Registrar rotations at Barts and the London School of Medicine and Dentistry (the London). One of which was endocrinology, and that became my chosen specialty. I fell into the research program that Graham Hitman was leading at the London on the genetics of type 2 diabetes. The first couple of years of research were difficult, but by the third year, I felt I was making progress. To test my research confidence a bit further, I secured an MRC Fellowship in Boston with Eric Lander, which was pivotal. I came back to a position in the UK after that which was half clinical and half research, but as the years went by, I found myself doing more research and less clinical work. I moved to Oxford in 2002 as the Robert Turner Professor of Diabetic Medicine, where I led a global research group that focused on the genetics of type 2 diabetes, obesity and related conditions. In 2019, I moved to Genentech, to lead up their efforts in human genetics (across multiple disease areas), putting what I had learned in Oxford to support target and biomarker discovery.

What attracted you to endocrinology?

It was pretty clear from my time as a student that I was going to be a physician, not a surgeon. So I rotated through a series of medical SHO positions before ending up in endocrinology. Two things about that rotation convinced me that this was the direction I wanted to go in. First, I was fortunate enough to work for John Monson, the endocrinologist at the London, who was just the most fantastic mentor and paragon of medical excellence – I owe him a huge debt of gratitude. Second was the practice of endocrinology itself – endlessly fascinating, (mostly) logical, and, for many patients, transformative.

“The practice of endocrinology itself [is] endlessly fascinating, (mostly) logical, and, for many patients, transformative.”

What is your career highlight so far?

I had the opportunity to be part of the team leading the Wellcome Trust Case Control Consortium, which in the mid-2000s performed the first large-scale, genome-wide association studies. It was thrilling to be part of such a seminal study. We didn’t know if it was going to work out, and there were huge technical and computational hurdles that the team had to overcome, but the study really transformed the field of common disease genetics and set in motion the explosion in our understanding of these conditions over the past 15 years. During the project I was particularly involved in type 2 diabetes, which revealed the first common variant influencing the risk of obesity.

Who have been your mentors?

There were three people who had a significant impact on my career. John Monson, who instilled in me a passion for endocrinology and a commitment to the ethical aspects to practising medicine and science. Graham Hitman, who guided me through my first few traumatic years in the lab, and pushed me towards more computational and analytical research (which was a good thing since I was much safer with a keyboard than a pipette). And Eric Lander who welcomed me into his lab in Boston, and gave me the belief that I could thrive in research.

What do you think are the most exciting breakthroughs in your field?

We are going through a revolution in research that brings together three complementary advances. Increasingly we are able to gather genetic and genomic data with both massive scale and high resolution. This started with human genetics and the ability to do genome wide association scans (rather than having to look one gene at a time), but we see the same now in genomics, for example through the power of single-cell and spatial genomics. We are also now able to gather data in humans, rather than animal models, which to state the obvious is the species we are most interested in. That’s in part down to genetics, but also through developments in the research of cellular and organoid models from human sources. Finally, we have these awesome advances in computational methods (most obviously in machine learning and AI) which allows us to make sense of vast, complex and diverse data sets.

“We have these awesome advances in computational methods (most obviously in machine learning and AI) which allows us to make sense of vast, complex and diverse data sets.”

What are the biggest challenges your field faces?

Too much of the data we have comes from European populations, so there’s much more that needs to be done to ensure that we embrace diversity in research and translation. Also we still have some way to go to ensure that we make use of these rich and diverse data sets to guide us to safe and effective ways of improving patient care.

Tell us what’s coming up in your SfE BES 2022 Medal Lecture

One of the most exciting developments in human genetic research relates to the use of polygenic risk scores. These aggregate data across multiple small genetic effects, and are becoming increasingly powerful at identifying those at extreme (whether high or low) risk of disease; and in some cases, in dissecting some of the clinical heterogeneity that we see in many of these conditions (with regard to progression, complications, and therapeutic response). I am going to describe three examples from my own research that I hope will give some sense of the translational potential of these approaches.

Do you have any advice for aspiring endocrinologists?

Follow your passion.

You can attend Professor Mark McCarthy’s Dale Medal Lecture “Mining the genome for gold on Monday 14 November at 5:45 – 6:15pm.

Take a look at the full scientific programme for SfE BES 2022.

Meet Anja Eckstein, the 2022 British Thyroid Association Pitt-Rivers Lecturer

Professor Anja Eckstein is an ophthalmologist specialising in orbital inflammatory disease. She is the head of the orbital centre of oculoplastics and orthoptic at University of Duisburg, Essen. In this interview she tells us about her academic inspirations, challenges in her field and what we can expect from her SfE BES lecture.

Tell us about your career so far?

I trained as an ophthalmologist at Moorfields Eye Hospital, University Eye Hospital in Tübingen and at the University of Duisburg-Essen. Currently, I’m head of the department for oculoplastic and reconstructive surgery, the orbital centre, and the orthoptic department at the University of Duisburg-Essen.  While in medical school I started research with a project on isolated retina and measured light potentials in different cell types with microelectrodes. So I started off my career in the field of medical retina but switched later to the ocular adnex disease, and the main clinical and research focus in Essen are orbital inflammatory diseases.

“The opportunity to exchange knowledge with the members of this research association has always inspired me, I especially enjoy the sense of humour of my British colleagues”

Who is your academic inspiration?

 I would like to give special thanks to my British colleagues. Participating in the EU INDIGO (Investigation of Novel biomarkers and Definition of the role of the microbiome In Graves’ Orbitopathy) project under the lead of Professor Marion Ludgate from the University of Cardiff was a particular academic inspiration. It was great to work with colleagues from many EU countries. I have been a member of EUGOGO since 2006 and the opportunity to exchange knowledge with the members of this research association has always inspired me, I especially enjoy the sense of humour of my British colleagues. A special mention goes to my excellent colleague Petros Perros from Newcastle. And, my colleague Simon Pearce whose work I admire in bringing new therapies to patients with autoimmune thyroid disease. I would also like to mention the always fruitful exchange with my colleagues in EUGOGO and ITEDS.

What do you enjoy most about your work? 

In our orbital centre we have many translational research topics that have a direct impact on patient care. We conduct molecular research on both in vivo and in vitro models of Graves’ orbitopathy. Here we look for new targets for therapeutic intervention and new possibilities for prevention. We also participate in phase 2-4 clinical trials testing new targeted therapies for patients with Graves’ orbitopathy. As a member of EUGOGO, I have also been able to take part in other clinical studies. The great thing about translational and clinical research is that the results go directly to the patient and improve patient care.

What are the biggest challenges your field faces?

We do research on rare, autoimmune diseases. Most research funding goes to oncology and cardiology, so it can be difficult to get funding for our research. Furthermore, a lot of the large companies who perform approval studies for drugs are mainly interested in common diseases, which can make it difficult for our field to secure support. For this reason, though, it is all the more gratifying that targeted blockade of the thyroid stimulating hormones (TSH) receptor by autoantibodies and small molecules is being researched through several therapy options.

What are the most exciting developments happening in your field?

Definitely the studies currently exploring the targeted blockade of the autoantibody-stimulated TSH receptor. If successful drugs can be approved here, it will prevent a series of painful and major surgeries in patients with Graves’ orbitopathy.

“The great thing about translational and clinical research is that the results go directly to the patient and improve patient care”

What are you presenting at your SfE BES lecture?

I will be giving a historical overview of milestones in Graves’ disease research, and illustrating the impact that these discoveries had on the care of patients with Graves’ orbitopathy. I will also be highlighting both the importance of both in vivo and in vitro models, since this is a focus of our molecular laboratory. Furthermore, I will address the new EUGOGO guideline for the treatment of patients with Graves’ orbitopathy, and the challenges of some new drugs being available in the USA but not yet in Europe.

Do you have any advice for aspiring endocrinologists?

As an ophthalmologist, this is a bit difficult for me. But in general I would recommend attending many international and national scientific meetings and cultivating exchanges with colleagues. You always get new ideas for work.

You can attend Professor Anja Eckstein, the 2022 British Thyroid Association Pitt-Rivers Lecture “TED/GO from bench to bedside on Wednesday 16 November from 8:30 – 9am.

Take a look at the full scientific programme for SfE BES 2022.

Meet Maria Fleseriu, the Society’s 2022 Clinical Endocrinology Trust Visiting Lecturer

Dr Maria Fleseriu is a neuroendocrinologist, she is Director of the Pituitary Centre and Professor of Medicine and Neurological Surgery at the Oregon Health and Science University in Portland, USA. Her work focuses on developing novel treatments for Cushing’s syndrome and acromegaly. Read our interview to learn more about her career path, what she loves most about her field, and a taster of her SfE BES 2022 lecture.

Tell us a little about your career path, so far?

I’ve always been fascinated with medicine. After learning how the heart’s mechanical valves and electrical system intertwined in the 6th grade, I became hooked. I would outline them on the foggy windows of my childhood home and my mum remembers how much work it was to clean the window smudges… After medical school, I trained in endocrinology in Romania, and subsequently completed another residency and then a fellowship at the Cleveland Clinic in the USA. I specialise in neuroendocrinology and currently hold two positions at the Oregon Health and Science University in Portland, USA.

Why did you choose to specialise in endocrinology?

During the first year of medical school, I became fascinated with the negative feedback system that regulates the hypothalamic-pituitary-axis. The fact that a pea-sized organ is the ultimate “master” gland intrigued me, so for my first research project I focused on improving imaging of the pituitary. This was the moment where neuroendocrinology became my passion.

Can you tell us about your current project?

My research focuses primarily on novel treatments for acromegaly and Cushing’s syndrome. I am also working to elucidate the extent and the recovery rate of pituitary dysfunction after surgical and/or other adjuvant therapies for pituitary adenomas. I have served as principal investigator or global principal investigator in multiple clinical trials studying novel chimeric molecules, new somatostatin multi-receptor ligands, adrenal steroidogenesis inhibitors, antisense oligonucleotide therapy and glucocorticoid receptor blocker use for the treatment of acromegaly or Cushing’s.

“I have great appreciation to the thousands of patients who have contributed time and energy for research studies, allowing us to better understand, and to discover new treatments for, this complex disease”

What do you love most about your work?

Although I’m no longer drawing on windows, I still get very excited about hormonal feedback! As the science and understanding of the pituitary gland improves, hopefully we will be able to diagnose pituitary conditions sooner. Early treatment could reduce complications and improve patients’ outcomes and I love to share the knowledge we’ve accumulated. When I saw my first patient with a pituitary tumour, almost 3 decades ago, all we had in terms of treatment was bromocriptine. We now have several classes of medications that we can use based on a “trial and error” approach, but personalised treatment regimens are increasing. I hope we will move closer to an individualised model, similar to that used in oncology.

What are the biggest changes in managing Cushing’s syndrome?

We face challenges at all stages, diagnosis can be difficult, especially in earlier, less ‘full-blown’ cases. The phenotype that we see is shared with several other conditions, which are much more common and necessitates physicians to be more aware of this syndrome, ‘to think about it’ and screen when needed.

Localisation can sometimes be challenging and the management itself can also be complicated, although we have better treatments, they don’t always work and recurrence rate in Cushing’s disease is quite high.

“Our mission is to educate our patients and medical community about hormones and promote innovative science – both of which will lead to better patient care. It is not easy, but it is fulfilling and rewarding”

Where do you see the next breakthrough happening in your field?

These are exciting times for specialists like me who have dedicated their career to the pituitary gland. Several histological and molecular markers have been developed that allow us to move translational research closer to the ‘clinic’. Physicians will soon have the right tools to predict the clinical course of pituitary adenomas more precisely and to develop individualised plans for management, also including patients’ preferences.

Could you tell us about your SfE BES 2022 lecture?

My lecture will highlight recent advances in management of Cushing’s disease, which should also consider comorbidities and complications associated that might compromise patient health and quality of life. I will discuss how treatments that specifically target certain pathways will create a paradigm shift in how we treat pituitary disorders, but WE ARE NOT THERE yet. I have great appreciation to the thousands of patients who have contributed time and energy for research studies, allowing us to better understand the aetiology and complications, and to discover new treatments for this complex disease.

Do you have any words of wisdom for future endocrinologists?

Pituitary disorders are complex and usually require a multidisciplinary approach. Every day, I communicate with a range of specialists, from neurosurgeons to gynaecologists, psychologists, and primary care physicians. While the hormones abnormalities are at the centre, they cause diverse health problems that warrant specific evaluation and management. Our mission is to educate our patients and medical community about hormones and promote innovative science – both of which will lead to better patient care. It is not easy, but it is fulfilling and rewarding.

You can attend Dr Maria Fleseriu’s Clinical Endocrinology Trust Visiting Lecture “Novel Approaches for Cushing’s Medical Management: Guidelines to Clinical Practice on Monday 14 November from 2 – 2:30pm.

Take a look at the full scientific programme for SfE BES 2022.

Meet Adrian Clark, the Society’s 2022 Jubilee Medal Lecturer

Professor Adrian Clark is an Honorary Professor of Endocrinology at Bart’s & the London School of Medicine & Dentistry, and Chair of Bioscientifica. He enjoyed a varied academic career in endocrinology, from studying at Bart’s Medical College to becoming Head of the Academic Department of Endocrinology at Bart’s. He is the current editor-in-chief for Endocrine Connections. In our interview he discusses his academic career, the importance of resilience in research, and tells us what we can expect from his SfE BES 2022 lecture.

Tell us about your career so far

I trained in medicine and biochemistry at Bart’s Medical College, and following various junior clinical training positions, took up a research position with Harry Keen at at Guy’s Hospital Medical School before moving to the National Institutes of Health (NIH) in Bethesda, USA to work on cloning the epidermal growth factor (EGF) receptor with Ira Pastan. I subsequently moved to Kevin Catt’s lab at NIH, working on cloning the angiotensin receptor, before returning to London to Mike Besser’s Department of Endocrinology at Bart’s to establish the Centre for Molecular Endocrinology with Medical Research Council support. I later became Head of the Academic Department of Endocrinology on Mike’s retirement, and Deputy Director of the William Harvey Research Institute. I took on the post of Dean of Research at St George’s University of London in 2012 before retiring from full time work in 2015. Since then I have maintained my research involvement at Bart’s and been Chair of Bioscientifica since 2017. I was editor-in-chief of the Journal of Endocrinology and Journal of Molecular Endocrinology for 6 years, and now I’m editor-in-chief of Endocrine Connections.

What attracted you to endocrinology?

Endocrinology provided ‘precision medicine’ decades before the term was even invented. It was the ability to apply objective data to the diagnosis and management of human disease in contrast to all other medical specialties at the end of the last century that was perhaps the main attraction. In addition, the opportunity to understand disease processes as aberrations of biology really brought science and medicine together in a manner unequalled at that time, which appealed to the basic scientist in me.

“The opportunity to understand disease processes as aberrations of biology really brought science and medicine together in a manner unequalled at that time, which appealed to the basic scientist in me”

Who has inspired you most in your career?

This is impossible to answer. I have worked with, and been taught by, many great endocrinologists over the years – Mike Besser – whose teaching sessions as a medical student were legendary, Lesley Rees, Steve Bloom, Harry Keen and Kevin Catt, to name a few. My greatest “inspiration” however was at a University of Exeter open day as a seven year old when I visited the biology department. I can still remember my amazement at the many exhibits there, such as viewing living protozoa under the microscope. My parents had to drag me away.

What are you most proud of academically?

In research, pursuing the idea that the adrenocorticotropic hormone (ACTH) receptor required an adrenal co-factor when precedents were lacking, and for eventually discovering this co-factor through a rather unexpected route. Perhaps a greater achievement, though, is maintaining a research environment that trained many outstanding researchers and leaders in endocrinology in this country and abroad!

What do you think are the biggest challenges in your field?

Research funding, and attracting and supporting talent. Research in endocrinology understandably lacks the mass appeal of cancer, brain or cardiovascular research. Arguably, this means that funded endocrine research has to be of greater quality, but it also means that endocrinology can be a tough and discouraging place to establish a career at the post-doctoral and junior faculty level. Added to this is also the probability that the attractions of studying and working in the UK will be significantly reduced since Brexit, depriving us of the wealth of European talent from which our research has undoubtedly benefitted in the past.

“My greatest ‘inspiration’ was at a University of Exeter open day as a seven year old when I visited the biology department. I can still remember my amazement… My parents had to drag me away”

Where do you see the next breakthrough happening in your field?

I think that with the greater understanding of the molecular mechanisms underlying signalling we are on the brink of development of really sophisticated tools that could be used to manipulate the pituitary-adrenal axis in patients.

Can you tell us about your SfE BES 2022 lecture?

I aim to summarise about three decades of work which led to the discovery and understanding of the unique role of the melanocortin receptor accessory proteins (MRAPs) and to highlight a couple of underexplored aspects of their role in the control of adrenal function.

Do you have any words of wisdom for future endocrinologists?

Resilience, when papers and grant applications are rejected, it is an essential requirement for success. Ask questions – those you fear are silly questions are often the most revealing. Find and keep a mentor you trust. Keep abreast of developments in other areas – they sometimes provide you with remarkable insights and even real “eureka” moments.

You can attend Professor Adrian Clark’s Jubilee Medal Lecture “The MRAP Files” on Tuesday 15 November from 8:30 – 9am.

Take a look at the full scientific programme for SfE BES 2022.

Meet Joanne Brown – Early Career Nurse Member

Joanne Brown is the first Endocrine Clinical Nurse Specialist at Stockport NHS Foundation Trust. She tells us about her nursing career path, experience at our Endocrine Nurse Update meeting and her role in the Society.

What inspired you to choose endocrinology?

My career started in theatres, recovery and then critical care. I completed an MSc in advanced practice whilst working within a busy regional neurosurgical centre. I then returned as an advanced critical care practitioner and independent prescriber for a couple of years. It was during my time working as an advanced nurse practitioner in neurosurgery that my interest in endocrinology was sparked. I then started to look for a job in endocrinology that would give me a better work life balance, but that I still found interesting and challenging.

What do you enjoy most about your work?

One of the best things about my role is how varied it is; I have my own nurse-led clinics for thyroid and I’m developing my knowledge for hyperparathyroid nurse-led clinics too. I also manage a weekly endocrine investigation unit, develop clinical protocols and standard operating procedures and produce patient information leaflets. I have led on a service evaluation and organised a way to receive patient feedback for the endocrine investigation unit. I teach and support patients and staff throughout the Trust about how to manage adrenal insufficiency safely. I am also a member of the Society’s Early Career and Nurse Committees. My role has also opened opportunities for me to be involved with writing for peer-reviewed publication and to participate in a podcast about my career. It is truly very varied.

“Being involved with the Society can enhance patient care or your services and will expand your knowledge, whilst building on your CV”

There is something special about supporting patients, for example, those who are newly diagnosed with adrenal insufficiency, teaching them and their family members; being there for them when they have concerns or questions. It’s rewarding to have a long relationship with patients and understand how their disease impacts on them personally.

What you are most proud of in your career so far?

I am really proud to be the first endocrine clinical nurse specialist at Stockport NHS Foundation Trust and I believe my role is now making a difference to patient care. Setting up an endocrine investigation unit was challenging but a huge achievement and is benefitting patient care and management. I’m also proud that I successfully managed to contact all our patients with primary or secondary adrenal insufficiency during the start of the COVID-19 pandemic to provide them with support regarding sick day rules. I haven’t yet completed any research, though I have an interest in patient experience and would welcome research opportunities in this area.

How has the COVID-19 pandemic affected your research work?

I started my role just before lockdown, so I can’t really compare it to before COVID-19. However, during the pandemic whilst face-to-face clinics were cancelled, we set up a telephone clinic. I could run the clinic from home, contacting our patients with primary or secondary adrenal insufficiency and provide education about sick day rules and COVID-19. I also ensured that each patient had an emergency injection kit prescribed and were provided with a new steroid emergency card. This clinic proved that some elements of our jobs can be completed over the telephone, it also highlighted that many patients prefer face-to-face contact. I think it’s important and beneficial to be able to offer a range of appointment styles to patients, to support their preferences and clinical need.

How did you enjoy your first Endocrine Nurse Update meeting?

It was so nice to meet other endocrine specialist nurses from around the country and swap contact details, to support each other. It was fantastic to meet members of the Nurse Committee too and to be involved as a speaker. It was all such a great experience.

The lectures were all interesting and relevant, I particularly enjoyed the clinical case presentations and steroid management group session, which gave me a lot to think about how I could improve my practice. The exhibition stands enabled me to speak to various support groups and that has proven very beneficial.

Since attending the meeting I have placed thyroid information leaflet QR codes in our out-patient area to make the information more readily accessible for patients.

I have also been supported by the Addison’s Disease Self-Help Group and carried out a successful Addison’s Disease Awareness Day event at Stockport NHS Trust for staff.

What have you gained from joining the Early Career Committee?

“I would recommend getting involved in events and any activities that are advertised through the Society, it’s an excellent way to meet other endocrine specialist nurses”

The Society website had lots of supportive information that benefitted me as a new endocrine specialist nurse, so I joined to gain full access to the nursing resources. The Society helped me to contact an experienced nurse who listened to my plans and ideas for my role and offered me support, guidance and encouragement. I then presented an Endocrine Nurse Skills webinar on nurse-led clinics, and hosted another.

These were both great experiences and something I hadn’t done before, so I found it all really interesting. I then applied to be part of the Early Career Committee, as I had ideas about how early career nurses could be better supported by the Society. It has also enabled me to be a voice regarding what other early career nurses feel would benefit them. I then applied for a position on the Nurse Committee, which is useful for linking early career ideas into the Nurse Committee and fantastic for supporting the wider nursing community.

What do you think are the biggest challenges in your field?

The biggest challenge I find is managing patient expectations with limited resources, when we all want the patient experience to be good. There is a lot of pressure on the service for appointments with the consultant team. There is much more that could be done by a clinical nurse specialist and I would hope in the future to expand the service. Patients are however very grateful for my support and the part I play in their care.

Would you advise others to apply for roles within the Society?

I would recommend getting involved in events and activities advertised through the Society, it’s an excellent way to meet other endocrine specialist nurses. I received peer support from Emily Falconer, who was also relatively new to her role at the time when I first started my job.

Being involved with the Society can enhance patient care or your services and will expand your knowledge, whilst building on your CV. Check the Society’s website for details of the committee roles available and I’m always happy to talk to you about the role and the areas I am involved in, so feel free to contact me too.

How have mentors helped your career so far?

My clinical mentor is Dr E.D Aflorei, who has been incredible at supporting me to build my knowledge, experience and confidence with patients. Dr Aflorei also encouraged me to join the Society. I will remain grateful for this advice as it enabled me to contact Sherwin Criseno, who then supported and guided me. Sherwin helped me to focus on the Society for Endocrinology Competency Framework for Adult Endocrine Nursing a bit at a time, rather than feeling overwhelmed with it all and guided me with regards developing clinical guidelines and patient information leaflets.

Support from a nurse mentor and clinical mentor is essential when you are developing your role, it gave me confidence to get involved in Society activities too and reach out to other nurses across the country. Working as the only endocrine specialist nurse in a district general hospital could feel lonely, but knowing I can contact many nurses, very easily, really does support me in my practice.

Visit our dedicated endocrine nurse careers webpages for more advice and opportunities.

Meet Louise Breen our first Nurse Committee Chair Elect

Louise Breen is an Advanced Nurse Practitioner and Lead Nurse in Endocrinology at Guy’s and St Thomas’ NHS Foundation Trust. Here she tells us about her path to nursing and her involvement in the Society which culminated in her becoming the first Chair Elect of the Nurse Committee.

How did you get into endocrinology?

My interest in endocrinology was triggered in 1996 working as a staff nurse for pre-assessment and endocrine testing during a 3 month line of work at the Diabetes and Endocrine Department at St Thomas’. I returned the following year as a research nurse undertaking pharmaceutical company sponsored clinical trials in diabetes and endocrinology. It was the research in adult growth hormone deficiency that interested me most.

I was extremely fortunate to work with Professor Peter Sonksen who had a very progressive and supportive attitude to the advancement of endocrine nursing, he encouraged me to push myself in developing my knowledge and skills. I continue to be surrounded by an innovative, enthusiastic and supportive team.

“If you feel you don’t have time for a committee position, think about putting yourself forward to present at Society conferences, Chair a session or submit and present an abstract”

What do you enjoy most about your work?

  • Team work
  • Making a difference to patient care
  • Continued learning & development in my role, clinically and strategically
  • Mentoring staff

Can you tell us what you’re most proud of in your career, so far?

When I started out there was no designated endocrine specialist nurse, in 2003 we successfully proposed the first ESN role, I got the job and our ESN service has continued to grow.  We now have a team of eight, and provide the following services: Nurse-Led Clinics, MDT support (Pituitary, Adrenal and NET), Endocrine Testing and Reporting, Patient Education, Education for other HCP and active input into research, audit, the development of guidelines/protocols and standard operating procedures.

My qualifications in Advanced Assessment and my registration as a Non-Medical Prescriber have allowed me more autonomy in practice and improved my knowledge and skills in endocrinology.

In 2011, I established the Nurse Led Virtual Thyroid Clinic which was well received by patients and has gone from strength to strength. Pre-COVID we undertook on average 30 virtual reviews per week, which put us in a good position during the pandemic.

How has the COVID-19 pandemic affected your work?

Fortunately we were well set up for virtual reviews and maintained a reasonable amount of scheduled activity, albeit with staff deployment. We are gradually getting through the backlog and returning our focus to ongoing service developments, research and audits. Remote meetings have been invaluable and in many cases a more productive and inclusive way to meet.

On reflection I have identified areas where we can be more efficient and recognised that we had little give in our service for ESN cover, as a result we proposed and created Band 6 and Registered Nursing Associate roles.

Why do you think it’s important to get involved with Society roles?

The Society are an excellent organisation to work with and the team supporting the Nurse Committee are very motivated, enthusiastic and supportive. I have served two four-year tenures and am now in my one year term as Chair Elect before I proceed to the role of Chair. My organisation views these roles as important for professional development, supporting me to attend relevant Society meetings.

Being at the hub of endocrine nursing in the UK has so many advantages in improving your knowledge and expertise in endocrinology and in my case has aided career progression.

The progression and advancement of endocrine nursing and my career have motivated me to continue my work with the Society. I have been extremely fortunate to work with exceptional people in this role and have made long lasting friendships.

What inspired you to apply to be Chair Elect of the Nurse Committee?

It is a pivotal time for the advancement of endocrine nursing and I wanted to be part of that ongoing process. The GIRFT report made it clear that we must focus on the retention and progression of nurses in endocrinology.

My experience and close working relationship with the Society and the Nurse Committee has readied me to take on this position. As Chair Elect it is a huge advantage to work alongside Anne Marland, our current Chair, to better understand the roles and responsibilities of the position and to continue to push the nursing agenda forward as I move into the role of Chair.

“The Society is an excellent organisation to work with and the team supporting the Nurse Committee are very motivated, enthusiastic and supportive”

What advice would you give to anyone considering being more active in Society activities?

Believe me when I say there is always something you can contribute. Many nurses hold back from applying for committee positions, thinking they don’t have enough experience, expertise or time. The committee is very welcoming and supportive.

Getting your employer on board to support time to attend meetings and undertake committee tasks is an important consideration, most employers will generally see the mutual benefit of this role. Travel expenses are covered and there are a number of virtual meetings to avoid too much time out of clinical roles.

If you feel you don’t have time for a committee position, think about putting yourself forward to present at Society conferences, Chair a session or submit and present an abstract. Get in touch with the Nurse Committee if you have any queries.

Visit our dedicated endocrine nurse careers webpages for more advice and opportunities.

Endocrine Ambassadors’ new teaching series gives confidence to clinical trainees

Society Endocrine Ambassadors Dr Gemma Gardner and Dr May Khine are both foundation year two clinicians in the Peninsular deanery (Torbay and Derriford Hospital) who intend to specialise in endocrinology and diabetes. In this short blog they share the endocrinology and diabetes teaching series they have developed.

We are both very excited to share our endocrinology and diabetes teaching series which took place between October and November 2021. When working as foundation year one trainees, we felt that dealing with diabetic and endocrinology related dilemmas on the ward was often daunting for junior members of the medical team. We decided to develop and organise a five-session teaching series aimed at junior doctors, physician associates and medical trainees with the aim of improving their confidence and knowledge for managing endocrine and diabetic issues on the ward and on call.  

“It was a great opportunity for students to ask and discuss topics with experienced endocrinologists which ultimately gave medical trainees a confidence boost to manage endocrinology and diabetes ward/ on-call dilemmas.”

The teaching sessions were delivered online by endocrine and diabetes registrars and consultants, both at Torbay and Derriford Hospital, who kindly gave up their time to be involved in the teaching sessions. The sessions were highly informative and interactive with top tips shared around each topic. It was a great opportunity for students to ask and discuss topics with experienced endocrinologists which ultimately gave medical trainees a confidence boost to manage endocrinology and diabetes ward/ on-call dilemmas. 

It was a valuable experience to host and lead this teaching series and we were very pleased to receive such positive feedback from participants which attended from across the Peninsular deanery. These are some typical examples of feedback we received:

Type 1 diabetes and types of insulins – “A really helpful lecture on a topic that I am often uncertain about managing on cover shifts. It was really useful to have stepwise advice as to what to do when called to see a hyperglycaemic patient on the ward and how to adjust their insulin in response”.  

Great practical advice pitched at a good level for junior doctors about common issues” .

Electrolyte abnormalities – “Picked out important points and gave clear algorithms, thank you for organising”.

Endocrine emergencies and disorders – “Information was concise and cleared up some misconceptions I had”.

We look forward to inspiring and promoting the Society for Endocrinology to the younger trainee population in future events. Look out for more events through our teaching platform “How2Doc” on Facebook or contact us through email gemma.gardner9@nhs.net or may.khine1@nhs.net.

If you want to find out more about our Endocrine Ambassadors or would like to apply to become one please visit our webpage.

Meet Aldons Chua the Endocrine Nurse Grant Awardee

Aldons Chua is a nurse manager of the endocrine investigation suite in Eastbourne. In our interview he tells us about how he came to this role and the research he is doing with his Endocrine Nurse Grant.

How did you get into endocrinology?

I began my career working as an endoscopy and liver transplant nurse in the Philippines. I set foot in England in 2016 and started as a staff nurse in an acute medical unit at Eastbourne DGH. Endocrinology nursing was unknown to me until a colleague and friend who is now my manager, Maria Ravelo, invited me to do some extra shifts in the endocrine suite. During my shifts, I met patients with rare endocrine conditions and hearing their stories made me fascinated with the specialty.

Can you tell us about your current position?

My main role at present is managing the endocrine investigation suite, covering two district general hospitals, which includes performing dynamic function tests and providing health education for patients with adrenal insufficiency. I also facilitate the commencement and monitoring of treatment for general endocrine disorders.

What do you most enjoy about your work?

What I really enjoy is the autonomy as a nurse and collaboration with the multidisciplinary team. There is also so much support from colleagues even from different organisations and a variety of opportunities to grow personally and professionally. And, of course, seeing my patients have an improved quality of life through the care our team provided is the most rewarding part.

What are you most proud of in your career?

Becoming a nurse in the UK is what I consider as my proudest moment. As an overseas Filipino worker, it was a big leap of faith to move away from my family and homeland to work in another country with so much difference in language and culture. But it is such a blessing to have very supportive colleagues and managers who I have worked with since the very beginning, especially when it comes into my career aspirations.

How has your work been affected by the COVID-19 pandemic?

It has been very challenging. My associate practitioner and I were re-deployed to a COVID ward for 2 months during the first lockdown and our endocrine service was placed on a 10% service capacity. This caused a significant impact on the timings of our patient appointments, especially the investigations and teaching. However, it also made us resilient and innovative in our efforts to maintain the quality of care we provide while ensuring patient safety.

What do you think are the biggest challenges in your field?

We have a vision in our endocrine nursing service to provide excellent, safe and compassionate patient-centred nursing care. The biggest challenge is to keep the vision going, knowing that we only have very limited time and resources.

You have been awarded an Endocrine Nurse Grant, what was the application process and how did you find it?

Initially, I was reluctant to apply, as I had reservations about whether I qualified as I am still an early career nurse. I am very grateful to my mentor/research supervisor Dr Sofia Llahana who encouraged and guided me throughout the process. Also, the Society for Endocrinology set clear guidance on the website and the team were helpful in responding to my queries which made the process easier to follow.

What will the grant be used for?

The grant will be used to fund our research project which is investigating the barriers and enablers in the use of injection devices during adrenal crises for adrenal insufficiency (AI) patients. In the UK, most centres provide 3ml syringes and a needle or a safety syringe, depending on the centre, which are included in an emergency hydrocortisone injection pack. Although AI patients receive training on how to use these syringes there are still reports that they are unable to administer the hydrocortisone injection during an adrenal crisis due to the complexity of the device. First-hand reports of these problems from our own AI patients led to the research project. Adrenal crisis is a life-threatening event and the emergency injection of hydrocortisone can save a patient’s life. This grant will help us explore the experiences of AI patients on their use of the current hydrocortisone device during an adrenal crisis. The outcome will provide evidence of potentially modifiable barriers associated with the use of the current parenteral hydrocortisone in preventing adrenal crisis and will inform the development of future interventions.

What are your plans after completing this project?

I am looking forward to take on future projects looking at how we can further help and support our patients with adrenal insufficiency manage their condition even better. We are starting new nurse-led clinics soon and expanding the endocrine nursing service to help accommodate our increasing number of endocrine patients.

What advice would you give to anyone considering applying for the Endocrine Nurse Grant?

My first challenge was how to begin, so I connected with a mentor who works in the same area. Then, I familiarised myself with how to make a competitive research proposal as this is my first application. I believe that as nurses we have a huge desire to make a difference to the lives of our patients, and research is just one way. Take courage, and if you fail on the first attempt don’t lose heart, just keep on trying and improving.

Learn more about the Society’s Endocrine Nurse Grant and how to apply before the next deadline. Visit our dedicated endocrine nurse careers webpages for more advice and opportunities.