Meet the 2019 Clinical Endocrinology Trust Clinical Science Abstract prize winner

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.

Meet the 2019 Society for Endocrinology Dale Medal Winner

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.

Meet veteran expert in vitamin D and diabetes Dr Barbara Boucher

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 as should.

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.

Meet the 2019 winner of the Clinical Endocrinology Trust Basic Science Abstract prize

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.

Please 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.

What 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 therapy.

Is 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. 

What 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.

What 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.

What 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.

Who do you most admire professionally, or otherwise, and why?

I have 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.

Any 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.

Meet the winner of the 2019 Society for Endocrinology Medal

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 and research?

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?

I am really looking forward to the Basic Physiology Workshop: Modelling endocrinology in vitro, in vivo & in silico and hearing about the exciting work done by the early career researchers.

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 project.

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 locations.

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.

Meet the winner of the 2019 Society for Endocrinology European Medal

Prof Felix Beuschlein is head of the Department of Endocrinology, Diabetology and Clinical Nutrition at the University of Zurich and winner of the Society for Endocrinology European Medal. He has carried out ground-breaking work in adrenal research for many years, now with a focus on endocrine tumours and hormonally-induced hypertension. In our interview, Prof Beuschlein tells us more about his research, career and his prize lecture at SfE BES 2019.

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

I’m the head of the Department of Endocrinology, Diabetology and Clinical Nutrition at the University of Zurich clinic in Switzerland. I have been in the field of adrenal research since the start of my career, and my research has two broad directions. The first is on endocrine hypertension and everything to do with endocrine cardiovascular research, and the other is on endocrine tumours. 

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

I specialised in adrenal research for my doctoral thesis, then moved several times within Germany and to the U.S. during my medical career, before moving to Switzerland. As you can imagine, moving so often was not always appreciated by my family and it can make friendships more difficult. However, you also get to engage with many different people from your field, sharing new ideas and opportunities all the time. So I view these moves as an enrichment of my career, rather than a challenge.

I am most proud of the very good and broad network of people, from all the different places I have worked and beyond. I have many colleagues in Europe and all over the globe, who I can rely on and trust, which has led to many interesting collaborations. I am also proud to be a co-founder of the European Network for the Study of Adrenal Tumours.

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

My lecture will tell the story of how tiny little deviations that start off in the genome of a single cell can lead to a myriad of changes in the human body. There are very specific genetic changes that we, and others have identified, that predispose for adrenal tumours by causing small modifications in biological pathways. For example, hypercortisolism or excessive secretion of aldosterone, causes many changes in target organs, which then affect metabolism and lead to metabolic changes that define the phenotype witnessed by medical doctors.

Is there anything that you are particularly looking forward to at the conference?

Usually when I go to meetings like this I don’t prepare too much and like to just see what’s happening – maybe by chance I will find a brilliant talk, which I might have otherwise missed. In general, I like intersecting fields that are not immediately apparent to be endocrine-related but encourage us to think outside the box, opening our field to new ideas and new thinking.

What do you think have been the biggest challenges so far in your research area?

Right now one of the biggest problems is the maintenance of good registries and biobanks for clinical research. It is a major challenge to find funding to build and maintain them, to keep them going for a long period of time, so that you can build a cohort of patients with very rare diseases, and then follow up on them. Another challenge is keeping up awareness of particular topics, be it from the patient perspective, or that research is necessary. Then of course there is the challenge of Brexit and nations drifting apart and not knowing how that will turn out.

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

I would say pattern recognition and artificial intelligence. As an endocrinologist this would mean not measuring one hormone, but rather looking for patterns of different hormones. ‘Omics technologies make it possible not only to measure one particular analyte, but a whole bunch. This means we can generate large datasets, over longer periods of time. Not a human being, nor an endocrinologist, nor a doctor are able to digest this information by themselves but computerised analysis of this data can indicate if disease is present or not. I think these possibilities will not only change science but also how we diagnose patients. Although this may be seen as frightening from some doctors’ perspectives, I think it will happen in the near future. We are already able to generate so much more data, but making sense out of it is the real challenge.

What do you enjoy most about your work?

My work in general is very varied, from seeing patients every day, to doing administrative things, to doing research. I also enjoy engaging with my network of scientists, talking and discussing with bright minds all over the globe. This is particularly rewarding, very interesting and is probably among the best things about research. Regardless of nationality, religious beliefs or any other differences, you come together and find common ground for discussion.

Who do you admire most professionally and why?

I have had a number of colleagues over the years who I see as role models but there are two that stand out most Martin Reincke has been a colleague and friend for over many decades and has followed my career very closely. The other important person is Bruno Allolio who was my mentor and teacher early in my career. He unfortunately passed away far too early but I remember him in many aspects of my scientific and medical career.

Do you have any words of wisdom for aspiring endocrinologists?

When I think back to what I have enjoyed the most and what I am most proud of in my career, I think it’s important for young endocrinologists to get connected with colleagues and other researchers. These networks are the fertile ground for all your future projects and career path. Endocrinology is a close community, so it is likely you will meet the same people again, which is also a great starting point for new friendships. It is also important professionally to have these networks to help you start multi-disciplinary or multi-centric projects.

You can hear Prof Beuschlein’s plenary Medal Lecture, “Mechanisms and consequences of endocrine autonomy – lessons learned from the adrenal cortex” on Tuesday 12 November at 18:20. Find out more about the scientific programme for SfE BES 2019.

Misleading medical reporting in the media: Over-diagnosis of low testosterone levels in men

A story published on Monday 9 September in the Guardian has provoked outrage at the Society for Endocrinology.

Dr Richard Quinton, Dr Channa Jayasena and Dr Ahmed Al-Sharefi, three of our expert Media Ambassadors, contacted the Society Press Office to express their concerns over the lack of accuracy and impartiality in the article: ‘My energy is back: how testosterone replacement therapy is changing men’s lives’ by .

They feel that this article is written and presented in an irresponsible manner that is misleading to the reader and potentially exploitative. The Society is committed to helping promote accurate and responsible reporting of endocrinology-related topics in the media, so we have backed their concerns, in the form of the open letter below, as our official position, and call on the Guardian to retract the article, pending appropriate revisions.

“Dear Guardian,

This article published in the Guardian addresses the important issue of treating hypogonadism. However, we are concerned that the article will (inadvertently) serve as an advertisement for “fringe” private medical healthcare services that contradict the advice and experience of qualified NHS specialists, who have specifically trained in hormone medicine (endocrinology),  with no platform offered to provide a more informed viewpoint.

It is easy to do a blood test for testosterone but it is equally easy for a non-specialist doctor (such as those quoted in the article) to misinterpret the result, and thereby misdiagnose hypogonadism.  In healthy, normal men, testosterone levels peak in the early morning and fall during the day; they also fall after meals, so it’s vital for accurate diagnosis that the blood test (preferably 2 of them on different days) be performed fasted and before 10-11 am. Moreover, testosterone levels also fall naturally below “normal” after a sleepless night, or during any form of illness, and men who are overweight or obese typically have low levels of the testosterone-binding protein, such that their levels of biologically-active free testosterone may be normal, even when total testosterone is slightly low.

What doctors lacking training in hormone medicine may also fail to appreciate is that properly documenting two separate low testosterone levels (total and calculated-free) is not a final diagnosis in itself, but rather an entry point to making a proper diagnosis, which may even involve MRI scanning the pituitary gland. Thus, just starting a man with “low testosterone” on testosterone replacement, not only exposes them to the risks of unnecessary treatment – testosterone-induced infertility, shrinkage of testes, or an abnormal rise in haemoglobin that can predispose to heart attacks, along with the costs to them or the NHS of drugs and monitoring blood tests – but also to the risk of a serious underlying condition being missed, such as a pituitary gland tumour, which could expand and cause blindness.

There has been an explosion in testosterone prescribing in the UK over the past 20 years, much of which has been exploitative of the vulnerabilities and insecurities of middle-aged and older men, but which has sadly passed other men completely by, whose genuine hypogonadism has not yet come to specialist medical attention.

We therefore highlight, four simple red flag features that should make any doctor take the finding of a low testosterone level (fasted & early morning) that much more seriously and refer to an appropriately qualified specialist:

– the presence of anaemia or low haemoglobin
– a history of osteoporosis or fracture
– a history of infertility
– raised levels of pituitary hormones LH or prolactin”

Dr Richard Quinton MA MD FRCP(Edin), Consultant Endocrinologist, Newcastle-upon-Tyne Hospitals & University 

Dr Channa N. Jayasena PhD FRCP FRCPath, Clinical Senior Lecturer in Endocrinology, Imperial College London

Dr Ahmed Al-Sharefi MBChB , MRCP (UK), Senior higher specialty trainee in endocrinology, The Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation trust

Declaration: Both Richard Quinton and Channa Jayasena are Investigators on the National Institute of Healthcare Research (NIHR) funded Testosterone Efficacy and Safety (TestES) Consortium, and Media Ambassadors for the Society for Endocrinology*

Our Media Ambassadors have successfully worked with Health and Science correspondents at the Guardian in the past to ensure accurate and responsible reporting, and we look forward to continuing to work with them on endocrine-related stories in the future.

The Society is committed to engaging journalists, patients and the public with hormone science to encourage informed health decisions, and to demonstrate the value of endocrinology to the wider world. Our Media Ambassadors are experts that work alongside the press office to help provide expertise, context and analysis to promote accurate and responsible reporting.

If you are interested in helping to improve the quality of science and health reporting, read our Media Ambassador guide or email media@endocrinology.org to find out how you can get involved.

Resolving Uncertainties in Diagnosis & Management of Thyroid Neoplasia

CARLA MORAN WEB IMAGES 1 (3)Dr Carla Moran is a Consultant Endocrinologist at the University of Cambridge and a convenor of the Society’s Thyroid Endocrine Network. In 2017 she was awarded a Society Themed Scientific Meeting Grant to hold the one-day meeting, Resolving Uncertainties in Diagnosis & Management of Thyroid Neoplasia, on 8 March 2019 at Churchill College in Cambridge. The meeting brought together international and UK experts, as well as practicing clinicians and non-clinical scientists, to discuss advances in the field. Here Carla gives us a report of the day.

Need for the meeting
The landscape of investigation for thyroid neoplasia and management of low risk thyroid cancer is changing. Overascertainment of thyroid nodules has fuelled an epidemic of thyroid neoplasia but the death rate from thyroid cancer is unchanged. Many of these nodules are unnecessarily over-investigated, and if cancer is detected, may be overtreated. It has been suggested that more than 200,000 cases of thyroid cancer have been unnecessarily detected in the USA between 1988 and 2007, and the UK has not avoided this phenomenon of overdiagnosis[1]. In addition, in the UK, almost all radiologically and cytologically indeterminate nodules undergo surgery for diagnosis, resulting in high rates of unnecessary surgery for benign disease. Although our international colleagues are using RNA and DNA diagnostic techniques to stratify the likelihood of malignancy in these nodules, such tests have not been evaluated in UK clinical practice. Pathological definitions of thyroid neoplasia are being revised, such as redesignation of follicular variant of papillary thyroid cancer to noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP). Lastly, management of thyroid cancer is evolving, with surgical extent, radioiodine use and dose and TSH suppression all being tailored to disease risk. This suggests that a stratified approach, with use of better markers (radiological, cytological, molecular) to select nodules for investigation and treatment, is required.

Overview of the day
Current guidelines advocate a multidisciplinary approach to thyroid nodules and cancer, with input from endocrinologists, radiologists, pathologists, surgeons, oncologists and nurse specialists, however no national meetings are held with all these disciplines in attendance. Led by the Society Thyroid network, in partnership with the British Thyroid Association and UK Endocrine Pathology Society, this meeting gathered international and UK experts in all these disciplines, as well as practicing clinicians and non-clinical scientists, to discuss current UK practice and advances in the field. Invitations extended to members of other societies (e.g British Association of Endocrine and Thyroid Surgeons) and patient groups (British Thyroid Foundation, Butterfly Thyroid Cancer Trust) interested in the field.

Topics reviewed included: the thyroid cancer epidemic (Krishna Chatterjee, Cambridge), ultrasonographic classification (Steve Colley, Birmingham), cytological categorisation (Sarah Johnson, Newcastle), molecular pathogenesis (Chris McCabe, Birmingham), nodule molecular diagnostics (Bryan McIver, USA), pathological risk stratification (David Poller, Portsmouth), surgical management of low risk tumours (Dae Kim, London), papillary microcarcinoma (Carla Moran, Cambridge) and stratified management of thyroid cancer (Jonathan Wadsley, Sheffield). Oral presentations demonstrated that high quality UK research is being performed in this field.

Collaboration is key
Collaboration between disciplines was essential for this meeting; the primary speciality leading diagnosis & management of nodules varies widely between centres across the UK, such that specialist society (e.g. endocrine, surgery, pathology, radiology) meetings often exclude many interested professionals; it is exceptionally rare for all relevant disciplines to meet to discuss the topic. Discussing areas of uncertainty identified by all specialties allowed us to compare approaches. Internationally, variation in practice variation is also substantial, most notably with regard to the use of molecular diagnostic techniques. Clinicians in the UK do not have any significant experience of using such diagnostic tools, such that Dr McIver’s experience and opinion of this area was highly informative. Lastly, attendees were individuals experienced and interested in the field; this ensured that discussions were highly applicable and informative.

Funding was crucial
When organising this meeting, funding received from the Society for Endocrinology was invaluable; without it we would not have been able to attract such high-quality speakers from the UK and US. Feedback from the meeting was universally strongly positive, with many attendees expressing a desire to attend a similar meeting in future.

Future
A unique aspect of the meeting was the workshop held the day after the main programme, attended by those interested in pursuing research aiming to identify solutions to challenging areas of current practice. We hope the meeting will inform scientific design of a UK-wide, multicentre, prospective study to evaluate diagnostic utility of new molecular technologies alongside current cytological/pathological practice. In addition, participants in this meeting are likely to be key members of a working group which will formulate national guidance on the diagnosis & management of thyroid nodules in the UK.

References
1. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. N Engl J Med. 2016 Aug 18;375(7):614-7.

Meet the editor – Professor Martin Haluzík

Meet Professor Martin Haluzík, Professor of Internal Medicine at the Charles University in Prague, Deputy Head of Centre for Experimental Medicine and Head of the Department of Experimental Diabetology at the Institute for Clinical and Experimental Medicine in Prague, Czech Republic. Professor Haluzík is a deputy editor of the Journal of Endocrinology and Journal of Molecular Endocrinology. His major research focus is on the etiopathogenesis of obesity, insulin resistance and type 2 diabetes. In this interview, Professor Haluzík tells us more about his research and career.

Tell us about your particular field and research?

Our lab explores the etiopathogenesis of obesity and type 2 diabetes aiming to find preventive and treatment strategies. We are particularly interested in bariatric surgery and endoscopic methods of treatment along with novel pharmaceutical targets. Our research is both experimental and clinical, involving patients with obesity and type 2 diabetes.

What techniques do you use in your research?

At the moment, a lot of our research is focused on immunometabolism/subclinical inflammation in adipose tissue using flow cytometry and continuously trying to refine it. We are also using metabolomic and proteomic methods in collaboration with other laboratories. In patients, we often use glucose clamps to characterise insulin sensitivity before and after interventions. We are also testing numerous novel endoscopic methods for treatment of obesity/type 2 diabetes in both experimental models and in patients.

What inspired you into endocrinology?

It was primarily my mentor, Professor Vratislav Schreiber, who was a leading, internationally-recognised, experimental endocrinologist. His primary focus was hypothalamus/hypophysis research but he was the one who, after discovery of adipose tissue hormone leptin, came up with the idea that we should focus on the endocrine function of fat.

What do you enjoy most about work?

I really enjoy its variability – doing both experimental and clinical research brings some challenges but this combination is never boring. I very much like scientific discussion with my colleagues about our results and brainstorming how to explain it and put it into context. I also like writing the papers, especially when nobody is calling and I have a couple of hours to focus on thinking about data and writing.

What does your day-to-day work life involve?

I do both clinical work (seeing patients with diabetes/endocrine diseases) and experimental research. Nevertheless, I have to admit that I am not very useful in the lab anymore. My job is mostly to write grant applications, organize things, write and refine the papers and support my colleagues and PhD students.

What are you most looking forward to in becoming an editor?

I am very much looking forward to a chance to contribute to shaping and refining the focus of such well-respected journals of Journal of Endocrinology and Journal of Molecular Endocrinology. Also, I really like interaction with the Editorial Board and other members of the team that bring most interesting ideas that help us to improve the journal.

Who/what research has inspired you the most?

My first mentor, Professor Vratislav Schreiber, who contributed to the discovery of TRH. He was very inspiring by a combination of being extremely smart and modest at the same time, while having an unforgettable sense of humour.

What is the best feedback or advice you have ever received?

“Work smart not hard” although I am still learning how to do it, which involves a lot of hard work.

Is there any advice you can give to someone just starting off in science?

Go for it! I would make the same choice again if I could start over. It is a lot of work but you don’t really need any other hobbies. You can think about science all the time.

How can we inspire our future leaders in endocrinology and the Society?

Graham Williams with Award winners SfE BES 2017
Prof Graham Williams (centre) with Award winners SfE BES 2017

The Society has launched a new Leadership & Development Awards Programme, to recognise and nurture emerging talent in endocrinology and help Awardees become the future leaders of our discipline. In our interview, Prof Graham Williams, President of the Society for Endocrinology, introduces the Awards Programme and explains how it will be used to inspire and support our leaders of tomorrow, and why early career endocrinologists should apply.

What are the aims of the new Awards programme?

My main priorities as President of the Society have been to ensure that we cater for every member and that we are prepared for the future by being able to develop and respond to change. An important part of that is to support people who are enthusiastic and dedicated to endocrinology so they are equipped to be our future leaders. The Society Officers and Council have introduced the Leadership & Development Awards Programme to help identify these individuals and prepare them; by providing opportunities to learn more about how the Society works, how it is governed, how the committees work and what its strategic aims are. The main purpose is to give everybody an equal opportunity to become more involved, and to ensure that all categories of our membership are well represented in the future.

Towards this goal, the Awards Programme is open to clinicians, clinicians-in-training and research scientists. We are also considering, with the Nurse Committee, how to bring forward a similar initiative that will suit our nurse members, who have different career pathways and needs, and will require an alternative selection process.

The overall aim is to ensure the Society is in a strong position for the future, by securing the engagement of our most dedicated members to help grow and develop our community.

Why do we need an Awards Programme to identify our future leaders?

Our members have always been engaged with endocrinology but the discipline is rapidly changing. It is no longer so easy for people to identify themselves as endocrinologists. There has been a move away from a traditional organ and disease based focus, with increasing emphasis towards interdisciplinary science, whole organism physiology and cellular and molecular signalling. This means many more people are dipping in and out of endocrinology as a discipline, which in turn impacts on the Society. We need to move with the times and ensure we include cross-cutting disciplines that are integrated fully within the Society and endocrine community.

What are your hopes for the Awards Programme in the longer term?

I don’t want to predict the future but I think the Society needs to be agile and responsive as the discipline changes. So we aim to equip Awardees with the skills they need to influence Society strategy and develop our plans as the field advances. Endocrinology is also global discipline and I think that building collaborations with other medical disciplines will be essential both in the UK and also with colleagues all over the world.

What advice would you give to applicants for the Award?

Answer all the questions as completely as possible but most importantly be yourself. When people answer honestly, it allows them to express their true sense of excitement and enthusiasm – and that is what we are looking for – people who are the ‘enthusiastic doers’.  Of course we are looking for those who can demonstrate clinical and scientific excellence in endocrinology, but they need to be excellent communicators and ambassadors as well.

What qualities do you think are important in our future leaders?

I think openness, honesty and the ability to listen to, and to take advice from, others are some of the most important leadership qualities. By sitting on lots of committees you can learn a lot from the chairs. The best ones are great listeners, adept at summing up and have the ability to direct people towards a sensible consensus. Excellent communication skills and wanting to help others are essential qualities for all leaders.

Apart from a dedication to endocrinology, it is important that Awardees are rounded individuals with other outside interests . Working hard is important but it is important to switch off at times and enjoy other interests.  For me this has come from sport and the great outdoors, but whatever it is “work hard and play hard” and you won’t go far wrong!  Having diverse interests also helps with networking, getting to know colleagues and in developing long-lasting friendships that cement the endocrine family together.   

What have you enjoyed most while serving on Committees and as President?

It has to be the people. I feel in a really privileged position to be able to work in the field I love, but serving the Society has extended that experience into being part of a community. Being able to meet and work with like-minded and fantastic people, from different disciplines, from all over the world, and who all want to achieve similar things has been very inspiring.

Who were your early mentors?

I have been fortunate to have had many outstanding mentors over the years but here are the early ones that inspired me into endocrinology and then research. As a medical student, I loved anatomy and was all set to be a surgeon.  However, my first house job was with Professor David London at the Queen Elizabeth Hospital in Birmingham.  He is an eminent clinical endocrinologist and long-standing Society member.  During my time as his houseman, we had lots of interesting endocrine challenges and his infectious enthusiasm got me hooked, so I decided to change and take up a career in endocrinology.

After completing general medical training, I was encouraged to move into the laboratory to work on thyroid hormone action with Michael Sheppard and Jayne Franklyn.  They subsequently encouraged me to branch out and go to Boston to continue my research training at Harvard Medical School, and this move inspired me to pursue an academic career in basic clinical science.  Throughout my career many people have been inspirational and provided support and this never stops; you develop an expanding network that brings new ideas, collaborations and opportunities.  It is here that the Society makes such a difference and will continue to do so as the next generation takes the reins and leads us into the future.

I feel strongly that the new Leadership & Development Awards Programme will serve the future of the Society and the future of endocrinology well.  It will provide unique opportunities for those who apply and I hope it will help to support the careers of our talented trainees.  The applications are open to all so please don’t feel inhibited – just go for it!

Are you an early career endocrinologist interested in developing your leadership skills and becoming more involved with the Society? Applications for the Leadership & Development Awards Programme are open 1 April – 14 May 2019.

Full details of the selection process, benefits and how to apply are on our website.