Author: Society for Endocrinology

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 Davies^1
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 Varley^1
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.

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.

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 .

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.

Recent graduate Helen Loo reveals all

Helen Loo, Endocrine Specialist Nurse at Oxford University Hospitals, is one of our first students to successfully complete the Oxford Brookes Masters-level Module in Endocrine Nursing. This module provides nurses with an opportunity to develop their careers and improve standards of patient care in line with the Competency Framework for Adult Endocrine Nursing. The Society collaborates with Oxford Brookes to deliver this 40-credit module, enabling nurses to get academic recognition for all their hard work. All credits can be directly counted towards the Oxford Brookes University MSc in Health Sciences or transferred to Masters-level qualifications at other institutions.

Read our interview with Helen to get valuable insights in to the module and find out about her career as an endocrine nurse.

What inspired you to choose endocrinology as a career?

Before I started working in endocrinology I was living abroad. When my family and I decided to move to the UK, I saw a position advertised to work in endocrinology. After I started researching the area, I was inspired to apply. Endocrinology appealed to me as the discipline is so vast and mixes both acute medicine and chronic disease management.

Tell us a little about your current position and what you enjoy most about your work

I work in a large endocrine team at a busy tertiary referral centre at Oxford University Hospitals, and see patients with many diverse endocrine disorders. Endocrinology is a rewarding area to work and study within as the discipline is constantly changing. There are many opportunities to learn and to apply your learning in practice. I particularly enjoy developing innovative solutions to improve quality of care and nursing practice. As an endocrine nurse, I also feel very privileged to be able to support our patients holistically through the various stages of their diagnosis and treatment.

Tell us about your main research interest

I take a special interest in the areas of male fertility, adrenal insufficiency, gender dysphoria and support the treatment and diagnosis of patients with Cushing’s syndrome. During my Masters-level Module in Endocrine Nursing, I specifically looked at the management of adrenal insufficiency, prevention strategies, and innovation in endocrine nursing care. I was interested in this area of endocrinology because I was inspired by a complex patient who came to us with a medical alert dog, who alerts the patient when their cortisol levels drop. In 2019, I presented a poster at the Society’s Annual BES Conference on this subject and was privileged to be the recipient of the Annette Louis Award. You can read more about this in The Endocrinologist.

Why did you decide to apply for the Oxford Brookes module?

I applied for the Oxford Brookes module as I wanted to build on my experience, knowledge, and skills in endocrine nursing, while advancing my understanding of the health needs that directly relate to our patients. I hoped that it would develop my confidence in undertaking research, enhance my critical enquiry skills and improve my evidence-based practice.  All these expectations were met and more!

What is your advice for anyone considering doing the Oxford Brookes module?

This is an excellent course and will really help to give you more expertise in your chosen area and develop your profession. I would advise those considering the module to plan well and to take a responsible approach to their own learning.

What were the challenges of the module and how were you supported?

My biggest challenges were that it had been quite a few years since I had done academic work and I also had two primary aged children. The university provided me with support to get back into writing academically and I reduced my hours to enable me to have a better work life balance. My mentor was also amazing. She supported and encouraged me to manage my own learning to develop my skills and maximise my potential.

What are the biggest challenges in your field?

I think some of the biggest challenges are working within the constraints of the NHS, as well as the effects of the pandemic on health care. Challenges always provide opportunity however, and it is with this mind set I move forward.

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

Endocrine nursing is a continually evolving specialty and is now becoming academically accredited. The competency framework benchmarks endocrine nursing with continual scope for development and innovation. I am really excited for the future and the part I will play.

Our 2020 Society for Endocrinology Dale Medal winner, Frances Ashcroft, is Professor of Physiology at the University of Oxford and a Fellow of Trinity College Oxford. She will be talking about her fascinating research on ion channels and their role in insulin secretion during SfE BES 2020 Online. Find out more about her career and research and get some invaluable words of advice in this interview article.

Tell us a little about your current research

My research interests are ion channels and the metabolic regulation of insulin secretion. These two fields come together in our studies of the role of ATP-sensitive potassium channels in insulin release. I am excited to understand how the metabolism of beta cells works, and how high blood glucose levels in diabetic patients change these beta cells, so that they don’t secrete insulin anymore.

Can you tell us about your career path and what you are most proud of?

I did my undergraduate and graduate studies at the University of Cambridge in zoology. I then did post-docs in Leicester with Peter Stanfield and Los Angeles with Susumu Hagiwara, where I worked on calcium and potassium currents in muscle. After this I set up my own lab in Oxford and chose to study beta cells. I used a technology called patch clamping to look for ion channels closed by glucose. I was a total novice at patch clamping and I was fortunate that others helped me get started and that I got a grant to do it. I have always been led by the science and followed what I am interested in, which in my case is ion channels. I have written a popular book on this subject called the Spark of Life.

I’m most proud of the success of all the brilliant students and post-docs who have worked in my lab. It’s also been wonderful to meet some of the neonatal diabetes patients who have been helped by our work.  Andrew Hattersley and his team found that 50% of neonatal diabetes cases are due to mutations on the ion channel I had been working on for 20 years, and we were able to show that these mutations impaired the ability of ATP to close the channels and thus prevented insulin secretion. However they could still be closed by sulphonylurea drugs. This was very exciting because it enabled the patients to transfer from insulin injections to oral tablets.

What inspired you to choose endocrinology as a career?

When I was an undergraduate it was thought that electrical activity was mainly confined to muscle and nerve cells, so I remember being fascinated at finding that it also occurred in endocrine cells, like pancreatic beta-cells. When I took up an independent position at the University of Oxford, I decided to work in a field that was different from my previous one and where there were people at Oxford with whom I could collaborate. I picked beta-cells because of their interesting electrical activity and because I met Stephen Ashcroft, who was working on the biochemistry of insulin secretion. It was the start of a long and happy collaboration.

What do you enjoy most about your work?

There are three main things I enjoy most about my work. Firstly, making discoveries – there is nothing quite like the exhilaration of finding out something new. Secondly, seeing the people who have worked in my lab flourish is a constant joy.  And finally, the wonderful long-term collaborations I have had with some outstanding scientists, such as Steve Ashcroft, Patrik Rorsman, and Andrew Hattersley.

How has the COVID-19 pandemic affected your research?

Lockdown was a twofold problem because it prevented us from working in the labs. It was also impossible to keep all of our animal colonies going because of reduced staff in the animal house. We are back in the labs now, but social distancing means that we cannot work at the same intensity as normal. There’s also a constant low level of anxiety about the virus that affects everyone.

What will you be presenting during your lecture at SfE BES online 2020?

I’ll be talking about our work on the role of the ATP-sensitive potassium (KATP) channel in glucose-stimulated insulin secretion. Glucose has to be metabolised by the beta-cells for it to stimulate insulin release. This is because metabolically generated ATP closes the KATP channel, thereby triggering electrical activity, calcium influx and insulin exocytosis. I’m going to show how mutations in the KATP channel that impair ATP inhibition cause neonatal diabetes and increase the risk of type 2 diabetes. I’ll also talk about how chronic hyperglycaemia impairs the metabolic generation of ATP, reducing insulin secretion and speeding the progression of impaired glucose tolerance to full-blown diabetes, and what this means for diabetes therapy.

What do you think about the move to virtual meetings?

The biggest benefit is that you don’t have to travel – which is both good for the planet and saves a great deal of time.  Another benefit is that if the talks are posted online, you can listen to bits you’re particularly interested in again at your own convenience. This means you don’t run the risk of missing a talk because another you want to hear is scheduled at the same time. The drawback is that you don’t get to meet your colleagues in person and you miss out on those unexpected and stimulating conversations that lead to new collaborations.

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

I think this year has taught us that making any predictions about the future is very unwise, because we never know what’s going to come around the corner!

Any words of advice for aspiring endocrinologists?

My best advice is to ‘find a friend’ – a good person to collaborate with who you not only admire scientifically, but whose company you enjoy. My collaborators have supported me through the inevitable difficulties a scientific life throws at us, have celebrated with me when things went well, and are endlessly and wonderfully stimulating to interact with.

I also think it is important to do what makes you excited and follow what you are interested in. As science is a hard field, unless you love what you are doing, it is perhaps not the best career for you. I’d also recommend you remember Churchill’s advice – never, ever, give in. Perseverance gets you a long way in science.

You can hear Prof Frances Ashcroft’s medal lecture “Metabolic regulation of insulin secretion in health and disease” during SfE BES 2020 Online on Wednesday, 18 November, at 13:05-13:35 GMT. If you haven’t already, register for SfE BES Online now!

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.

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.

As we wave goodbye to 2019, the Society for Endocrinology reflects on another great year of achievements and changes that brought together the global endocrine community, to share ideas and advance our discipline. We awarded several grants and supported career development at all stages, launched a new online communication tool, revamped the Society’s annual conference, and continued to promote accurate reporting of science in the media, to name a few! Check out our top 9 highlights of the year below.

1. Our new online communication platform, SfE Connect was launched to enable members to share knowledge and best practice within their specialist fields. Based around the Endocrine Networks, the platform is a simple and convenient way to talk to your Network colleagues, in a professional space, to help find solutions to challenges within your specialty. 

2. Our new Endocrine Network; Endocrine Consequences of Living with and Beyond Cancer, was launched to help advance research and clinical practice in this area. Members can join this Network, by logging to the Members’ Area.

3. This year’s programme for our annual Society for Endocrinology BES conference underwent a face lift, with a stronger focus on each of the endocrine subspecialties and their Endocrine Network communities. Read our conference highlights in The Endocrinologist. 

4. As part of our aims to engage the public with endocrinology and its impact, we tackled two misleading articles in mainstream media this year. The Times published an inaccurate article that was ultimately retracted – a success! Whilst an irresponsible article in the Guardian was amended, in response to Society concerns. 

5. The Society Press Office generated over 790 press articles on research presented in our journals and at SfE BES during 2019, and our Media Ambassadors answered over 130 journalist queries to help ensure accurate reporting of endocrine-related topics in the media. Find out how you can help improve science reporting by becoming one of our Media Ambassadors.

6. We helped support career development at all stages through awarding Early Career Grants, funding Summer Studentships, supporting Nurse Members to undertake a Masters-level module in Endocrine Nursing; launching our Leadership and Development Awards Programme  and holding a National Endocrinology and Diabetes Taster Day jointly with Young Diabetologists & Endocrinologists, to encourage the next generation to choose endocrinology as their specialty.

7. In response to recent clinical advancements and changes in treatments, we published position statements on the safe treatment of hyperprolactinaemia and on the cancer risks associated with radioactive iodine treatment in patients with hyperthyroidism, to help ensure best practice.

8. We helped organise volunteering opportunities for members at outreach events across the UK, including the Big Bang Fair in Birmingham, Swansea Science Festival, and Café Scientifique in Brighton, with guest speaker Giles Yeo. A dedicated event for schools at SfE BES 2019 aimed to inspire over 70 children to choose an endocrinology-related career. Learn about opportunities for you to get more involved with outreach.

9. Content Editors joined the Editorial Board for our public website, You and Your Hormones, to help create new content on hormones and hormone-related conditions and ensure accurate and up-to-date information is available for all.

After looking back on such a successful year with so many achievements, we would like to thank all those who made it possible and worked so hard towards advancing knowledge and research, improving patient care, and engaging the public with endocrinology.

Let’s work together to make 2020 an even greater success! Visit www.endocrinology.org for more information on Society activities and opportunities.

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.

Dr Constantine Stratakis, Scientific Director at the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) and Society for Endocrinology Dale Medal winner, shares insights into his career and fascinating research on the genetics of pituitary tumours, ahead of his lecture at SfE BES 2019.

Could you tell us about your current position and your research?

I am the Scientific Director of NICHD, one of the 27 Institutes and Centres that form the National Institutes of Health (NIH) in the United States. I am privileged to have been the scientific leader there for the last 10 years. As an investigator, I have been running my own laboratory at NICHD, NIH for over 25 years now. My laboratory focuses on identifying the genes or other genetic defects underlying the development of endocrine tumours. We started with the study of pituitary and adrenal tumours associated with endocrine neoplasia syndromes, but gradually expanded to other lesions and cancers, both inherited and sporadic.

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

I’ve been at the NIH now since 1993. However, I have been in endocrinology research since 1985 and am originally from Greece. Between medical school and my post-doctoral years, I spent some time in Paris, France where many of my collaborators are from.  Over the years, I have been very fortunate to have built a great network of friends, mentors and collaborators, globally.

I’m indeed grateful to my many extraordinary collaborators from all over the world who have been so loyal and good to me – some for over 35 years! I would not have achieved what I have without them.

What more specifically will you be presenting in your Medal Lecture at SfE BES 2019?

In my lecture, I will talk about the genetics of pituitary tumours and how studying rare syndromes, such as Carney complex, Multiple Endocrine Neoplasia types 1 and 4 (MEN 1 and MEN 4), X-linked acrogigantism (X-LAG), and others,  have uncovered important clues on what leads to the formation of both hereditary and sporadic pituitary tumours. I will outline some of our most important published work about the genetics of pituitary tumours and will also present some recent and unpublished data that shed light on new genes and pathways that may predispose a patient to pituitary tumours.

Is there anything you are particularly looking forward to at the conference and would recommend to others?

The SfE BES conference’s convenient size offers more opportunities to see a lot more than you would at larger conferences. I’m looking forward to attending lectures that bridge basic and clinical science, meeting trainees that may be interested in working in my laboratory in the US, consult with collaborators in the UK and elsewhere, and of course, meeting with my old friends and colleagues.

I like the ‘Meet the expert’ sessions and am planning to go to the session ‘Update on DSD genetics’, the symposium ‘New insights into PCOS’, and the oral communications session ‘Neuroendocrinology, pituitary and neoplasia’.

What do you think are the biggest challenges in your research area at the moment?

I think the biggest challenge right now is the handling of large datasets. With today’s tremendous technology, we have the ability to produce massive amounts of data, but the ability to analyse this data is lagging behind. For endocrine trainees and researchers alike, the challenge is receiving proper training in bioinformatics, so that we don’t have to rely on people who may not be trained in the molecular physiology of endocrine tumours. We need to bring bioinformatics to the point where you can analyse these large datasets by combining old knowledge with new knowledge.

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

I think artificial intelligence is not that far away and will allow us to incorporate the various “-omics” data into one important piece of information that will be immediately translatable to discoveries. Analysing data from both cell line work with clinical information from patients with tumours will really help with the discovery process.

What do you enjoy most about your work?

The biggest joy of doing this type of work is analysing the mysterious, being excited by the discoveries, and coming up with the next questions. Yes, answers are important, but it is the questions and curiosity that excites me more than the answers themselves. I love Einstein’s quote: “The most beautiful thing we can experience is the mysterious. It is the source of all true art and science. He to whom the emotion is a stranger, who can no longer pause to wonder and stand wrapped in awe, is as good as dead —his eyes are closed”. And to this day, I have at my office hanging over my desk the poster that Dr J. Aidan Carney gave me (when we started working together back in 1994), with Albert Szent-Gyorgyi’ s saying: “Discovery consists of seeing what everybody else has seen and thinking what nobody else has thought”.

Is there anyone you admire most professionally or otherwise?

I consider myself very fortunate to have met and learned from Dr J. Aidan Carney from the Mayo Clinic and admire him for his extraordinary acumen, commitment to academia, and dedication to discovery. He discovered three different diseases, including Carney’s complex, the foundation of my career in genetics. There is now a disease that bears our names: Carney-Stratakis syndrome. Dr Carney taught me what I now enjoy most about my work – the pleasure that comes from discovering something new and exciting within what was previously unknown or ignored, as Albert Szent-Gyorgi said.

Beyond Dr Carney, I have been very fortunate to have met and been inspired by giants in medical genetics like Drs Robert J. Gorlin and Francis Collins. I also had mentors in my early career that were amazing to me, including Prof Menelaos Batrinos, Dr Spiros Pitoulis, Prof Jean-Pierre Luton, Dr Owen M. Rennert, Prof George P. Chrousos, and Dr Carolyn Bondy. It is their teachings and leading by example that guide me today. 

Do you have any words of wisdom to aspiring endocrinologists?

My advice would be to follow your heart and do what you want to do. Don’t be dissuaded by what others say, about the lack of funding or the lack of opportunities. As Nelson Mandela said, “it always seems impossible until it’s done”. Surround yourself with great mentors, friends, collaborators, and eventually, yes, trainees; be nice to all of them because they will be there for you for the rest of your life. And remember that the travel is yours, only yours: success is a travel for which there is no other path than the path you make, very much like what Antonio Machado said: “traveller, there is no path. A path is made by walking (caminante, no hay camino se hace camino al andar).”

You can hear Dr. Stratakis’ plenary Medal Lecture, “From Carney complex to gigantism and Cushing disease: an insight in the genetics of pituitary tumors” on Monday 11 November at 18:10. Find out more about the scientific programme for SfE BES 2019.