Dr Alessandro Prete from the University of Birmingham is this year’s proud winner of the Clinical Endocrinology Trust Clinical Science Abstract prize and is presenting his latest work at SfE BES 2019. In this interview, Dr Prete shares inspiring words of wisdom for future endocrinologists and tells us about his research on adrenal tumours and the challenges in his field.

Can you tell us about your current position and research?

I am a clinical research fellow working towards a PhD at the Institute of Metabolism and Systems Research (IMSR), University of Birmingham. The IMSR is an exciting place to do endocrine and metabolic research, as it is highly multi-disciplinary and collaborative. I also love that it is such an international place, in my group alone there are people from more than 10 countries. In my PhD project, I investigate the mechanisms linking cortisol excess in adrenal tumours to its adverse metabolic consequences, including the use of multi-omics approaches for studying global and steroid metabolism. My project is very multi-disciplinary and I collaborate with metabolomics specialists, computer scientists and human in vivo physiologists.

Please tell us a little about your career path so far, and what you are most proud of?

After completing my training in endocrinology and diabetes in Italy, I successfully obtained EU funding in 2016, which allowed me to join the IMSR at the University of Birmingham. In 2017, I also had a valuable experience as a visiting fellow at the Department of Endocrinology at the Mayo Clinic in the USA. Finally, in 2018 I was awarded a Diabetes UK Sir George Alberti Research Training Fellowship. Obtaining this prestigious funding offered me a unique opportunity to carry out my research and training project for my PhD.

What more specifically are you presenting at your Medal Lecture at SfE BES 2019?

I was delighted to hear that I have been selected as the best clinical abstract at SfE BES 2019! I am excited to present the most recent results of my research into the metabolic consequences of benign adrenal tumours. Adrenal tumours are very common and a relevant proportion of these produce a mild, chronic excess of cortisol that can lead to adverse cardio-metabolic outcomes. I have investigated the 24-hour urinary excretion of adrenal steroids from a large prospective sample of these patients and found that this approach can be used to identify subjects with a higher metabolic risk.

Is there anything you are particularly looking forward to at this year’s conference and you would recommend to others?

I have been an enthusiastic attendee of the SfE BES meetings since I started working in the UK. I particularly enjoy attending basic science sessions because they provide an overview of the cutting-edge research that takes place in the UK and beyond. I also like strolling around posters during the breaks as it is an excellent way to network with other researchers. Finally, I cannot recommend this highly enough to my younger colleagues: please don’t miss the Early Careers Curry and Quiz on Monday night!

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

The detection of benign adrenal tumours associated with mild autonomous cortisol excess (MACE) poses a therapeutic dilemma – should we observe and pursue medical management of the metabolic comorbidities or go for the surgical resection of the tumour? I would love to find out if MACE causes the increased risk in metabolic disease, or metabolic disease is just co-incident with MACE, or metabolic disease causes MACE. Clinically, it is clear that patients with adrenal tumours associated with MACE have a higher rate of diabetes, hypertension and dyslipidaemia.

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

Current biochemical testing is often not enough to pinpoint those patients with benign adrenal tumours at higher risk of developing metabolic dysfunction. I think that a multi-omics approach to these patients will offer a much better prognostic stratification that can hopefully be translated to clinical practice. Moreover, these patients are often elderly and with multiple comorbidities that increase their perioperative risk if they go down the surgical route. I expect that, in the near future, randomised clinical trials will clarify whether medical treatment with cortisol-lowering medications can be a valid alternative to surgery in these patients.

What do you enjoy most about your work?

Endocrinology has fascinated me since the first years of medical school. It is a vast and extremely intricate world but gratifying at the same time, because of its consequentiality. Everything, even the most complex and paradoxical observations, are based on cause-effect mechanisms and each phenomenon has its own explanation if you are inquisitive enough.

Who do you most admire professionally and why?

Endocrinology and millions of past, present and future patients owe their life to Edward Kendall, who isolated cortisone and thyroxine. He spent Christmas Day in 1914 crystallising thyroid hormones from over 6,000 pounds of pig thyroid glands – frankly, I can’t think of a better example of dedication to medicine and science!

Any words of wisdom for aspiring endocrinologists out there?

Endocrinology is a rewarding and stimulating discipline but, at the same time, research can be daunting. Failures are part of our work – take advantage of them to develop resilience. Be humble but keep an inquisitive mind, and above all… do not take anything for granted!

You can hear Dr Prete’s presentation, “Urine steroid metabolome analysis allows for metabolic risk stratification in 1309 prospectively recruited patients with benign adrenal tumours and different degrees of cortisol excess” on Tuesday 12 November at 10:15. Find out more about the scientific programme for SfE BES 2019.