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.
Dr Julia Prague is a clinical consultant and clinical academic at the Royal Devon and Exeter NHS Trust and University of Exeter. In our interview, she tells us about her clinical practice and research projects, as well as how she thinks endocrine practice will evolve after the COVID-19 pandemic.
Tell us a bit about your current positionand what you enjoy most
As a clinical consultant and clinical academic I split my time almost 50/50 through the week. At the moment, my clinical commitments include outpatient endocrinology, and inpatient endocrinology, diabetes and general medicine. I moved from London to Exeter last year, and one of the big reasons to move was that near 50/50 split between clinical commitments and research. It’s a great balance that gives me time and space, not only to be with the patients, but also to investigate and take forward some of the issues that they bring up in clinic. Forming new collaborations and being in a new unit with new colleagues is pretty exciting too.
Research wise, I’m particularly interested in the menopause through a number of different collaborations. I’m working with the respiratory department on a project looking at lung conditions and sex hormones. Investigating the impact of the menopause in diabetes. I’m also still involved in establishing the role of neurokinin 3 receptor (NK3R) antagonists to treat hot flushes and improve sleep during the menopause.
What got you interested in research on menopause?
Spending hours with the women in our research study of a new treatment for menopausal flushes, and from receiving hundreds of emails from menopausal women wanting to take part. My admiration for them was huge, not least because they so often described themselves as struggling to cope, yet they were the complete opposite of that, meeting endless challenges with amazing fortitude and whilst mostly suffering in silence. To then see them leave misery and suffering behind and find themselves feeling vibrant and human again was rewarding beyond measure.
Furthermore, the majority of women will have menopausal symptoms that impact on all aspects of their daily life, but many will also have co-existing medical conditions before their menopause and these can also be impacted too. Many medical conditions are influenced by the menstrual cycle and that’s an aspect that is under-investigated and I think is really interesting. Inflammatory bowel disease, for example, can fluctuate during the menstrual cycle and Crohn’s disease typically gets better in pregnancy.
Diabetes is also impacted by the menstrual cycle, and it’s the same hormones that are changing during the menopause but this hasn’t been investigated, which is why I’m now interested in this, as this is something patients often report as being a problem for them. I think it’s important to listen to what patients are telling you and then try and investigate why that is, to hopefully find an improved solution for them.
How was your work affected by the COVID-19 pandemic?
I was a Senior Registrar at King’s College Hospital at the height of the first wave, so I became involved in a lot of the management and service re-design work within the diabetes and endocrinology department, including rota management to facilitate re-deployment to general medicine but whilst maintaining a core specialist service and whilst supporting our junior trainees and particularly our international medical graduates who were isolated from their families, and ensuring our patients were supported and aware of sick day rules and had all the medications they needed. Our department was also therefore part of the frontline team. I was the medical registrar on call for the first peak weekend of King’s admissions. Then I got COVID-19 and could not get out of bed/off the sofa for 4 weeks.
I moved to Exeter towards the end of summer 2020 to take up my Consultant job. Since then I have continued to do quite a lot of frontline COVID inpatient medicine. Now we’re involved in recovery and trying to catch up. Many patients couldn’t be seen through the pandemic because resources had to be syphoned off elsewhere.
I never imagined I would interview for my consultant job on Zoom! Moving to a new city, a new department, a new consultant role and a new research role during the pandemic was definitely an interesting twist at such a significant stage of my life and career.
What are you proudest of in your career so far?
My work on menopause and NK3R antagonists – being published in The Lancet was a huge honour, and the potential that this work has to relieve suffering of women is incredible. As a doctor, all you want is to relieve suffering in your patients and this has that opportunity. It’s also given me a platform to continue working in that field and to be invited to speak at international conferences, as well as develop new collaborations.
This drug class are now in phase three studies and it looks like they’re probably going to be marketed from around 2023/2024. This research is still advancing within the pharmaceutical field, butte top-line results coming out continue to show great promise for the therapy. Seeing the NK3R antagonists come to market will be amazing. For me, to have played some part in that will be awesome and to see patients being able to go to clinicians and get that medication prescribed will be great.
There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.
What do you think are the biggest challenges in endocrinology?
We have to mention COVID recovery, in what was an already overstretched system. However, somewhat linked to that, is the pull of general medicine on our time as endocrinologists. The pandemic has further highlighted this to be an important issue. Hospital inpatient medicine is busy and can’t be cancelled. However, it is essential for recruitment, training, and retention that our specialist time is more protected. The new internal medicine training (IMT) programme will change the number of specialty training years to shorten it, which could have some quite big consequences for the endocrine discipline.
COVID-19 has brought some positives though; it’s highlighted that we can achieve quite a lot remotely with patients using virtual appointments, and some patients prefer fitting their appointments in to their life rather than having to attend the hospital. How this translates going forward though could involve big changes for the specialty.
The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
What do you think will be the major changes in the future of endocrinology?
I think there will continue to be a drive for a smaller number of national centres of excellence in endocrinology. There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic. That will be good for patients overall but the downside could be that there will be a smaller number of centres with specialist services, which means that staff may have less involvement in specialist endocrinology. A lot of these changes will be driven by the GIRFT recommendations, which will affect how all services are delivered going forward.
What challenges do you see for your research?
Availability of funding will be critical. COVID has had an impact on available funding but so has Brexit, there’s now a lot of European grants that UK researchers will not be eligible for. Universities have less money because they’ve had fewer students and international students may think differently about studying in the UK post-Brexit and post-pandemic. Charities that fund research have also been hit as many of their fundraising activities were suspended during the COVID restrictions. The Government has a significant financial deficit to address. Availability of research funding was already challenging but it’s going to be even more difficult in the years to come. It’s usually funding that restricts research activity rather than a lack of ideas or collaborations.
How would you like to see the Society develop?
My overwhelming memory of attending my first Society meetings in 2006/2007 is of a lot of senior white men wearing tweed jackets! Now every time I come to Society meetings it’s such a stark change from that. Everything that the Society has done, and is doing, to make itself more reflective of everyone within it is really important. Recruiting the next generation is also a huge part of that, and it is great to also see more focus on this now than then too. The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
That level of change takes time and effort and over the years I’ve tried to play some part in helping to make the Society a more different place to the one that I initially knew.
As a Leadership and Development Awardee I was really looking forward to SfE BES 2020 as we were going to be paired with award lecturers, and it is also always a great opportunity to catch up with friends, previous colleagues, and previous as well as potential new collaborators. But of course, that didn’t happen. I’ve just been finding my feet as a new consultant and researcher in a new city but being an Awardee has opened up other opportunities. I’ve been involved in discussions with an external organisation exploring new collaborations and identifying our shared goals and objectives that we could achieve together. I’m sure that being an Awardee has helped me be offered these opportunities.
Who have you been most inspired by?
Prof John Wass, obviously, but I have also been very lucky to have amazing clinical and research mentors. From the literal beginning to the end of my clinical training and beyond (now over 15 years!) with Dr Simon Aylwin at King’s and Dr Roderick Clifton-Bligh in Sydney. I also learnt a lot from Prof Waljit Dhillo whilst doing my PhD at Imperial.
Why do you love endocrinology?
The balance of the acute and long-term follow up of patients, and the importance of making the right diagnosis for patients based on their history, examination and targeted investigation. Many patients with endocrine conditions go undiagnosed or misdiagnosed for a long time, so when you make the right diagnosis and instigate the right treatment, they feel and do so much better and you often see it unfold in front of you. As endocrinologists we are also part of a much wider multidisciplinary team, which is great.
Any words of wisdom for aspiring endocrinologists?
I’ve always tried to be involved with the Society in recruiting the next generation. It’s important that they get to see the ‘real’ endocrinology and diabetes because often, those rotation attachments are mostly inpatient general medicine.
My advice would be to try to get to clinic as much as possible because a lot of our patients are outpatients, and also to go and review specialty patients on the wards when they are admitted. Remember also that there’s lots of different sub-specialties within endocrinology (and diabetes) so there is a place for everyone and an opportunity to be involved in the areas that you find most interesting/rewarding.
Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet! I also always recommend going to SfE BES, it’s a really good platform for meeting other clinicians and scientists involved in the field, and hearing about the patients that we look after. Get involved, come along and see what the specialty really has to offer.
We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.
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.
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.
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 Timespublished 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.
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
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.
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
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.
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
Is there anything you
are particularly looking forward to at the conference and would recommend to
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.
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.
Dr Barbara Boucher spent a long and extremely busy career as a physician at the (Royal) London Hospital and its medical school, and was amongst the first post-NHS cohorts of female medical students. She has made important contributions to the field of diabetes, with a number of discoveries on the adverse health effects of vitamin D deficiency and on the addictive habit of chewing betel-nut. Despite being retired, she is still helping to advance her scientific field and will be presenting at this year’s SfE BES annual conference. We spoke to her ahead of the conference to hear more about her long career and research interests.
Could you tell us
about your current position and your research?
I am now long retired but have maintained interests in two
major research areas: vitamin D deficiency and betel nut chewing. Since 1970, I
have worked on adverse health effects of vitamin D deficiency and how
deficiency can be avoided. My main hope now is to see deficiency abolished at
the population level, as has been done in Finland. Betel nut chewing is very
common in all South Asian countries and causes many major health problems. It
has been confirmed for many years now that this habit – the 4th most
common globally – causes many cancers, but I am interested in the role it has
in causing metabolic syndrome, both in chewers and across generations.
Can you tell us a
little bit about your career path and what you are most proud of?
I was accepted by the London Hospital Medical College where
I studied medicine and anatomy, soon after the NHS first started requiring
medical schools to take women. I completed my training in medicine and worked
for various firms, as well as the academic medical unit after I qualified, and
eventually I was appointed as an academic/NHS physician.
I was the first female consultant physician at the (Royal) London Hospital, which was a very interesting experience, though initially rather unpleasant since most of the consultant body back then weren’t keen on women in medicine. I spent most of my career working there and carrying out research, mainly focused on diabetes and endocrinology.
There are three things throughout my career that I feel especially
pleased with. One is a diagnosis I made in a young woman with Lyme disease, the
first case I’d ever come across. She had seen consultants in six different
departments to try to determine what was wrong with her, before I made the diagnosis.
We managed to get her the necessary antibiotics just in time for her to make a
full recovery and throw away a wheelchair and two hearing aids.
I am also glad that I have persisted in pursuing the idea that
lack of vitamin D might worsen metabolic syndrome and increase the risk of type
2 diabetes since, and that I have lived long enough to see both mechanistic and
clinical evidence to suggest that this could be true.
The third thing I am proud of is publishing a series of
papers about South Asian men who chew betel-nut and how they, and their
children, have increased risks of metabolic syndrome, heart disease, type 2
diabetes, and liver disease. Ten years later, it has just been shown that betel
chewers are also dying early due to these health conditions. Next, we’re hoping
to look at how many years it takes, after stopping chewing, for the risks to decrease
to the same levels as are seen in never-chewers.
What will you be
presenting at your SfE BES 2019 lecture?
My talk will be about the known health benefits of vitamin D
and the importance for vitamin D supplementation trials to be properly designed.
There have been many trials analysing the effect of vitamin D supplementation
in people who are not deficient, or were not adequately supplemented, resulting
in statements that vitamin D doesn’t affect general health, despite all the
other evidence to show that it does.
What are you most
looking forward to at this year’s conference?
I would like to see that young endocrinologists are still as
enthusiastic about what they are doing as my generation were, as I sometimes
wonder how medicine, let alone research, is surviving with all the constraints
placed on how people work these days.
What are the biggest
challenges in your research area?
One of the biggest challenges in my area is getting future randomised,
controlled trials right and stopping them from obscuring things that are true.
It is important that researchers doing such trials understand the mechanistic
data and plan with this in mind, which has not always been the case. I think
this is a problem, at least in part, because in modern medicine people don’t meet
together or get to chat to each other as much as they used to, and also because
researchers and clinicians may not always collaborate as closely in these areas
What do you think
will be the next breakthrough in your field?
One obvious breakthrough would be getting any future trials
designed to provide optimal conditions for testing health benefits of vitamin D.
But the best breakthrough would be the abolition of the deficiency.
The next development for the risks of betel-chewing will be obtaining
data on the people who stop chewing, to see if mortality risks then fall. This
would encourage more people who chew to give up the habit.
What do you enjoy
most about your work?
I enjoy getting to the bottom of things and seeing bits of
work come through that make sense and provide additions to current knowledge. However,
if something comes through that proves something I thought matters, doesn’t
matter, that’s okay too!
Who do you admire
most professionally and why?
Professor Wilson, who was the Professor of Medicine at the London
Hospital, was an excellent role model to me in my student days. He was always
prepared to sit down with students to work out a problem and was never didactic,
which a lot of consultants were in those days. He was also a very good ‘detective’.
Another person I learnt a lot from was Dr Stuart Mason, who
was the senior endocrinologist at the time I worked with him. One of the most
important things he taught me was how to look after people and how to work with
patients and provide the best care. He was a physician who cared deeply about
his patients and would always talk to them as human beings, answer their
questions honestly and look them in the face, all of which were very uncommon
traits at that time.
Do you have any words
of wisdom for aspiring endocrinologists?
In order to survive, make sure you’re working on something
you enjoy. If you don’t enjoy your work, you won’t do it well and you should
look for something else. If you have a hunch and you are able to follow it up,
go for it. You never know; some hunches are good, some aren’t, but it’s always
worth pursuing where there is a basis for some new approach. I would also say that
if you want happy and satisfied patients, act as their mentors and advisors and
find ways of talking to them and looking them in the face rather than always
looking at the ubiquitous computer screens!
You can hear Dr
Boucher’s talk, “Potential benefits of better vitamin D status for non-bony
disorders?” on Tuesday
12 November at 17:45. Find out more about the scientific
programme for SfE BES 2019.
Professor Fadil Hannan, Director of the Oxford Centre for the Endocrinology of Human Lactation, is this year’s well-deserved winner of the Clinical Endocrinology Trust Basic Science Abstract prize. His research focusses on the endocrine control of lactation and bone and mineral disorders. In this interview, Prof Hannan tells us more about his research and what he will be presenting at SfE BES 2019.
Can you tell us about your current position and research?
I’m based at the University of Oxford and have recently
been appointed as the Director of the Oxford Centre for the Endocrinology of
Human Lactation (OCEHL). I also work on characterising the genetic basis of
bone and mineral disorders. In addition, I am an honorary consultant chemical pathologist
at the John Radcliffe Hospital in Oxford.
tell us a little about your career path so far, and what you are most proud of?
My background is in chemical pathology – this is a small,
clinical discipline with very few academics. I decided to become an academic chemical
pathologist after undertaking a PhD in the lab of Prof Rajesh Thakker FRS, at
the University of Oxford. My proudest achievements include the discovery of
disease-causing mutations in the GNA11 and AP2S1 genes, which has
led to insights in the genetic basis of parathyroid gland function.
are you presenting at your Medal Lecture at SfE BES 2019?
I am presenting data on a mouse
model for a disorder known as familial hypocalciuric hypercalcaemia type 3
(FHH3). This is a recently identified disorder and we are utilising this model
to better understand the phenotype of FHH3, and also to evaluate targeted drug
there anything you are particularly looking forward to at this year’s
conference and you would recommend to others?
I’m looking forward to the nature versus nature debate for body weight. Clearly both influences are important but it’ll be nice to hear the arguments in favour of each contribution.
do you think are the biggest challenges in your research area right now?
I think more funding is needed to support
curiosity-driven research, as this is the type of research that is most likely
to lead to substantial advances in our understanding of biology.
do you think will be the next major breakthrough in your field?
This is difficult to predict,
however, I hope that suitable cellular models can be developed to allow us to
study complex physiological processes, such as lactation.
do you enjoy most about your work?
I really enjoy coming up with a scientific idea and then
going ahead and testing whether this idea has any merit or not. This process
pretty much sums up what science is about.
do you most admire professionally, or otherwise, and why?
many scientific heroes, so will mention just a couple of them. I have huge
admiration for Rajesh Thakker, who is my mentor. He is always on hand to
provide helpful advice and I have really enjoyed our robust scientific
discussions over the years. In addition, Carl Sagan has made a great impression
on me. He was a true scientific visionary and one of the great communicators of
science. I always wish that I’d had the chance to meet him.
words of wisdom for aspiring endocrinologists out there?
If you’re interested in working in an intellectually fascinating field, which involves interactions between many tissues and organs and includes a wealth of cutting-edge science, then endocrinology is the specialty for you!
You can hear Prof Hannan’s presentation, “Mice harbouring a germline heterozygous AP2S1 mutation, Arg15Leu, are a model for familial hypocalciuric hypercalcaemia type 3 (FHH3)” on Tuesday 12 November at 10:25. Find out more about the scientific programme for SfE BES 2019.
Prof Philippa Saunders is Chair of Reproductive Steroids at the University of Edinburgh and proud winner of the Society for Endocrinology Medal. Prof Saunders speaks to us about her research and career, ahead of her Medal Lecture at SfE BES 2019.
Can you tell us about your current position
I lead a research team based in the
Centre for Inflammation Research at the University of Edinburgh. Our work is focussed
on exploring the role(s) of steroids and their receptors in the endometrium, so
that we can develop better medical therapies to treat endometrial disorders including
endometriosis, infertility and heavy periods, which affect millions of women in
the UK and world-wide.
Please tell us a little about your career
path so far, and what you are most proud of?
My first degree
was in microbiology – the recent explosion of interest in the microbiome has
made this more useful than previously. After graduation I was unsure what to do
and took a job in Cambridge examining the role of uterine factors in supporting
development of the pig blastocyst – this turned out to be an absolutely
fasinating topic and I made it the basis of my PhD project. I spent 3 years as
a postdoc in the USA, which was pivotal in convincing me that I wanted to
become a successful principal investigator (PI), leading my own team. After a
brief period working in London, I moved to Edinburgh where I was fortunate to
have the chance to start my own lab within the MRC Human Reproductive Biology
Unit. I was made a Professor in 2005 and have taken on a number of leadership
roles including Head of Centre and Director of Postgraduate Research. I am
proud of my successful application for the MRC Centre for Reproductive Health
and the work my team have done to advance our understanding of the impact of
oestrogens and androgens on endometrial health and disease.
What more specifically are you presenting at
your Medal Lecture at SfE BES 2019?
I am going to be
talking about our most recent work exploring the impact of steroids on
endometrial function – this has a strong translational focus and benefits from
access to human samples, as well as bespoke mouse models.
Is there anything you are particularly
looking forward to at this year’s conference and you would recommend to others?
What are the biggest challenges in your
research area right now?
Funding! We are trying to better understand the mechanisms that
predispose some, but not all, women to develop endometriosis, a chronic
condition that can cause severe pain as well as subfertility. Even though up to
10% of women are affected during their reproductive years, it is incredibly
challenging to get money to fund basic research into the aetiology of this
condidition. Endometriosis and women’s health charities have little money and
funders with deeper pockets have many equally important claims on their funds.
We are looking at alternative sources of funding and have been happy to receive
several small donations and philanthropic funding.
What do you think will be the next major
breakthrough in your field?
I am excited about the use of new technologies such as single cell
sequencing and advanced in situ image
analysis, as I believe these will give us the tools to study spatial and
temporal changes in cell function within complex tissues, such as the endometrium.
What do you enjoy most about your work?
I enjoy working with my team and
clinical collaborators, all of whom are focused on doing their best to improve
the lives of women. One of the best aspects of the job is helping junior
colleagues advance their careers by encouraging them to be ambitious and open
to new ideas. I have also been fortunate to use my position as a Fellow of the
Academy of Medical Sciences to support a number of initiatives that are
supporting junior PIs to achieve their full potential – these include chairing
the Springboard grants panel, acting as a mentor and as co-chair of the Team Science
Who do you most admire professionally, or
otherwise, and why?
I have huge admiration for my clinical academic colleagues (Andrew Horne,
Hilary Critchley) who are dealing with the challenges of running multicentre
clinical trials. These trials are vital if we are to improve the lives of women
who are at risk of hormone-dependent disorders but involve many hours of work,
both to obtain funding and also to manage a diverse team based in multiple
Any words of wisdom for aspiring
endocrinologists out there?
Endocrinology is a really
important topic so please continue to work in the field and promote it to
others. In your own work please consider the impact of hormones on health and
disease, across the life course and in different genders, so that your results
will be relevant to as many people as possible.
You can hear Prof Saunders’ Society for Endocrinology Medal Lecture, “Sex steroids and the endometrium: dynamics and disorders” on Wednesday 13 November at 16:50. Find out more about the scientific programme for SfE BES 2019.