Meet our 2020 Jubilee Medal winner, Professor Anne White

Anne White is Professor of Endocrine Sciences at the University of Manchester and is our Jubilee Medal winner this year. Her research focuses on POMC peptides and energy balance and she will be presenting her medal lecture at SfE BES Online 2020, on Thursday 19 November. Read this interview ahead of her lecture to find out more about her research and her career in endocrinology.

Tell us about your current research

My research focuses on the processing of the precursor for adrenocorticotropic hormone (ACTH), propiomelanocortin (POMC), and the neuropeptide, alpha-Melanocyte-stimulating hormone (alpha MSH). For many years, my research has been involved with the diagnosis of ACTH related disorders, in parallel with understanding the role of POMC and alpha MSH in regulation of food intake and energy balance.

Tell us about your career path and what you are most proud of

In my first postdoc position, I developed monoclonal antibodies for the diagnosis of peptide and steroid hormones. This led to an interesting discovery that non-pituitary tumours causing ectopic ACTH syndrome secreted much higher concentrations of ACTH precursors, than ACTH. Having monoclonal antibodies and immunometric assays enabled easier diagnosis of these tumours. It was very difficult for a non-clinical scientist working in a clinical department to carve out a career – this was probably compounded by being a woman with young children! However, perseverance is my middle name and my interest in prohormone processing has underpinned my research in neuropeptide networks in the hypothalamus.

My early studies on the hypothalamic–pituitary–adrenal axis (HPA axis) and Cushing’s syndrome also led to research on abnormalities in the glucocorticoid receptor with David Ray, and subsequently on how chronic glucocorticoid treatment can lead to metabolic syndrome. My career has evolved despite not moving from Manchester for family reasons and I did a Royal Society Industry fellowship as my sabbatical close to home.

I am proud of the fact that I have had a rewarding career combined with a wonderful family life. I am also proud of the people who have worked for me over the years and who have established careers in their own right. I’m also proud of the work we’ve done to help patients and endocrinologists in the UK and abroad.

What inspired you to choose endocrinology as a career?

I didn’t choose endocrinology as a career, it sort of chose me! Having signed up as a post-doc, I became fascinated with the research questions and just couldn’t stop. It is much harder for a non-clinical scientist to gain the background in endocrinology that is needed to make it a career, but I had some very good mentors and the Society conferences were always a fount of information.

 What do you enjoy most about your work?

Solving research problems gives me a great sense of satisfaction. It’s a challenge and a lot of the time things go wrong, but then when you see a result which you recognise is important and you can present it successfully to your peers, it makes all the hard work worthwhile. 

I have also enjoyed working with such intelligent scientists, both those in my group and the numerous collaborators. There is also something worthwhile about doing research that I know will make a difference.

How has the COVID-19 pandemic affected your research?

Our labs were closed for a few months but we used the opportunity to write papers and grant applications. My research team has been so resilient and they were determined to get back in the labs as soon as they could.

Please tell us a little more about what you will be presenting during your lecture at SfE BES Online 2020?

I set myself the challenge of explaining what we know about different processing pathways for POMC at the cellular level, but I also wanted to highlight the questions still to be answered. In the pituitary, POMC is processed to ACTH, but in ectopic tumours this processing is disrupted. This results in higher concentrations of POMC than ACTH in the blood, which can be used for differential diagnosis in Cushing’s syndrome. In the hypothalamus, POMC-derived peptides are important in regulating energy balance. However, there are many more steps in the cellular processing of POMC to give the melanocortin peptides. We have learnt a lot from mutations in genes involved in this pathway that result in early onset obesity in children and from mouse models. Despite this, there are complexities in these POMC networks which we don’t yet understand. Addressing these issues will be important in understanding imbalances which drive obesity and metabolic syndrome.

What do you think about the move to virtual meetings?

Moving to virtual conferences will drive a change in the way we communicate, which could be beneficial in the long-term for scientific research. It has made it so easy to listen to a talk from someone in another part of the world. However there is no doubt that, as researchers, we gain a lot from the casual conversations at a conference. The loss of this is a big disadvantage.

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

We are living in very challenging times and it’s hard to predict the effect of COVID-19 on future research. It is probable that funding will be hit badly and therefore we will lose a lot of momentum. A separate challenge is trying to protect the experienced post docs and research fellows. Even without COVID-19, I would have said one of the biggest challenges is to safeguard the huge knowledge base and skill set of this group of people who have difficult career paths with a lack of secure contracts.

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

In most cases we see incremental increases in knowledge and when different findings are synthesised, we get a greater understanding. So I think major breakthroughs are only seen in retrospect. This requires endocrinologists with different skillsets building the knowledge base. The history of scientific research has taught us that discoveries often come from unlikely sources and we need to be open minded, both to support diverse research and to recognise the nature of the discovery.

Any words of advice for aspiring endocrinologists?

Identify someone you respect and ask them if they will mentor you. You need different mentors at different stages in your career, so be prepared to change mentor. I would also suggest that you find other researchers to collaborate with as they will bring a different perspective to your ideas and may have the same research interests/obsessions, so will carry on talking with you when others are bored! This could also lead to new friendships and new opportunities. My final piece of advice would be that you should be prepared to challenge your colleagues, although this should be in a gentle enquiring way to be most effective!

You can hear Professor Anne White’s Medal Lecture “POMC peptides: master regulators of the stress axis and neuroendocrine pathways in energy balance” on Thursday 19 November at 13:05 GMT. If you haven’t already, register for SfE BES Online now!

Celebrating International Open Access Week

Dalia Nikadon is currently Acting Publisher of Endocrine Connections, an open access journal jointly owned by the Society for Endocrinology and the European Society of Endocrinology (ESE). To celebrate International Open Access Week on 19-25 October this year, Dalia has written this guest post to let Society for Endocrinology members know a bit more about open access publishing, including its benefits and costs.

The open access model makes published articles available to all readers at no cost, as opposed to the traditional subscription model in which readers have access to published papers via institutional (or sometimes personal) subscriptions. This means that once an open access article is published, anyone in the world can access it with no restrictions, including the general public. There is ongoing debate surrounding the risks of open access publishing, for example members of the public accessing research proposing controversial treatment options, and the possible rise in predatory journals. However, most academics and clinicians would agree that the vision of open access is altruistic and positive, even with the possible obstacles in this model’s implementation.

Open knowledge

While many researchers and clinicians will have access to most relevant research via their institutions, nearly all researchers will have come across articles they cannot get access to, at least not without paying a one-off charge or obtaining the article via illegitimate means.

This demonstrates the main issue with the traditional publishing model – it is only accessible to members of certain institutions, or those who can afford (or want) to pay $30-50 for individual articles. This means that members of less well-funded institutions, those not associated with any institution, and readers from developing countries, are unable to access work which may be crucial to their own research or clinical practice.

This year’s International Open Access Week’s theme is “to be Open with Purpose: Taking Action to Build Structural Equity and Inclusion”. Although this year has been especially significant in highlighting inequality and injustice, as well as the need for crucial scientific research to be accessible to everyone, it is no coincidence the theme has been about equity and inclusion for the third year running. Equity and inclusion are the fundamental goals of open access publishing, not happy by-products.

Author owns their work and copyright

If you regularly publish papers, you may have come across the need to acquire permission (and pay a small fee) for figures or content reuse from publications where the copyright is assigned to the publisher. With open access publishing, authors often retain the full copyright for their published work, and other researchers wishing to reuse the work simply need to reference the original paper. Depending on which publishing license the author chooses, researchers can distribute and change the information however they want to – the most commonly used license is CC-BY and allows unlimited distribution and amendments. Some licenses are more restrictive, such as the CC-BY-NC license, which allows change and distribution of work, as long as it is non-commercial. The most restrictive – CC-BY-NC-ND – allows researchers to share your work only non-commercially and without changing it in any way.

Compliance

Europe, and especially the UK, is leading in the push towards open access research. Funders like the Wellcome Trust, Charity Open Access Fund, and UK Research Councils require all work funded by them to be published open access. Plan S is an initiative by 12 European funding bodies to ensure that all publicly-funded scientific research be made immediately open access. In the future, it is likely more funders will require open access publishing from researchers funded by them.

Cost

Unlike many subscription journals, open access publication comes with author-side publication charges. In line with the theme of this year’s Open Access Week, it is important to acknowledge that, while many institutions will provide funding for these extra costs, many less well-funded institutions, including institutions from developing countries, may be unable to provide this. One way in which publishers are trying to help is with Read and Publish deals, where institutions paying subscription costs include open access publishing fees for journals belonging to the same publisher. Additionally, Bioscientifica, the publisher for the Society for Endocrinology, waives all open access fees for authors from countries on Group A of the WHO HINARI list, and gives 50% discount to authors from Group B.

Society-owned open access

Bioscientifica is owned by the Society for Endocrinology and its profits from institutional subscriptions and open access publication charges go back to the Society and its members, via training, grants, and public outreach. Some of its profits also go to the Bioscientifica Trust, a charity which helps fund early-career scientists and clinicians. Big commercial publishers often report large profit margins, with small fractions going back to the scientific community.

The Society organises regular scientific talks from Society members for both Bioscientifica and Society staff, to show what research Bioscientifica’s profits help to fund. From personal experience, these talks are very meaningful and rewarding – not just the additional insight into the scientific aspect, but knowing that the profit we play a part in generating has an ultimately positive impact on the Society and the public.

My undergraduate degree was in biochemistry and I have found it greatly fulfilling to be able to contribute to the scientific community as Acting Publisher of Endocrine Connections. Endocrine Connections is jointly owned by the Society and ESE – Society members get a 40% discount on article publication charges. Bioscientifica also publishes OA journals on behalf of other societies, including the recently launched Reproduction and Fertility (RAF), owned by the Society of Reproduction and Fertility. All article publication charges are waived for RAF during its launch years, as well as for our other recently launched journal Vascular Biology. Endocrinology, Diabetes and Metabolism Case Reports is endorsed by 12 societies – members of these societies get a 25% discount on publication charges.

Visit the Society’s publications page for more information on its journals and visit Bioscientifica’s publishing section to find out more about its journal portfolio.

Further information on open access:

An introduction to open access

Open access in research: catch up on the debate

Podcast: The Benefits of Open Access

Podcast: The Future of Open Access: What’s the Plan (S)?

Podcast: Could open access have unintended consequences?

Meet Daniel Drucker the Society’s 2020 Transatlantic Medal winner

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

Tell us about your research and lab in Toronto

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

Tell us about your career path

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

What inspired you to choose endocrinology as a career?

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

What do you enjoy most about your work?

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

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

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

What do you think about the move to virtual meetings?

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

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

Funding!

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

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

Any words of advice for aspiring endocrinologists?

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

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

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

Meet Professor David Ray, 2020 Society for Endocrinology Medal Winner

Professor David Ray, from the University of Oxford, is the 2020 winner of our Society for Endocrinology Medal. His research focuses on circadian rhythms, nuclear receptors and metabolism, and he will be giving his Medal Lecture during SfE BES Online 2020 on Friday 20 November. Read this interview to find out more about his research ahead of the conference.

Tell us about your current position and research

I have been interested in nuclear receptors in health and disease since working on my PhD in the early 90s. As all endocrinologists learn about the importance of time of day in understanding endocrine gland function, it seemed natural to take an interest in the circadian clock. Indeed, one of my early attempts to do research came in Liverpool when studying circadian function in chronic fatigue syndrome. As I established my research group in Manchester, I started working with Andrew Loudon, one of the major players in circadian and circannual timing mechanisms. At the same time, the role of my favourite receptor, the glucocorticoid receptor, in the regulation of the circadian clock was becoming clear, so we wanted to focus our research on this. In 1998, I moved to University of Oxford as Professor of Endocrinology, where I am continuing to develop these research themes, as well as building on new opportunities to do more work with patients and volunteers.

Can you tell us about your career path and what you enjoy most about your work?

I trained in medicine in Manchester, and then in endocrinology in the North West of England. I did my PhD in Manchester, and post doc at the University of California, Los Angeles. 

I hugely enjoy discovering new things and talking about latest findings from the lab, trying to figure out what they mean and publishing the findings. I think the discussions with my research group and the interactions with other colleagues in the field are the best parts of my professional life. I take great pride in working with some of the amazing, bright, committed young scientists who join the group to make their own discoveries. I love seeing them develop, and surprise me!

What inspired you to choose endocrinology as a career?

I was drawn to endocrinology when I worked with David Anderson in Salford as an SHO. It seemed brimming with excitement, new discoveries, and powerful approaches to improve the lives of patients.

How has the COVID-19 pandemic affected your research?

It’s been hard, but my group has been amazing. We have switched a lot of effort to computational analysis and to entirely in silico projects, in order to maintain research momentum.  We have also taken the chance to complete writing up a number of papers!

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

So, I don’t want to spoil the main event! I will discuss the state of the art in circadian biology and will present new work from our group, showing how the circadian clock and its output pathways regulate inflammation and energy metabolism. We have two new projects to show, one centred on the macrophage, and other on the liver.

What do you think about the move to virtual meetings?

Well, we have to do something to maintain momentum and to keep us all connected. Science is not a solitary pursuit. Virtual meetings have the advantage that they are cheap to attend and there is no barrier to colleagues with caring responsibilities. However, I do miss the chance to talk through the latest science with colleagues face to face.

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

I think we face a major challenge maintaining the scientific infrastructure and funding for truly international science. We have made huge progress and the tools now at our disposal are awesome, but I think we as a community and the country face tough choices about our next steps. I don’t see that debate happening, but we are all aware that decisions are being made which will impact on how we can function in the future.

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

I think the effective translation of the amazing science relating to the circadian clock, its components, and role in physiology to benefit human populations is lagging. I think clock-acting compounds in the clinic and embedding clock logic in healthcare will be transformative.

Any words of advice for aspiring endocrinologists?

Do it!

You can hear Professor David Ray’s Medal Lecture “Circadian control of inflammation and metabolism” on Friday 20 November at 15:50 GMT+1. If you haven’t already, register for SfE BES Online now!

Meet Specialist Registrar in Diabetes and Endocrinology, Dr Shazia Hussain

Dr Hussain is a specialist registrar in endocrinology and diabetes on the North East London Rotation and is currently working at the Royal London Hospital, Barts Health NHS Trust. Her passions are clinical endocrinology and diabetes, as well as medical education and training. Within the Society for Endocrinology, she is a member of the Early Career Steering Group, an SpR member of the Clinical Committee, a Leadership and Development Awards Programme Awardee and has recently joined the ‘Future of Endocrinology’ working group

Can you tell us about your current position?

I am a final year specialist registrar working in a busy east London teaching hospital. My day-to-day job involves a diverse mix of inpatient and outpatient work where I get to meet patients with acute and chronic endocrine and diabetes related conditions. I also partake in a full-time general medical on-call rota. The diversity in my current position means there are unlimited opportunities for me to learn from and share experiences with colleagues which I find immensely fulfilling.

What inspired you to specialise in endocrinology?

I have always enjoyed problem-solving medicine and so I guess it’s no surprise that I have ended up pursuing a career in endocrinology – an intellectually stimulating field that is the perfect balance of specialist and general medicine. However, my decision to specialise in endocrinology was made after working with some highly inspirational and encouraging endocrinologists whose enthusiasm and passion for their work was contagious! I was fascinated by the patient mix in the inpatient and outpatient setting and the detail with which their symptoms and results were dissected to make a diagnosis and ensure the delivery of holistic care. I feel extremely fortunate to have been exposed to specialist endocrinology and be inspired at such a crucial stage in my training and hope I can have the same impact on my junior colleagues!

Why is endocrinology an exciting field to enter?

Endocrinology is a constantly evolving field of medicine with numerous exciting and diverse opportunities to suit different individuals. Whether you are interested in clinical endocrinology, academia, leadership, education or a combination of these there is something for everyone.

I love the fact that I have been able to shape my training to gain experience in areas wider than clinical endocrinology, which has not only kept me motivated but also allowed me to positively contribute towards patient care in more ways than one. 

Furthermore, endocrinologists work closely with multiple other specialties (radiology, surgery, oncology, paediatrics and obstetrics to name a few), which means you have so much to offer your patients – many of whom you will care for over several years.

What has been a highlight of your training so far?

It’s hard for me to pick one highlight. My clinical training thus far has been an enjoyable mix of district general, teaching and tertiary centre work and allowed me to learn from numerous clinicians and members of the wider multi-disciplinary team. However, I am pleased that I chose not to follow the conventional training pathway and took time out of programme to pursue my passion for medical education, undertake a teaching fellowship and complete a MSc in medical education. I am particularly proud of being the first Endocrinology RCP Chief Registrar at St Bartholomew’s Hospital, which gave me excellent insight into NHS leadership and I hope has paved the path for future endocrine trainees who wish to explore this challenging yet rewarding area of medicine.

What are your ambitions for your future career?

I am hoping to complete my training within the next year – though the situation has been slightly less predictable given the COVID-19 pandemic! I am looking forward to taking on my first consultant post and hope to combine my clinical, medical education and leadership skills to deliver high-quality patient care. I’m motivated to attract undifferentiated trainees to pursue a career in endocrinology and also to represent diversity within NHS leadership.

Who do you most admire professionally?

I’ve learnt so much from so many of my colleagues and am hugely grateful for the time and efforts they have put into training me.

In particular, I owe a lot to my incredibly supportive training programme director, Professor Will Drake, whose passion for endocrinology and excellent clinical skills inspired me to become an endocrinologist and who I continue to learn so much from; and Professor Tahseen Chowdhury who has been an amazing mentor and always goes the extra-mile for his patients and trainees.

Any words of wisdom for aspiring endocrinologist out there?

Come and work with us! There’s so much to see and learn in endocrinology and diabetes and the opportunities to shape your training to suit your interests continue to grow. If you’re unsure about whether endocrinology is for you then definitely make contact – speak to your senior colleagues (SpRs, research / clinical fellows or consultants), attend the annual National Taster Day in Endocrinology and Diabetes and/or spend some time in our clinics to see what the job involves. It’s a brilliant speciality which I would highly recommend.

View career profiles of other endocrinologists on our dedicated page.

Meet Diabetes and Endocrinology Consultant, Dr Justyna Witczak

Justyna is a Consultant in Diabetes and Endocrinology and Acute Medicine at the University Hospital of Wales. Her key interests lie in neuroendocrine tumours, thyroid disease, obesity, diabetes mellitus type 2 and inspiring the next generation of endocrine doctors. In 2015, Justyna was awarded the Lewis Thomas Gibbon Jenkins of Britton Ferry Fellowship from the Royal College of Physicians to undergo research into the characterisation of circulating extracellular vesicles in human obesity and is a recent Leadership and Development Awards Programme awardee with the Society for Endocrinology.

Tell us about your current position?

I work as a Consultant in Diabetes & Endocrinology and Acute Medicine at the University Hospital of Wales in Cardiff. Apart from providing specialist care to patients with diabetes and endocrine conditions, my job plan also involves research and teaching activities. My specialty interests include neuroendocrine tumours, thyroid disease and diabetes mellitus type 2.

As a Committee member of the Young Diabetologist and Endocrinologist Forum (YDEF) Wales, I am also very involved in organising various educational events for junior doctors and SpRs in order to promote diabetes and endocrinology as the specialty of choice for trainees. I was recently elected as the South Wales Representative for the New Consultants Committee at the Royal College of Physicians (RCP) with the aim to represent the views and interests of the young consultants’ community within the RCP.

What inspired you to specialise in endocrinology?

Since my medical school rotations, I have always considered diabetes and endocrinology as a very interesting and attractive medical field. During my CMT years, one of my placements was in diabetes and endocrinology and it gave me the practical exposure to the clinical work in this specialty which I really enjoyed. This paired with the encouragement and support from my clinical supervisors at the time helped me to make the decision to apply for the training number and I have never looked back since.

Why is endocrinology an exciting field to enter?

There have been lots of advances in endocrine research in recent years which allows us to understand better some of the endocrine conditions. It has a direct impact on patients’ management with various new therapies being already available and new ones being constantly developed. From the professional point of view, it is a great opportunity to be a part of these changes. Moreover, the endocrine community is quite small, well connected and very friendly both in the UK and Europe which is a wonderful platform for professional and scientific collaborations.

What has been a highlight of your training so far?

The highlight of my training was to have the opportunity to take time out of programme for research. I received a 2 year fellowship award from the Royal College of Physicians of Wales (The Lewis Thomas Gibbon Jenkins of Britton Ferry Fellowship). This enabled me to complete my research project on characterisation of circulating extracellular vesicles in human obesity which led to obtaining the MD degree at Cardiff University. I also had a chance to present my work at various national and international meetings.

Having a chance to work with the “non-clinical” endocrine scientists was a great experience which will hopefully lead to long lasting scientific collaborations in future.

What are your ambitions for your future career?

My long-term career goal is to be a practising NHS Consultant involved in both clinical and research activities. In the next few years I am planning to gain experience as Principal Investigator in various diabetes and endocrinology trials and will possibly be able to establish my own local research group.

Also, I would like to encourage trainees to the world of academia by creating exciting local research opportunities for out of programme research time for our diabetes and endocrinology SpRs, academic IMTs and intercalated students leading to publications and potentially supervise their MD/PhD work as well. 

Lastly, I am intending to focus on advertising diabetes and endocrinology as an attractive career option by organising local taster events and additional training events which hopefully lead to increased numbers of trainee applications and retention. I would like to take on a role of the Specialty Educational Supervisor and perhaps in future as the Diabetes and Endocrinology TPD/STC.

Who do you most admire professionally?

Generally, I admire all the female clinical and non-clinical endocrinologists who manage to find the right work-life balance between their careers and personal life and can still be successful and fulfilled in what they do. I aspire to be one of them.

Any words of wisdom for aspiring endocrinologist out there?

I would encourage everyone who is considering endocrinology as their future specialty to link up with their local endocrine teams in order to get an insight into what the specialty is really like. They should also use the opportunities to attend the taster events and other SfE organised meetings such as the SfE BES conference.

I would suggest they do not get discouraged by the 4-5 years training involving the general medical duties which often is very demanding. Instead they should look at the bigger picture and the exciting career prospects this specialty offers once the training is completed.

View career profiles of other endocrinologists on our dedicated page

From small seeds grow mighty oaks: how the Endocrine Nurse community is growing together to share knowledge

Lisa Shepherd, an Endocrinology Advanced Nurse Practitioner at Heart of England NHS Foundation Trust and Chair of the Society for Endocrinology Nurse Committee, discusses continuing education opportunities and the value of networking for endocrine nurses.

Endocrinology is a fascinating but complex area and nurses often work in isolation, so opportunities to develop and update their knowledge, benchmark their practice and network with other nurses are invaluable. The Society for Endocrinology Nurse Committee supports a number of strategies that promote networking amongst the Endocrine Nurse community.

Social media is increasingly used to build professional networks, so the Nurse Committee have set up an invite-only group on Facebook for endocrine nurses, which is a fast and easy way for the community to share protocols and information. Nurse Members of the Society also have a Twitter feed where training opportunities, research and nursing practice can be promoted to the wider community.

Face-to-face networking remains an effective means of sharing experience and learning from others, so a ‘nurses lounge’ was recently introduced at the SfE BES conference, to give nurses a dedicated space to meet each other in person. As many nurses are working in isolation it is valuable to provide a variety of opportunities, across different media that encourages endocrine nurses to support and learn from each other.

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Endocrine Nurse Update (ENU) is coming up soon. This yearly update is designed by nurses for nurses and offers a varied and active programme of endocrinology topics. I am very excited that this year’s ENU will feature the inaugural Endocrine Nurse Award lecture by winner, Nikki Kieffer. This award was introduced to recognise excellent nursing practice that can be shared to advance knowledge and understanding in the discipline. Nikki is an endocrine nurse specialist at Leicester Royal Infirmary and led the project that developed the Competency Framework for Adult Endocrine Nursing. This project is a great example of nurses working together to share best practice and Nikki will deliver the prize lecture at ENU 2017 in March.

There are also great benefits to networking with other closely related communities and this year, for the first time, ENU will include a workshop run collaboratively between clinician and nurse colleagues, Dr Richard Quinton, Dr Channa Jayasena and Dr Andrew Dwyer. Whether you are a nurse new to endocrinology or a nurse with many years of experience, the ENU programme, in combination with Clinical Update has something to offer all. I hope you can join us at the meeting or follow us online, to learn from your colleagues and share your experience.

Nominations for the 2018 Endocrine Nurse Award are open until 16 June 2017, find out more.

Travel grants are available for ENU 2017, apply before 15 March.

View the ENU 2017 programme.

 

Should prednisolone be the first line for glucocorticoid replacement in adrenal insufficiency?

At 18.30 on Monday 7 November Professor Jeremy Tomlinson is chairing a debate on the treatment of adrenal insufficiency at SfE BES 2016. Ahead of the debate, we asked Professors Stafford Lightman and Karim Meeran to give you a little taste of their stance on this hot topic in endocrinology.

 

Professor Jeremy Tomlinson, University of Oxford – Chair

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The optimal strategy for glucocorticoid replacement in patients with adrenal insufficiency remains a contentious issue. In the majority of cases, hydrocortisone is used, but there are issues relating to the need for three times a day administration alongside the high costs of treatment. Are there alternatives?

Prednisolone is significantly cheaper, has a longer duration of action and therefore can be administered twice daily. However, it is a synthetic glucocorticoid that does not act in an identical way to hydrocortisone.

Head-to-head comparisons with meaningful clinical end points are lacking, and in the modern NHS, treatment costs play an increasingly important role.

Let the debate begin!

 

Professor Stafford Lightman, University of Bristol – AGAINST

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The evolution of Homo sapiens from early mammals has taken about 200,000,000 years. During this time we have developed many highly specialised physiological systems –including the key homeostatic system we call the Hypothalamo-Pituitary-Adrenal axis. This system maintains key cognitive, metabolic and immunological systems in optimal state and is also a rapid response system to protect us against stress. The hormone that has evolved to do this is cortisol.

In the absence of endogenous cortisol no-one would disagree that the gold standard therapeutic hormone replacement should be the closest we can get to normal physiology, so if we have to go second-best and provide a different steroid or pattern of plasma steroids it is incumbent on us to prove that this alternative treatment is as good as the best possible therapy available with the native compound.

Prednisolone differs from cortisol in many ways. Not only does it have different characteristics of glucocorticoid mediated gene transcription with no simple dose response comparison to cortisol, but its plasma half-life and metabolism are also unphysiological.

During the debate, I shall demonstrate why these aspects of prednisolone replacement are potentially disadvantageous at cognitive, metabolic and immunological levels. I will explain why I feel it would be dangerous to submit patients to such long duration therapy unless appropriate long term studies are able to show non-inferiority of this regime.

 

Professor Karim Meeran, Imperial College London – For

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Patients with endocrine deficiency need replacement therapy.

We are getting better at making new analogues of replacement hormones that are more patient friendly and improve compliance by lasting longer. Thus for insulin, we have moved away from normal human insulin to analogues of insulin that have variable half-lives, but are a totally different molecule. There is no evidence that the new analogues are any better than native insulin, but production of some preparations of native human insulins have ceased and many of us use these new insulin analogues. Vasopressin is replaced with a modified molecule, 1-desamino-8-D-arginine vasopressin; the D-enantiomer is used (which never occurs in nature) because it lasts longer. The argument in some quarters that “natural” cortisol would be better thus has no basis.

Similarly, rather than give hydrocortisone several times a day, we need to modify the molecule slightly by inserting a double bond, which increases its half-life and potency, and enables once daily administration. A slow release preparation has been developed and costs £400 per month, but it is far better to use a drug that has an appropriate half-life.

We don’t need to develop one because, remarkably, prednisolone has a half-life that is perfect for a once-daily administration. It happens to be extremely cheap, but that should not deter us from using it!

We now have an assay available for prednisolone, and present data at a number of posters at the BES in November confirming that a once-daily dose of prednisolone 3mg is equivalent to hydrocortisone 10mg plus 5mg plus 5mg. I have converted several patients, who regularly report how well they feel on prednisolone 3mg, and how much easier it is to take.

The main reason that patients should take once-daily prednisolone is its convenience. Added benefits for those in the UK are the low price of prednisolone compared to hydrocortisone, which is substantially more expensive in the UK than in other countries because of a peculiar licensing issue, and the fact that the NHS is not allowed to import it.

We have a serious problem in the UK with the cost of hydrocortisone, and every patient who is switched to prednisolone will save over £100 per month.