Embracing the diversity of endocrinology: an interview with Dr Julia Prague

Dr Julia Prague is a clinical consultant and clinical academic at the Royal Devon and Exeter NHS Trust and University of Exeter. In our interview, she tells us about her clinical practice and research projects, as well as how she thinks endocrine practice will evolve after the COVID-19 pandemic.

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

As a clinical consultant and clinical academic I split my time almost 50/50 through the week. At the moment, my clinical commitments include outpatient endocrinology, and inpatient endocrinology, diabetes and general medicine. I moved from London to Exeter last year, and one of the big reasons to move was that near 50/50 split between clinical commitments and research. It’s a great balance that gives me time and space, not only to be with the patients, but also to investigate and take forward some of the issues that they bring up in clinic. Forming new collaborations and being in a new unit with new colleagues is pretty exciting too.

Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet!

Research wise, I’m particularly interested in the menopause through a number of different collaborations. I’m working with the respiratory department on a project looking at lung conditions and sex hormones. Investigating the impact of the menopause in diabetes. I’m also still involved in establishing the role of neurokinin 3 receptor (NK3R) antagonists to treat hot flushes and improve sleep during the menopause.

What got you interested in research on menopause?

Spending hours with the women in our research study of a new treatment for menopausal flushes, and from receiving hundreds of emails from menopausal women wanting to take part. My admiration for them was huge, not least because they so often described themselves as struggling to cope, yet they were the complete opposite of that, meeting endless challenges with amazing fortitude and whilst mostly suffering in silence. To then see them leave misery and suffering behind and find themselves feeling vibrant and human again was rewarding beyond measure. 

Furthermore, the majority of women will have menopausal symptoms that impact on all aspects of their daily life, but many will also have co-existing medical conditions before their menopause and these can also be impacted too. Many medical conditions are influenced by the menstrual cycle and that’s an aspect that is under-investigated and I think is really interesting. Inflammatory bowel disease, for example, can fluctuate during the menstrual cycle and Crohn’s disease typically gets better in pregnancy.

Diabetes is also impacted by the menstrual cycle, and it’s the same hormones that are changing during the menopause but this hasn’t been investigated, which is why I’m now interested in this, as this is something patients often report as being a problem for them. I think it’s important to listen to what patients are telling you and then try and investigate why that is, to hopefully find an improved solution for them.

There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.

How was your work affected by the COVID-19 pandemic?

I was a Senior Registrar at King’s College Hospital  at the height of the first wave, so I became involved in  a lot of  the management and service re-design work within the diabetes and endocrinology department, including rota management to facilitate re-deployment to general medicine but whilst maintaining a core specialist service and whilst supporting our junior trainees and particularly our international medical graduates who were isolated from their families, and  ensuring our patients were supported and aware of sick day rules and  had all the medications they needed. Our department was also therefore part of the frontline team. I was the medical registrar on call for the first peak weekend of King’s admissions. Then I got COVID-19 and could not get out of bed/off the sofa for 4 weeks.

I moved to Exeter towards the end of summer 2020 to take up my Consultant job. Since then I have continued to do quite a lot of frontline COVID inpatient medicine. Now we’re involved in recovery and trying to catch up. Many patients couldn’t be seen through the pandemic because resources had to be syphoned off elsewhere.

The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.

I never imagined I would interview for my consultant job on Zoom! Moving to a new city, a new department, a new consultant role and a new research role during the pandemic was definitely an interesting twist at such a significant stage of my life and career.

What are you proudest of in your career so far?

My work on menopause and NK3R antagonists – being published in The Lancet was a huge honour, and the potential that this work has to relieve suffering of women is incredible. As a doctor, all you want is to relieve suffering in your patients and this has that opportunity. It’s also given me a platform to continue working in that field and to be invited to speak at international conferences, as well as develop new collaborations.  

This drug class are now in phase three studies and it looks like they’re probably going to be marketed from around 2023/2024. This research is still advancing within the pharmaceutical field, butte top-line results coming out continue to show great promise for the therapy. Seeing the NK3R antagonists come to market will be amazing. For me, to have played some part in that will be awesome and to see patients being able to go to clinicians and get that medication prescribed will be great.

There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.

What do you think are the biggest challenges in endocrinology?

We have to mention COVID recovery, in what was an already overstretched system. However, somewhat linked to that, is the pull of general medicine on our time as endocrinologists. The pandemic has further highlighted this to be an important issue. Hospital inpatient medicine is busy and can’t be cancelled. However, it is essential for recruitment, training, and retention that our specialist time is more protected. The new internal medicine training (IMT) programme will change the number of specialty training years to shorten it, which could have some quite big consequences for the endocrine discipline.  

COVID-19 has brought some positives though; it’s highlighted that we can achieve quite a lot remotely with patients using virtual appointments, and some patients prefer fitting their appointments in to their life rather than having to attend the hospital. How this translates going forward though could involve big changes for the specialty.

The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.

What do you think will be the major changes in the future of endocrinology?

I think there will continue to be a drive for a smaller number of national centres of excellence in endocrinology. There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic. That will be good for patients overall but the downside could be that there will be a smaller number of centres with specialist services, which means that staff  may have less involvement in specialist endocrinology. A lot of these changes will be driven by the GIRFT recommendations, which will affect how all services are delivered going forward.

What challenges do you see for your research?

Availability of funding will be critical. COVID has had an impact on available funding but so has Brexit, there’s now a lot of European grants that UK researchers will not be eligible for. Universities have less money because they’ve had fewer students and international students may think differently about studying in the UK post-Brexit and post-pandemic. Charities that fund research have also been hit as many of their fundraising activities were suspended during the COVID restrictions. The Government has a significant financial deficit to address. Availability of research funding was already challenging but it’s going to be even more difficult in the years to come. It’s usually funding that restricts research activity rather than a lack of ideas or collaborations.

How would you like to see the Society develop?

My overwhelming memory of attending my first Society meetings in 2006/2007 is of a lot of senior white men wearing tweed jackets! Now every time I come to Society meetings it’s such a stark change from that. Everything that the Society has done, and is doing, to make itself more reflective of everyone within it is really important. Recruiting the next generation is also a huge part of that, and it is great to also see more focus on this now than then too. The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.

That level of change takes time and effort and over the years I’ve tried to play some part in helping to make the Society a more different place to the one that I initially knew.

As a Leadership and Development Awardee I was really looking forward to SfE BES 2020 as we were going to be paired with award lecturers, and it is also always a great opportunity to catch up with friends, previous colleagues, and previous as well as potential new collaborators. But of course, that didn’t happen. I’ve just been finding my feet as a new consultant and researcher in a new city but being an Awardee has opened up other opportunities. I’ve been involved in discussions with an external organisation exploring new collaborations and identifying our shared goals and objectives that we could achieve together. I’m sure that being an Awardee has helped me be offered these opportunities.

Who have you been most inspired by?

Prof John Wass, obviously, but I have also been very lucky to have amazing clinical and research mentors. From the literal beginning to the end of my clinical training and beyond (now over 15 years!) with Dr Simon Aylwin at King’s and Dr Roderick Clifton-Bligh in Sydney. I also learnt a lot from Prof Waljit Dhillo whilst doing my PhD at Imperial.

Why do you love endocrinology?

The balance of the acute and long-term follow up of patients, and the importance of making the right diagnosis for patients based on their history, examination and targeted investigation. Many patients with endocrine conditions go undiagnosed or misdiagnosed for a long time, so when you make the right diagnosis and instigate the right treatment, they feel and do so much better and you often see it unfold in front of you. As endocrinologists we are also part of a much wider multidisciplinary team, which is great.

Any words of wisdom for aspiring endocrinologists? 

I’ve always tried to be involved with the Society in recruiting the next generation. It’s important that they get to see the ‘real’ endocrinology and diabetes because often, those rotation attachments are mostly inpatient general medicine.

My advice would be to try to get to clinic as much as possible because a lot of our patients are outpatients, and also to go and review specialty patients on the wards when they are admitted. Remember also that there’s lots of different sub-specialties within endocrinology (and diabetes) so there is a place for everyone and an opportunity to be involved in the areas that you find most interesting/rewarding.

Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet! I also always recommend going to SfE BES, it’s a really good platform for meeting other clinicians and scientists involved in the field, and hearing about the patients that we look after. Get involved, come along and see what the specialty really has to offer.


The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!

We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.

Would you like to get involved and share your views? Simply complete this short questionnaire or send your comments to media@endocrinology.org.

Embracing the diversity of endocrinology: an interview with Dr Alexander Comninos

Dr Alexander Comninos is a consultant in endocrinology and diabetes and honorary clinical senior lecturer at Imperial College London. His research interests are in reproductive endocrinology and metabolic bone disease and he has presented internationally, winning several prestigious prizes including the Society’s Early Career and Clinical Endocrinology Trust Prizes. Alex currently sits on the Society’s Science Committee and is a previous Leadership and Development Awards Programme Awardee. Read our interview with him to find out about his career, the current challenges in his field, and how he thinks endocrinology will change in the future.

*A late night collaborative meeting at a Kebab House during SfE BES 2015

Tell us about your current position

I feel very fortunate as my current role combines clinical work, research and teaching. One day I may be running our endocrine bone clinic, the next day I could be on call for acute medicine, or analysing data and finishing a research paper, lecturing and tutoring undergraduates, or meeting my PhD students. I really enjoy the fact that each day is different and endocrinology is the theme through most of it, with so many opportunities to combine clinical and academic work.

I love endocrinology because it encompasses the whole body system and has so many possibilities for research to improve patient care.

What are you proudest of in your career so far?

Looking back on my career so far, I am so happy that I made it through all the harder times in medicine and academia. Long runs of night-shifts and previous unsuccessful grant applications certainly tested my perseverance but made me stronger!

What do you think are the biggest challenges in endocrinology right now?

With increasing patient use of social media and the internet in general sometimes misinforming patients, we have to ensure that we provide clear and accurate information to patients and address their concerns. In addition, although we are hopefully emerging from the COVID-19 pandemic, an element of remote medicine is clearly here to stay. With patient compliance, subtle symptoms and blood tests so integral to endocrinology, we need to find new ways to monitor these in a remote medicine environment.

How do you think your field of research will change in the future

Genetics is such a rapidly developing field. I suspect we will be routinely performing full cheap gene sequencing and using this information to guide management at an individual level.

In the future I think we will see the increasing incorporation of genetics to guide individualised treatment.

What is it like being involved with the Society for Endocrinology?

We are lucky to have such a well-run society. I currently sit on the Science Committee which is an absolute pleasure. Interacting with other basic and clinical endocrinologists, each with different opinions and interests is really fascinating and constantly thought-provoking. I would like to see the Society push on with in-person meetings, when safe to do so, as I feel this is so important for our morale on an individual as well as a collective basis.

Who are your most inspirational endocrinologists?

Like many others, Professor Karim Meeran is a large part of why I chose endocrinology, and Professor Waljit Dhillo is the inspiration behind my academic pursuits. Their dedication to trainee development, super approachable nature, calmness and sense of what is best, is really incredible and I am sure numerous trainees would agree. I also have to say that Dr Cox at St Mary’s has been a real clinical inspiration for me. I was his house-officer many years ago, and now to sit next door as a consultant colleague always makes me smile. His incredible experience, knowledge and deep interest in endocrine physiology have certainly helped shape my early consultant years, and we have had many enthralling clinical discussions!

Any words of wisdom for aspiring researchers in endocrinology?

It is a wonderful specialty, full of surprises and opportunities. Be inquisitive constantly, question things to understand concepts and remember the journey is lifelong.



The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!

We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.

Would you like to get involved and share your views? Simply complete this short questionnaire or send your comments to media@endocrinology.org.

Embracing the diversity of endocrinology: an interview with Dr Gareth Nye

Dr Gareth Nye is a lecturer in anatomy and physiology at the University of Chester. His main research interests are maternal and foetal health. In our interview, he tells us about his career so far, his research and how he thinks his field will develop in the future.

Tell us a bit about your current position

My recent research has been focused on improving outcomes for both mum and baby before, during and after pregnancy. More specifically I’ve been researching placental causes of foetal growth restriction, whilst also looking into the ongoing impact of the COVID-19 outbreak on maternity care.

I love endocrinology because it impacts every aspect of human health and disease

The most enjoyable aspect of my role as a lecturer is getting engagement from the students. When a student is really exploring a topic and that enthusiasm comes out in lectures or otherwise, it’s such a great feeling. With my research being in a field where you can make such a huge difference is also so rewarding. There’s still so much we don’t fully understand around pregnancy, so there is always new areas to look into.

What are you proudest of in your career so far?

There are many career moments that I’m proud of, for a wide range of reasons. Being nominated for “most inspirational lecturer” from students at the University of Chester is an achievement I’m proud of, for both personal and professional reasons.

Additionally, I’m particularly proud of our review of placental oxygenation in the Journal of Physiology and finally, speaking at the International Federation of Placenta Associations conference in Tokyo was an amazing experience!

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

I think there are multiple challenges within maternal and foetal health and pregnancy research. If I had to name three major themes they would be

  • Ensuring every baby is delivered healthy and that every mum remains healthy, during and after the pregnancy. Finding novel interventions to improve foetal outcomes in utero, without the need for early delivery and shining a spotlight on the physical and mental changes that pregnancy has on the mother’s body, both during and after the pregnancy itself
  • Fully understanding the impact the maternal environment has on foetal lifelong outcomes – this involves the discussion around Developmental Origins of Health and Disease
  • Exploring the maternal/foetal interface to improve outcomes for the baby – this includes the placenta, breastmilk and circumstances following birth

Can you explain more about how you think your field of research will change in the future?

In the future we will challenge the current understanding around pregnancy and early childhood. Not enough is known yet and it's limiting our ability to intervene productively.

As pregnancy research, particularly in humans, is challenging for a number of reasons I can see the field collaborating more with other disciplines, even though not necessarily involved in medicine. For example, I have recent research papers with mathematicians, engineers and physicists, who can bring their knowledge and expertise to fill in gaps in our biological knowledge. Additionally, with the improvement of imaging techniques, we can slowly begin to understand the important microanatomy of the placenta and uterus to see if/how we can improve pregnancy outcomes. Without thinking of our research fields as one slice in a huge pie, we can never make true advances and so collaborating with different areas is key. Particularly as everything can be influenced by the body’s endocrinology!

What is it like being a Society for Endocrinology member?

I have to say, since joining this society I have felt so welcomed into a community. I’ve been given opportunities that have never been presented to me before from other societies. The Society on the whole seems to actively push and support their more junior members.

Unfortunately, I’ve not had the chance to attend any Society events in person yet but hopefully I will get the opportunity to attend soon!

Who is your most inspirational scientist?
Again, speaking personally, the most inspirational endocrinologist to me is Frederick Banting, the discoverer of insulin. This is because my 4 year old daughter has type 1 diabetes and without insulin, she wouldn’t be with us anymore! I think a lot of people have Banting’s discovery to thank!

John Hunter always sticks out as someone who should be more famous than he is. He truly is one of the greatest anatomists of our time, discovering much of what we know now around anatomy and physiology all without a formal school education. Of interest to my work – he was the first to note that maternal and foetal blood supplies are separate during pregnancy

Any words of wisdom for aspiring researchers in endocrinology?

Speaking from experience, something I like to tell my students is not to stick to your own little bubble. Everything in medicine and biology is connected in one way or another and keeping an open mind to your research can allow you to progress, where you may not have otherwise. Due to this, don’t be afraid to switch “topics” because you can always find common themes.

Finally, make sure you enjoy what you do! I’ve been lucky to work in some amazing areas, with amazing people but what’s really helped is enjoying my work!



The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!

We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.

Would you like to get involved and share your views? Simply complete this short questionnaire or send your comments to media@endocrinology.org.

Meet the Endocrinologist: Stafford Lightman, expert on regulation of the hypothalamo-pituitary-adrenal axis

Meet Stafford Lightman, Professor of Medicine at the University of Bristol. His research focuses on understanding the role of the hypothalamo-pituitary-adrenal (HPA) axis in health and disease, and in particular its interface with stress and circadian rhythms and its effects mediated through glucocorticoid signalling. He has been awarded the SfE Medal and will be delivering his Medal Lecture at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, he tells us more about his career, research and what he is looking forward to at the SfE BES 2018 conference.

*Prof Lightman is pictured at the Goroka Festival, Papua New Guinea’s equivalent of Glastonbury! 

Can you tell us a little about your current position and research?

When I was appointed Professor of Medicine at the University of Bristol, very little endocrine research was going on there, which had the great advantage of providing me with a clean slate and the ability to develop my own research theme. Now I have a lab group that ranges from the very basic cell and molecular science through physiology, right up to clinical research. I really enjoy being able to translate up to humans and then back translate down again to animal models. Having a group of scientists and clinicians working together is a really exciting environment to work in.

Can you tell us a little about what inspired you into endocrinology?

I was always interested in human biology and my earliest research was in anthropology, which naturally led into human behaviour and to neuroscience. I initially wanted to be an academic clinical neurologist but at that time neurology research centred around the peripheral nervous system, and I was interested in the brain! The one way I could investigate brain function was through the window of hypothalamic-pituitary function, therefore I became a neuroendocrinologist. Since then I have been working at the interface of endocrinology and neuroscience, which I find fascinating.

What you are most proud of in your career so far?

I am most proud of the people that I have helped to train, who have gone on to do well afterwards. It is also really rewarding to have set up lots of collaborations with mathematicians, and fascinate them in the dynamics of hormones. They have of course also been very both for me and the subject, developing   the concept of hormone dynamics. With the exception of GnRH, endocrinology was often considered a homeostatic but relatively static science, where hormone levels are measured and found to be either too high or too low. This is clearly far from reality and trying to bring the idea of dynamic hormonal systems into the mainstream is something I have been very involved with.

Tell us what you enjoy about your role as President of the British Neuroscience Association (BNA)?

I love meeting lots of really interesting people. The brain is such an interesting area and I enjoy understanding how it interacts with all aspects of our lives. The BNA 2019 Festival of Neuroscience will be held in Dublin on 14-17 April 2019, and will be in collaboration with the British Society for Neuroendocrinology, and include a scientific symposium sponsored by the Society for Endocrinology. So, there will also be a strong element of endocrinology running throughout the meeting. However, it is a great event for bringing together lots of diverse areas of neuroscience.

What are you presenting in your Medal Lecture at SfE BES 2018?

I will be discussing how aspects of HPA physiology are governed by dynamics, from the stress response to the circadian rhythm. The underlying dynamics of this system are what allow us to be flexible and to maintain a homeostatic state. I will also be talking about improved ways of diagnosing endocrine disorders. If we can harness novel technologies to measure dynamic changes in hormone levels in patients at home, we can gather much better information for diagnosis and treatment.

What are you looking forward to at this year’s conference?

From my own point of view the best part of the conference will be discussing posters with young, enthusiastic scientists right at the start of their careers. The posters are a really exciting area where people are putting out new ideas, in all areas of endocrinology. I like to be educated, so enjoy going to posters in areas where I don’t know much and hearing about what people are doing and why they find it exciting.

What do you think are the biggest challenges in endocrinology right now?

I think there are two main challenges, one of which I alluded to earlier.

  1. In terms of HPA the challenge lies around how we can measure dynamic changes in hormone levels in patients at home. I think the whole field of medicine is moving away from keeping people in hospital, to do lots of blood tests, sending them home, calling them back in to discuss results and finding you don’t have the right answer. Diagnosis can then be prolonged, inaccurate and very expensive, all of which is bad for patient care. The real challenge is finding better ways of doing this, and doing it in patients at home.
  2. Another challenge concerns the best way to give glucocorticoid replacement therapy. There is currently great debate on this in the field but it is important that we find the answer. Poorly managed glucocorticoid replacement is associated with considerable morbidity and mortality, so lots of attention is focused on finding a better way of doing it.

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

I think the ability to monitor patients’ hormone levels over a 24 hour period will be a major breakthrough, and will provide the basis for better understanding of normal physiology and better diagnostic methodologies.

We have been developing a wearable collecting device that can be worn by patients at home. Using this device, patients would need only a quick visit to have it fitted and another, 24 hours later to have it removed. This is sufficient to provide full tissue biochemistry over a 24 hour period. This would minimise the time in hospital and provide a personalised medicine approach with a wealth of data that gives an overall picture of the individual’s health. This type of approach could revolutionise diagnostics and really improve patient care.

Once we understand how to apply this technology we will have better more rational ways of targeting and timing treatments, to address the challenges mentioned in the previous question.

What do you enjoy most about your work?

I love the challenge of new ideas and using them to work out answers to important questions. It is also a pleasure and privilege to have the opportunity to work with great colleagues.

Who do you admire most in the world of endocrinology?

The first piece of endocrinology that ever excited me was Vincent Wigglesworth’s work on the hormone, ecdysone. He was a brilliant entomologist and his beautifully designed experiments on the extraordinary process of metamorphosis was a real eye opener. He was my first endocrine hero!

Any words of wisdom for aspiring endocrinologists out there?

Enjoy, enjoy, enjoy! You really need to enjoy your work, or you should be doing something else. I describe what I do as privileged play!

You can hear Professor Lightmans’s SfE Medal Lecture, “HPA activity: Don’t forget the dynamics” on Monday 19 November, in the Lomond Auditorium at 17:30. Find out more about the scientific programme for SfE BES 2018.

Meet the Endocrinologist: Leanne Hodson, expert on metabolic physiology

Meet Leanne Hodson, Professor of Metabolic Physiology at the University of Oxford. She specialises in changes in metabolism caused by nutrition including the metabolic consequences of obesity.  She has been awarded the SfE Starling Medal and will be delivering her Medal Lecture at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, she tells us more about her career and what she is looking forward to at this year’s conference.

Can you tell us a little about your current position and research?

I am currently a British Heart Foundation Senior Research Fellow in Basic Science and Professor of Metabolic Physiology at the University of Oxford. The lab is focussed on research related to human health and metabolism; this includes the influence of specific nutrients and the consequences of obesity and obesity-related diseases, such as non-alcoholic fatty liver disease (NAFLD). Although our work has a focus on hepatic metabolic physiology, it covers a number of broader areas including: endocrinology, nutrition, hepatology, diabetes and liver transplantation.  We use a combination of human in vivo, ex vivo and in vitro models to undertake our studies.

Can you share some of your proudest career moments?

I am originally from New Zealand and had various career paths before eventually making it to University, where I obtained my PhD.  In 2004, I received the Girdlers Health Research Council (New Zealand) career development fellowship which provided the opportunity to work at the University of Oxford with Professors Keith Frayn and Fredrik Karpe. I was awarded a British Heart Foundation Intermediate Basic Science Research Fellowship in 2011, and became an Associate Professor of Diabetes and Metabolism in 2014. In 2015, I was awarded a British Heart Foundation Senior Basic Science Research Fellowship and in 2018 became Professor of Metabolic Physiology.

I am proud of many things including the reputation and the quality of work my lab, which leads to collaboration requests from well-respected and very talented scientists. Getting my fellowships, becoming a professor and getting the SfE Starling medal are definitely highlights. However, I am most proud of the environment I have been able to create for my research group, which is dynamic, productive and supportive – I am fortunate to work (and collaborate) with a wonderful group of individuals.

What are you presenting at your Medal Lecture at SfE BES 2018?

My group is interested in understanding why fat starts to accumulate in the liver and what the effects of insulin and specific nutrients or therapies are on this process, including the subsequent effect this then has on metabolism. In my Medal Lecture I will present what we have learnt over the last 14 years and how we have further developed and incorporated new models and state-of-art methodologies to study human liver fat metabolism.

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

I am very much looking forward to hearing the Early Career talks and going to the poster sessions, as it is a great chance to learn what work is coming out. Also I am going to the applied physiology workshops, as these are something I have not experienced before and I am sure I will learn a lot from them.

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

Developing models (particularly in vitro models) that better recapitulate the human disease that we are trying to study, as the historical ones, although interesting, are not reflective of human physiology.

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

Good question! I would like to think we will soon have more sensitive and specific biomarkers to detect the different stages of NAFLD. Improved biomarkers will allow us to study changes in hepatic metabolism at clearly defined stages during the progression of NAFLD, therefore increasing our likelihood of developing therapeutic agents to treat the disease.

What do you enjoy most about your work?

There are two things I most enjoy about my work:

  • the process of watching projects come to fruition and seeing the results come together is really exciting,
  • creating a supportive environment that challenges individuals to reach their full potential and grow in confidence.

Who do you most admire professionally?

Professionally, there have been many people (both senior and junior) past and present who I admire for a multitude of reasons; including their professionalism, patience, knowledge, determination, resilience and enthusiasm. They have passed on little gems of information – through their actions and words. These individuals know who they are and I cannot thank them enough for their support over the years.

I have been involved in the sport of rowing for over 30 years and, as a coxswain, I have been involved in boats that had world-class coaching and two coaches particularly stand out, despite their very different coaching manners. They both fostered a strong team commitment, had the ability to personalise their coaching to bring out an individual’s full potential (and beyond), and kept the focus on the process (rather than the outcome). For this I have huge admiration and have learnt to apply these techniques to my academic career.

Finally my grandfather, who passed away 4 years ago was a very important person in my life, along with a great work ethic (and zest for life) he was an incredibly well-respected rugby coach who had a unique ability to bring out the best in teams.

Any words of wisdom for aspiring endocrinologists out there?

Take the unexpected opportunities that present themselves (they could be the best decision you ever make) and if you are unsure find a mentor, who you trust and who is honest and constructive (listen to their advice, even if it is not what you want to hear). Remember that an academic career comes with disappointments. I don’t use the word failure as none of us fail, we just take different paths to successes, so it is important to persevere and build resilience but most importantly enjoy what you do!

 

You can hear Professor Hodson’s Starling Medal Lecture, “Hepatic fatty acid metabolism: the effect of metabolic and nutritional state” on Monday 19 November, in the Lomond Auditorium at 14:45-15:15. Find out more about the scientific programme for SfE BES 2018.

Meet the Endocrinologist: Ursula Kaiser, expert in neuroendocrine regulation of puberty

Meet Ursula Kaiser, Professor at Harvard Medical School and Chief of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital. Her research is focused on neuroendocrine regulation of puberty, reproductive health and fertility. She has been awarded the SfE International Medal and will be delivering her Medal Lecture at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, she tells us more about her work and what she is looking forward to at the SfE BES 2018 conference.

Can you tell us a little about your current position and research?

At Harvard Medical School and as Chief of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital, I lead and direct a group of over 60 clinical and research endocrinologists at a large academic medical center. My laboratory studies the genetic and molecular mechanisms underlying the neuroendocrine regulation of reproductive development and function, with an emphasis on the mechanisms regulating gonadotropin-releasing hormone (GnRH) and gonadotropin production. We use translational approaches including clinical and laboratory observations in humans, investigations in mouse models, and molecular and cellular studies to elucidate the molecular and biological underpinnings of reproductive disorders.

Can you tell us a little about what inspired you into endocrinology?

I grew up in Canada, where I received my undergraduate degree in biology at University of New Brunswick followed by my medical degree at University of Toronto. Early in medical school, I became fascinated by the feedback loops of endocrinology and by the many systems affected by hormones, and was quickly convinced that endocrinology was my calling. I completed my clinical training and licensure in internal medicine and in endocrinology in Toronto, but became intrigued by the molecular underpinnings of endocrine disorders. I moved to Harvard Medical School and Brigham and Women’s Hospital to pursue basic science research training in the regulation of gonadotropin gene expression under the mentorship of Dr. William Chin in the Genetics Division. My initial research focused on the mechanisms of differential regulation of luteinising hormone and follicle stimulating hormone; more recently, I have moved “further up” the hypothalamic-pituitary-gonadal axis to study the neuroendocrine regulation of GnRH secretion.

What you are most proud of in your career so far?

Scientifically, I’m most proud of our discovery that mutations in a gene known as MKRN3, or Makorin Ring Finger Protein 3, cause central precocious puberty. This was the first major genetic cause of precocious puberty to be identified and is now recognized to explain close to half of all cases of familial central precocious puberty. This discovery has identified the first known inhibitor of human GnRH secretion and has opened up an entirely new field of investigation. It is also important translationally and has highlighted the role of genetic imprinting in the control of human pubertal timing. I’m particularly proud of this accomplishment because of its collaborative and multidisciplinary nature – it has involved an international network of collaborators and has helped to launch the careers of several of our trainees.

What are you presenting in your Medal Lecture at SfE BES 2018?

I will be talking about our discovery of the role of MKRN3 in the timing of puberty and the link of loss of function mutations in MKRN3 with central precocious puberty.  In particular, I will expand on the studies we have performed since discovering this link in order to better understand the role and mechanisms of action of MKRN3 in puberty onset.

What are you looking forward to at this year’s conference?

I’m particularly looking forward to seeing my British and other international friends and colleagues, to catch up and hear about their new work, and to discuss ongoing and potential future collaborations. One thing that I would recommend to others is to take maximum advantage of the opportunity to catch up with new advances in their fields and to network with colleagues. It’s a great opportunity to meet new colleagues and make new connections!

What do you think are the biggest challenges in endocrinology right now?

Two of the biggest challenges in endocrinology are addressing the rising rates of obesity and diabetes mellitus. The prevalence of these metabolic disorders is rapidly increasing, not only in developed countries, but also in the developing world. We need more research to better understand the pathogenesis of these metabolic disorders. Interestingly, neuroendocrinology is increasingly recognized to play a key role in metabolic disorders, with neuropeptides and neural circuits playing key roles both in appetite and energy homeostasis, as well as linking metabolism to other areas of physiology such as reproduction and growth.

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

I believe that neuroscience is an incredibly exciting area that is poised for major breakthroughs. The combination of advances in human genetics together with advances in our abilities to study the brain are allowing neural circuits to be mapped in detail and are leading to new discoveries in mechanisms underlying neurological and neuroendocrine diseases. I am hopeful that these advances will in turn lead to new treatments for these disorders. Endocrinology is particularly important for our understanding of sex differences in predisposition to and responses to treatments for neurological disorders, such as Alzheimer’s and Parkinson’s disease.

In addition, advances in our understanding of neuroendocrine circuits will lead to new therapies targeting neuroendocrine pathways controlling metabolism and reproduction. The recent discovery that menopausal vasomotor symptoms (i.e., hot flashes) are mediated by the neuropeptide, neurokinin B, and that neurokinin B antagonists can effectively target and reduce the frequency of these vasomotor symptoms, is a great example of such a breakthrough.

What do you enjoy most about your work?

I’m so fortunate to have one of the best jobs in the world! My work is intellectually and socially stimulating. No two days are alike – between teaching students, doing research, and seeing patients, I’m learning new things every day. I have wonderful opportunities to meet and interact with a broad variety of interesting and kind people.

Any words of wisdom for aspiring endocrinologists out there?

Endocrinology is a fantastic field! The diversity of endocrine disorders and the multi-system effects of hormones leads to a very integrative field that is intellectually stimulating and satisfying. There is still so much to be learned and so many research questions to be answered. Furthermore, the endocrine specialty provides the opportunity to have sustained, long-term relationships with patients and to observe the impact of treatment on their health and quality of life.

You can hear Professor Kaiser’s International Medal Lecture, “Puberty: what are the neuroendocrine triggers for the biological end of childhood?” on Monday 19 November, in the Lomond Auditorium at 14:15-14:45. Find out more about the scientific programme for SfE BES 2018.

Meet the Endocrinologist: Matthew Simmonds, expert in pancreatic transplant genomics

Meet the Endocrinologist: Meet Dr Matthew Simmonds a Senior Lecturer in Biomedical Science at the University of Lincoln. His research is focused on the genetics of pancreatic transplant function and he will be presenting at the Early Career session at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, he tells us more about his work and what he is looking forward to at the SfE BES 2018 conference.

Can you tell us a little about your current position and research?

I am a Senior Lecturer at the University of Lincoln where I have been now for just over two years.  My research career has revolved around trying to identify genetic contributors to a series of autoimmune endocrine diseases including autoimmune thyroid disease and type-1 diabetes.  My current research is specifically focused on looking at genetic predictors of long-term pancreas transplant function in people with severe type 1 diabetes.

What inspired you in to this field?

The immune system is amazing and without it we would never have survived and evolved on this earth. What I find so interesting about the autoimmune endocrine diseases is how the immune system, which is meant to protect us, actually starts to attack parts of the body leading to changes in how the endocrine system works.  I am passionate about understanding how disease pathways are triggered/progress and how we can use these insights to inform better treatments for people with these different conditions.

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

I think the major challenge within pancreas transplantation is both the number of donor organs available for transplantation into people with severe type-1 diabetes and trying to ensure that the transplanted organ remains functional throughout the recipient’s life to ensure the benefits these transplants provide, of retuning insulin production and halting/reversing secondary diabetes related complication in that person, remain for as long as possible.

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

I think both the advances being made in using induced pluripotent stem cells, combined with gene editing, to create new beta cells, will provide unparalleled new opportunities for transplantation purposes. Combined with the decreased costs around genome and other proteomic screening for patients and our increased understanding of how genetic variation impact upon autoimmunity and transplant success this will give us new understanding of disease progression and provide better individual tailoring of therapeutics.

What will you be doing at SfE BES 2018 in Glasgow?

Well as you have asked – nothing like a bit of shameless plugging – I will be doing a talk on the Tuesday as part of the Early Careers session ‘Navigating the Academic Pathway’.  My talk is entitled ‘The lectureship route’ where I will be providing some insights into this career pathway, the challenges and benefits of this route and some tips on how to be get such a position.

What are you looking forward to at this year’s conference?

I think as an early career researcher I loved going to conferences to be able to present my work and network with others working in the field – which is the same reason I enjoy attending conferences to this day. Whilst there are lots of fantastic talks, plenaries and other sessions throughout the conference with something to suit everyone’s research interests, one thing I would suggest to early career researchers is to take time to speak to other early career researchers at the poster sessions and after their talks.  You would be surprised how much you have in common with other researchers and how random conversations at conferences can lead to new collaborations and possibly job offers in the future.

Who do you most admire and why?

 I have been really lucky to have worked with some of the most amazing researchers in diabetes and endocrinology throughout my career so far – both in the centres I have worked and through numerous collaborations. I have been very lucky to have some amazing mentors throughout the years, and think that whatever stage in your career you are at it is important to keep listening, learning and being inspired by researchers at every level.

What words of wisdom do you have for someone starting out in research?

These type of questions always make me feel old.  Joking aside, I think the best advice I can give to any early career researcher is to think about where you want your career to go but don’t be so rigid in your approach that you may miss out on some unexpected opportunities that come your way. Also listen to your gut feeling about career decisions.  Whilst is it perfectly normal to be scared to take on new challenges be it new techniques, moving into different project areas or new jobs, sometimes you instantly know if something is a good or a bad move. From my own experience I have learnt that sometimes saying no to something that is not right for you is as important as the opportunities you say yes to.

You can hear Dr Simmonds presentation, “The lectureship route” on Tuesday 20 November, as part of the Early Career: Navigating the Academic Pathway session at 16:00-17:30. Find out more about the scientific programme for SfE BES 2018.

 

 

Meet the Endocrinologist: Jeremy Turner, expert in bone and calcium endocrinology

Prof Jeremy Turner is a consultant endocrinologist at Norfolk and Norwich University Hospitals NHS Foundation Trust. He has a particular clinical interest in calcium and metabolic bone disorders and is a convenor of the Society’s Bone and Calcium Endocrine Network.

What inspired you into endocrinology, and bone and calcium in particular?

I was fortunate enough to undertake my early postgraduate training in endocrinology at the (then) Royal Post Graduate Medical School/Hammersmith Hospital in the mid-1990s, where I worked with some inspirational colleagues in the bone and calcium field. I then went on to undertake an MRC clinical training fellowship in Raj Thakker’s lab in Oxford. The latter experience firmly cemented the place of calcium and bone endocrinology in my endocrine repertoire.

Can you tell us a little about your current work?

I have been consultant endocrinologist for the last 9 years in Norwich and was more recently promoted to honorary professor at the Norwich Medical School. I run the clinical metabolic bone/calcium service in Norwich with my great friend and colleague Professor Bill Fraser. We have established a good reputation for our clinical service and referrals come in from far and wide. We provide over 120 consultant delivered lists per annum and have succeeded in getting Norwich recognised as a Paget’s Association Centre of Excellence.

Historically, bone and calcium disorders have been somewhat “Cinderella” conditions in the wider context of endocrine services and I particularly enjoy advocating for this population of patients and developing services in this area. I am medical advisor to Hypopara UK and of course promote the charity and its work to our large population of hypoparathyroid patients. I have led the writing of a number of clinical guidelines including a post-operative hypocalcaemia avoidance and management guideline, have developed services such as a one-stop osteoporosis clinic and am currently working with colleagues in Cambridge to set up a rare bone disease network in the East of England. Naturally, the achievement I am proudest of is being appointed as a network convenor for the Bone and Calcium Endocrine Network of the Society for Endocrinology!

Over the last decade or so, what do you think have been the most useful/impactful advances in bone and calcium?

As a pure endocrinologist, the single most exciting advance has been the arrival of recombinant human parathyroid hormone (PTH) for the treatment of hypoparathyroidism. Finally, clinical endocrinologists now have a “full set” of replacement hormones to use in hormone deficiency states and this day has been a long time coming. However, no answer to this question would be complete without reference to the arrival of the many new therapies for osteoporosis and perhaps, as importantly, the expansion in understanding of treatment of osteoporosis that has occurred in recent years. This has included appreciation of risks of treatments as well as benefits, how to use the different therapies, where they fit in relative to each other, the growing use of bone markers, fracture risk calculators and so on – all of which are driving more nuanced, considered and targeted clinical approaches to treatment of osteoporosis.

What do you think are the biggest challenges faced by endocrinologists?

In my opinion, the biggest challenge faced by all endocrinologists has to be management of remorselessly growing demand. The population is expanding and ageing and at the same time more treatments are available across endocrinology. Awareness is growing amongst patients and general practitioners and thus referral rates are rising. This is a good thing, it means that our specialty is able to help more and more people for whom perhaps help was not always available in the past and also means that the place of endocrinology in clinical medicine as a whole is better recognised and appreciated. However, it is up to us to manage this demand, find new ways to see and treat as many people as possible and to modernise aspects of our practice. Not changing how we work is probably not an option!

Are there any controversies in bone and calcium endocrinology?

Of course there are many controversies but one of the greatest at the moment is probably the recent recognition of the end-of-treatment effect of anti-RANK ligand therapy whereby fracture rates may rise quite fast in some patients upon withdrawal of this therapy. This is a very pressing clinical challenge as numbers on this exciting and novel treatment are quite large, we have been using this for a period of time that means that some are already arriving at what was originally intended to be the end of treatment but now we know that simply stopping the treatment is probably not the best option for many patients. At the same time, there is a relative lack of evidence base to inform us with regard to what we should be doing next. While it is helpful that some guidance is beginning to emerge, this is largely based on expert opinion and it will be very interesting to see how this controversy unfolds over the next few years.

What do you enjoy about being an Endocrine Network convenor?

 So far it is early days but I am enjoying working with my co-convenor (Caroline Gorvin), with colleagues in the society and am looking forward to playing my own very small part in further raising the profile of bone and calcium medicine and research within endocrinology.

Do you have any words of wisdom for aspiring endocrinologists?

Yes, this is perhaps the easiest question; Enjoy your endocrinology! If you are enjoying your clinical practice you will be happy and more importantly your patients will be happy, correctly diagnosed and correctly treated.

 

The Endocrine Networks are platforms for knowledge exchange and collaboration amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses. The Networks enable members to discuss and find solutions to challenges within their specialist field.

To join an Endocrine Network login to the ‘My profile’ section of the Members’ Area and select ’Endocrine Networks’.

Meet the Endocrinologist: Dr Barbara McGowan, expert in obesity and bariatric surgery

Barbara McGowan is a consultant in diabetes and endocrinology at Guy’s and St Thomas’ in London, and a convenor of the Society’s Metabolic and Obesity Endocrine Network. Dr McGowan leads the obesity bariatric service at the hospital and her areas of research interest include gut hormones and remission of type 2 diabetes post-bariatric surgery.

What inspired you into endocrinology?

My initial biochemistry degree was inspired by a wonderful chemistry teacher. I had considered medicine at that time but the thought of a further five years in higher education was enough to suppress those feelings. I then tried my hand at selling my soul to the city and five years as an investment banker was enough to rekindle my spirit and courage to go to medical school. My love for molecules and metabolism made endocrinology an easy choice for me. I was lucky enough to stumble across Prof Meeran and Prof Bloom during my SHO years, who steered me towards a PhD in gut hormones and appetite control, which was supported by an MRC clinical fellowship. In 2009 I took a consultant post at Guy’s & St Thomas’ where I was tasked with developing a leading obesity service from scratch.

Tell us a little about your current clinical work

My work involves management of general and complex endocrinology, with a focus on hereditary endocrine disorders such as SDH disease and multiple endocrine neoplasia. As a lead for the medical obesity service, I also run a Tier 3/Tier 4 obesity service. My clinical research involves the running of several clinical trials on pharmacotherapy and metabolic surgery for the treatment of obesity. I am most excited about trying to understand mechanisms for weight loss and remission of type-2 diabetes post-bariatric surgery.

What do you think have been the most impactful advances in obesity and metabolism clinical practice?

From a clinical point of view, with the exception of metabolic surgery, we have had very little in terms of clinical advances for the treatment of obesity, which is quite surprising given that we have an epidemic of this disease. We have medication coming through but this is still not available in the NHS.

What do you think will be the next big breakthrough for treatment of obesity?

I am hoping that we will soon have much more effective pharmacological treatments that will include more powerful GLP-1 agonists and gut hormone combination therapies, to replicate outcomes from bariatric surgery, but without the surgery. The aspiration is to have better molecular markers that will help us to select patients likely to respond to different therapies.

What do you think are the biggest challenges faced by your clinical specialty?

Attracting high calibre trainees is big challenge. Endocrinology used to be considered an academic specialty, however service provision in NHS Trusts has become a burden that has detracted from the specialty. Furthermore, physicians wishing to pursue an academic career face funding challenges.

Are there any controversies in your practice area? How do you think they will be resolved?

Stigma regarding obesity is still rife, we need to educate the public, media and healthcare professionals and recognize obesity as a chronic disease. Until such time, prevention and treatment of obesity is unlikely to be prioritised.

What do you enjoy about being a Network convenor?

As a convenor, I am able to push the obesity agenda to help ensure it is well represented at SfE meetings. I was able to set up an annual Obesity Update conference at the Royal College of Physicians, and now run by Bioscientifica. The Network makes you part of an obesity family and allows like-minded people to get together and collaborate. Recently, I was able to use the Network to ask for opinion and support as to whether ‘Obesity should be recognized as a disease’. I would urge all members interested in obesity to join the network.

Do you have any words of wisdom for aspiring endocrinologists?

Endocrinology is a wonderful specialty, it spans many important organs and provides a diagnostic challenge for disease management. Do not be put off by the uncertainties and go for it! Speak to your mentors, friends and colleagues for advice, it is a friendly community. And for those interested in obesity as a specialty, sign up to the Network and I look forward to speaking to you!

The Endocrine Networks are platforms for knowledge exchange and collaboration amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses. The Networks enable members to discuss and find solutions to challenges within their specialist field.

To join an Endocrine Network login to the ‘My profile’ section of the Members’ Area and select ’Endocrine Networks’.