Resolving Uncertainties in Diagnosis & Management of Thyroid Neoplasia

DrP10 Carla Moran Photo Carla Moran is a Consultant Endocrinologist at the University of Cambridge and a convenor of the Society’s Thyroid Endocrine Network. In 2017 she was awarded a Society Themed Scientific Meeting Grant to hold the one-day meeting, Resolving Uncertainties in Diagnosis & Management of Thyroid Neoplasia, on 8 March 2019 at Churchill College in Cambridge. The meeting brought together international and UK experts, as well as practicing clinicians and non-clinical scientists, to discuss advances in the field. Here Carla gives us a report of the day.

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

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

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

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

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

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

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

Meet the editor – Professor Martin Haluzík

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

Tell us about your particular field and research?

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

What techniques do you use in your research?

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

What inspired you into endocrinology?

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

What do you enjoy most about work?

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

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

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

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

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

Who/what research has inspired you the most?

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

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

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

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

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

Tackling inaccurate and misleading reporting on science in the media

A story published on Saturday in The Times has provoked outrage amongst some Society members.

Dr Richard Quinton and Dr Channa Jayasena, two of our expert Media Ambassadors, contacted the Society Press Office to express their grave concerns over the article: The £195 hormone cream that’s changed my life by Olivia Falcon.

Both Dr Quinton and Dr Jayasena feel that this article is written and presented in an irresponsible way that is misleading to the reader, on a potentially unsafe and improperly tested product. The Society is committed to helping promote accurate and responsible reporting of endocrinology-related topics in the media, so we passed their concerns, in the form of the open letter below, to The Times.

Dear Editor

In 1916, a $20 fine was levied in Rhode Island, USA for the misbranding of Clark Stanley’s Snake Oil Liniment to treat rheumatism and bunions and animal bites. The term ‘snake oil salesman’ is still used today to describe someone who knowingly sells fraudulent goods. Anti-ageing products are in ever-increasing demand. Whereas, cosmetic (i.e. non-medicinal) products are established in the market, there is growing speculation that hormone (endocrine) supplementation could provide additional benefit for older men and women. However, it is critical to understand that products claiming to alter the endocrine (hormone) system should be termed drugs, and are quite rightly subject to rigorous safety regulation. Crucially, the websites from which Endo-Test cream can be purchased explicitly state that “it is for scientific or laboratory use only and not for human consumption”.

Endo-Test cream described in last Saturday’s edition claims to ‘increase testosterone levels dramatically’ and nearly double sperm count and The Times’ journalist reported that these claims were based on an independent study by the manufacturer. However, we were unable to find any evidence of scientific peer review or publication of these findings. Furthermore, there is currently no medication in existence known to increase a man’s sperm count, so the findings appear improbable.

Interestingly, whereas The Times’ journalist correctly described Endo-Test cream as a “hormone cream”, the AQ company website claims prominently that Endo-Test is “hormone-Free”. For the record, the cited ingredients include a human androgen (testosterone-precursor) hormone (DHEA), a major insect moulting hormone (20-hydroxyecdysone) and a synthetic hormone (Gonadorelin) whose clinical application in humans is to shut down reproductive hormones entirely for men with prostate cancer and women with endometriosis, or as part of hormone treatment of trans-gender individuals. The extent to which these are absorbed through the skin, as opposed to through their conventional routes of administration, has likewise not been substantiated. 

To protect the interests of the public, it is important that manufacturers make substantiated claims and that journalists scrutinise evidence of these claims prior to publication. Without this, how would people know whether or not ‘snake oil’ was indeed the fountain of youth?

Dr Richard Quinton MA MD FRCP, Consultant Endocrinologist, Newcastle-upon-Tyne Hospitals

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

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

*Please note these views are of expert members Channa Jayasena and Richard Quinton, and do not necessarily reflect the official position of the Society for Endocrinology.

The Times is now looking into the matter and will report back to us on how this will be addressed shortly. Our Media Ambassadors have successfully worked with Health and Science correspondents at The Times in the past to ensure accurate and responsible reporting, and we look forward to continuing to work with them on endocrine-related stories in the future.

UPDATE 8 March 2019 – The Times have now taken this article down, we thank them for their assistance with this matter and taking this positive action.

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

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

 

 

 

 

 

 

How an endocrine disease may have shaped British history

At SfE BES, Ashley Grossman, Professor of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, gave a presentation entitled, ‘What killed Queen Mary’. In our latest interview, he tells us about his investigation into the unclassified illness that plagued Queen Mary and ultimately led to her premature death, and what we can learn from her tragic story.

Can you tell us why you think Queen Mary’s death was endocrine related?

Reading through Mary’s life history, which is quite a sad story, it seemed to me that something endocrine-related may have been going on and I came up with some interesting conclusions about her death. Mary was unfortunately plagued with illness throughout her life and her documented symptoms included her periods stopping, she starting to lactate, suffered from increasingly bad headaches and, just before Mary died, she began to go blind. All of these symptoms suggest she was suffering from an expanding prolactin-secreting pituitary tumour. Increased prolactin levels would explain her lactation and amenorrhoea. As the tumour expanded it would have compressed the brain, including the optic nerve leading to blindness. It may also have made her infertile explaining her failure to produce an heir. Ultimately, as the tumour expanded it likely placed pressure on vital areas within her brain  that may have been the cause of her early death in 1558 at age 42.

What sparked your interest in Queen Mary?

 I confess, initially I did not know much about history or Queen Mary. However, when my third daughter pursued history as an undergraduate and then as a Master’s degree student, it sparked my interest. I delved in and began reading books on the Tudors and Mary seemed quite fascinating. The fact that she died so young and childless was pivotal, as it completely altered the course of British History. If she had produced a child, then Britain would have remained catholic and Phillip II would have become King, dramatically changing history, with no future Elizabeth I on the throne.

Is there any way we could prove your theory?

Of course, the conclusion that Mary died from a pituitary tumour remains speculation. However, renowned Austrian physician – Victor Cornelius Medvei, whose passion for endocrinology led him to write the definitive textbook – A History of Endocrinology – also investigated the death of Queen Mary in some detail. To my delight his conclusions, discussed with Prof. Howard Jacobs, matched my own and reading his research really firmed up what I thought.

Mary’s buried in Westminster Abbey, so we could do a computerised tomography scan of her coffin to see whether or not her pituitary was indeed enlarged. However, I don’t think the monarchy would be very happy for anyone dig up her coffin and do that! To make a diagnosis on someone who lived hundreds of years ago is not hard science, but it is amazing to think that a pituitary tumour changed the course of British history.

What can we learn from your research?

Although historical, I think there certainly are things people can learn from Mary’s tragic story. I believe it’s important that people recognise how much life has been transformed by modern medicine, and how lucky we are to have treatments to disorders that just a few hundred years ago were highly debilitating or even lethal. For example, what destroyed the catholic British monarchy can now be treated simply with a few tablets and the disease might virtually disappear.

Ashley Grossman presented ‘What killed Queen Mary’ at the annual SfE BES conference in Glasgow on 20 December 2018. Discover more about the work of endocrinologists in our Meet the Endocrinologist series of blog interviews.

Meet the Endocrinologist: Joseph Takahashi, expert on the genetic and molecular basis of circadian rhythms

Meet Joseph Takahashi, Professor of Neuroscience at the Howard Hughes Medical Institute at UT Southwestern Medical Centre. His research focuses on the genetic and molecular basis of the circadian clock in mammals. He has been awarded the SfE Transatlantic 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. 

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

I’m an Investigator in the Howard Hughes Medical Institute, and Professor and Chair of the Department of Neuroscience at the University of Texas Southwestern Medical Center in Dallas, Texas. My lab studies the genetic and molecular basis of the circadian clock in mammals. More broadly we are interested in the genetic basis of behavior. My lab is known for discovering the first circadian gene in mammals known as the Clock gene.

One of the initial surprises from cloning the mammalian clock genes was that they are ubiquitously expressed. This eventually led to the discovery that the circadian clock is cell autonomous and that virtually every cell in the body has the capacity for circadian oscillation. Thus, all of our major organ systems contain intrinsic circadian oscillators. This has led to a revolution in studies aimed at understanding the role of clocks in peripheral tissues as well as studies focused on understanding the systems level organisation of the multiple clocks in the body. The core circadian molecular pathway regulates thousands of genes in mammals, and this has led to the discovery of direct molecular links to a myriad of molecular, cellular and physiological pathways. These include direct links to endocrinology, metabolism, immune function, cell growth and cancer.

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

I have been incredibly fortunate to have had great mentors and colleagues as well as research institutions and funding agencies that have supported me throughout my career.  In college, I was interested in biology, but did not know what careers one could pursue except for med school. Later I had the good fortune to do an independent research project and learned that one could go to graduate school in biology(!). That was the beginning of my research career.  I took a post-baccalaureate year to work with Patricia DeCoursey, one of the pioneers in mammalian circadian rhythms, and then went to work with Michael Menaker for graduate studies. Menaker was the perfect mentor for me. He had a free and open lab environment that encouraged creativity, independence and scale and automation. We pioneered long-term ex vivo culture of tissues that contained and expressed circadian rhythms in the late 1970’s. These initial forays continue to pay off decades later as the entire circadian field uses large-scale data collection, automation and long-term in vitro circadian models.

After graduate school, I did a 2-year post doc with Martin Zatz at the NIH where we worked on the pharmacology circadian rhythms in the chick pineal in vitro.  I was then recruited to Northwestern University by Fred Turek. As an independent faculty member at Northwestern, my lab focused on reductionist dissection of the circadian oscillator in the chick pineal.  In addition to pharmacology, we worked on the biochemistry of various circadian pathways in the pineal.  However, eventually we were stymied, and my interest in the molecular biology and genetics of circadian rhythms was growing.  We knew that molecules and genes had to be important for mammalian circadian rhythms, but how to get there?  That was the beginning of my ‘second career’ as a geneticist.  Ironically as an undergraduate, I was not very interested in molecular biology or genetics (I was interested in animal behavior), but luckily I ‘had’ to take these courses.

In 1990, Larry Pinto, Fred Turek and I decided to use mouse genetics to try to find circadian rhythm mutants. We collaborated with William Dove at the University of Wisconsin-Madison, and Martha Vitaterna conducted our first screen of mice that were ENU mutagenised in the Dove lab.  In our first screen, we isolated the Clock mutant mouse which has a 28-hour period length and a loss-of-rhythm phenotype in circadian activity.  This mutant mouse then provided the means to identify the Clock gene by positional cloning. The isolation of the Clock mutant and the positional cloning of gene was the crowning achievement of my lab.

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

I plan on giving an historical account of our forward genetic approach to finding clock genes in mammals. The effort to clone Clock was massive.  Ten members of my lab worked together as a team for three years to complete the project. In the 1990’s there was no genome sequence. The Clock gene turned out to be huge: it had 24 exons and covered over 90 kB of genomic DNA. Then I will discuss more recent molecular and genomic analyses of the circadian clock gene network. Finally, I will describe our new work on the importance of time and caloric restriction for aging and longevity.

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

I am very much looking forward to seeing all the advances in the field of endocrinology as well as the plenary lectures.

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

It is of paramount importance to support research in basic science. It is very important to translate these basic science discoveries, but one must remember where these advances had their beginnings.  It is impossible to predict new discoveries and how they will impact medicine in the future.

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

Many important breakthroughs in the circadian field will be their connections to all aspects of cell biology, cancer and metabolism. New views of metabolism and longevity are already being linked to circadian biology.

What do you enjoy most about your work?

I love the fact that we are supported to pursue knowledge and discovery of biological systems.  Making scientific discoveries is like a treasure hunt for adults.  It never gets old, and one discovery always opens the door to countless new questions.  Also, as an academic, we have intellectual freedom that is rare in other professions.

Who do you most admire professionally?

My role models have been: Seymour Benzer at CalTech, who pioneered genetic approaches to complex behaviors; Eric Kandel at Columbia, whose systematic and scholarly approach to understanding learning and memory in simple model systems was fundamental; and Denis Baylor at Stanford, whose biophysical analysis of phototransduction was a thing of beauty.

Any words of wisdom for aspiring researchers out there?

My mantra is:  Always begin with first principles. What I mean by this is that you must understand what you are doing. To an electrophysiologist or biophysicist this is self-evident. But in today’s world of molecular biology and informatics, the kits that you use in the lab and the computer programs that you employ are frequently applied without a fundamental understanding what they are doing and how they work.

 

You can hear Professor Takahashi’s SfE Transatlantic Medal Lecture, “Circadian Clock Genes and the Transcriptional Architecture of the Clock Mechanism” on Monday 19 November, in the Lomond Auditorium at 18:00. Find out more about the scientific programme for SfE BES 2018.

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: Maria-Christina Zennaro, expert in the genetic mechanisms of aldosterone-related disorders

Meet Maria-Christina Zennaro, a professor in the Paris Cardiovascular Research Center at the French National Institute of Health and Medical Research (Inserm).  She specialises in genetic mechanisms of aldosterone-related disorders. She has been awarded the SfE European 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?

I am a research professor heading the team exploring the genetic mechanisms of aldosterone-related disorders at the Paris Cardiovascular Research Centre at the French National Institute of Health and Medical Research (Inserm). My team is interested in unravelling the genetic and genomic mechanisms of aldosterone-related disorders, particularly primary aldosteronism, by combining clinical work with genome-wide strategies and mechanistic studies in cell and animal models. I am also an associated investigator at the Genetics Department of the European Hospital Georges Pompidou (HEGP) in Paris, where I coordinate the genetic diagnosis of pseudohypoaldosteronism type 1 and primary aldosteronism at the genetics laboratory, which is the French referral centre for the genetic diagnosis of these diseases.

What inspired you into endocrinology?

I received my MD and board certification in endocrinology at the University of Padova (Italy) and completed a PhD in molecular endocrinology at the University Pierre et Marie Curie in Paris. I had the chance to have great mentors, in particular Decio Armanini, who shared his passion for research with me, and John W Funder, who has supported my career ever since. In Paris, I had the chance to work with major players in the field of arterial hypertension and aldosterone, setting the basis for my future research.

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

After obtaining a tenured position as an Inserm researcher twenty years ago, I developed my own research group, which is now benefitting from the outstanding environment of the Paris Cardiovascular Research Centre and HEGP. I am particularly proud of having been able to create our research group, with the successive recruitment of two great researchers, with whom I have taken pleasure in sharing my working career with for many years.

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

I will present an update on the genetic and molecular mechanisms involved in the development of primary aldosteronism. In particular, I will summarise our current knowledge on the genetics of primary aldosteronism, notably our recent paper identifying a new gene in early onset primary aldosteronism, and discuss the pathogenic mechanisms leading to increased aldosterone production and cell proliferation. I will also discuss perspectives for clinical management of patients and open questions to be addressed by future research.

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

There are many great sessions on the adrenal gland, featuring world-leading experts in the field, which I highly recommend. There are exciting plenary lectures and I am looking forward to hearing about the influence of the microbiome in endocrine disease on Tuesday afternoon.

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

I think the challenges are threefold. First, the scientific challenge of improving our understanding of common and rare endocrinological disorders. Second, to be able to efficiently transfer this knowledge to patient care, in particular the knowledge generated from large-scale ‘omics’ studies. Improving diagnosis, management and implementation of precision medicine in clinical practice is really important, and should be affordable and available for everyone anywhere. Lastly, but not least, a major challenge is gathering funding for research in endocrinology.

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

I hope it will be the development of new diagnostic procedures for endocrine hypertension, which will have a major impact on treatment of those patients and prevention of cardiovascular and metabolic complications, improving their quality of life.

What do you enjoy most about your work?

Most certainly it is the scientific exchanges with my colleagues all over the world and mentoring young people to transmit my knowledge with passion to future generations.

Who do you most admire professionally?

I have had the chance to meet many extraordinary colleagues, many of whom I admire for different reasons. I particularly admire a few of my senior colleagues and mentors: I consider it a great opportunity to meet them every year at different meetings around the world, to have discussions with them and benefit from their profound scientific knowledge and incredible experience, especially when they talk about experiments they did 30 years ago!

Any words of wisdom for aspiring researchers out there?

Endocrinology requires a deep understanding of the complexity of endocrine feedbacks and interactions throughout the body. Research in the field of endocrinology is exciting, as it addresses the many questions we have on the mechanisms regulating endocrine physiology and hormone action. In this sense, it is also very diverse, ranging from genetics to cellular and molecular mechanisms, not only in hormone-producing organs but also in the multitude of target organs.

You can hear Professor Zennaro’s European Medal Lecture, “Molecular mechanisms in primary aldosteronism” on Wednesday 21 November, in the Lomond Auditorium at 15:30-16:00. Find out more about the scientific programme for SfE BES 2018.

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’.

 

 

 

10 things your Society achieved in 2017

What a year 2017 has been! Although the bar was set high in 2016, this year was just as prosperous and filled with accomplishments, thanks to the work of all those who are part of the Society.

Here are some of the things your Society achieved in 2017…

1. Doubled the number of users of You and Your Hormones, our public facing website

The Society’s commitment to disseminating accurate information and expertise to non-specialists has been fruitful this year. In July, a more engaging, easier to navigate, and optimised for mobile viewing version of the You and Your Hormones website was launched. Since then, the number of visitors has more than doubled!

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2. Made it easier for members to publish Open Access

At the start of the year, Society members were gifted with free Open Access publishing in Endocrine Connections, leading to savings of up to £950 per publication, and encouraging members to support this high quality, peer-reviewed journal in its aim to be the leading Open Access title in the field. In June, the journal received its first impact factor of 2.541. Over the course of 2017, journal submissions have doubled, and published articles have increased almost four-fold!

Find out all about this and other member benefits on our website!

3. Launched the new Endocrine Nurse Grant

In order to support our nurse community, the Society’s Nurse Committee developed the Endocrine Nurse Grant, a new grant aimed at furthering nurses’ careers and improving nursing and clinical practice.

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4. Identified our first endocrinology champions!

Aimed at advancing the discipline and increasing the profile of endocrinology, the Endocrine Ambassador scheme was launched this year. By organising small research seminars in their home institutions, and representing and promoting the Society for Endocrinology, our Endocrine Ambassadors champion endocrinology and help to increase interdisciplinary collaborations.

5. Received outstanding impact factors for Society journals

2017 has been an excellent year for Society journals – all of them receiving strong impact factors that contributed to keep making these journals a reliable, high-impact home to publish the best science.

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Endocrine Connections received its very first impact factor – an impressive 2.541.  Journal of Endocrinology’s impact factor was its highest to date at 4.706, positioning the journal as the highest ranked basic science endocrinology journal for two years in a row. The Journal of Molecular Endocrinology’s impact factor increased an impressive 21% to 3.577, making this journal the leader in its field. Endocrine-Related Cancer received 5.267, its highest impact factor since 2003. The journal remains in the top quartile of both the oncology and the endocrinology and metabolism categories. And last but not least, Clinical Endocrinology received a strong impact factor of 3.327.

6. Helped improve media reporting of over 120 endocrinology-related stories

This year, the work of our Media Ambassadors, members who provide comments or advice to help journalists cover endocrinology-related topics, have helped improve science and health media reporting for over 120 stories, a 50% increase on last year!

Check out some examples of how our Media Ambassadors have helped journalists this year.

7. Empowered our members to meaningfully engage with non-specialists

Engaging with wider, non-specialist audiences is increasingly more important amongst the scientific and clinical community. It can deepen the impact of your work in the community, and it is also expected of higher education institutions. To help equip members with the skills needed to approach public engagement successfully, we offered two free-for-members, full-day workshops: an Introduction to Public Engagement session run by the National Co-ordinating Centre for Public Engagement (NCCPE), and a Media Interview Training session run by Boffin Media. Both workshops were highly rated by participants, and were described as comprehensive and highly professional.

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Outreach training opportunities are advertised on the Society website – be sure to check it out for updates!

8. Facilitated information sharing amongst the Endocrine Networks

We love to encourage community-building, and understand that our membership has diverse interests with different needs. To facilitate the work of the Endocrine Networks, in 2017 we established the Endocrine Network webpages – dedicated hubs for knowledge exchange amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses that work in particular specialist fields.

To further promote interdisciplinary collaboration, SfE BES 2017 also introduced the Endocrine Networks Research Incubator Meetings, where a selection of research ideas were presented to a panel of experts and the audience, in order to get constructive advice, identify collaboration opportunities and get new research ideas off the ground.

Wondering how to get involved? Joining an Endocrine Network is easy – just log into the Members’ Area and select ‘Endocrine Networks’.

9. Kept you updated on the latest in the endocrine world

This spring, we offered our membership exclusive access to Society event abstracts in the new volume of Endocrine Abstracts: Society for Endocrinology Endocrine Update, which included abstracts from National Clinical Cases, Obesity Update and Clinical Update.

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10. Promoted the success of your endocrine units, and worked together to overcome challenges

The Society Interdepartmental Peer Review scheme is an opportunity to improve the work of endocrine units, and achieve better clinical practice for clinicians, nurses and patients. Relaunched this year, the scheme allows centres to identify their strengths and weaknesses, and work collaboratively to support the changes needed to facilitate the delivery of best care, backed by sustainable services.

Read more about how the scheme can help strengthen endocrinology.

 

We can’t wait to see what 2018 holds in store for us all…

Happy holidays and happy New Year!

Meet the Endocrinologist: Dr Carel le Roux, Consultant in Metabolic Medicine and Obesity Update speaker

Meet Dr le Roux, Consultant in Metabolic Medicine at Imperial College London and Chair of Experimental Pathology at University College Dublin. During his career, he successfully established an independent research group and has been an important influencer in the field of metabolic medicine. His research focuses on diabetes and obesity, specifically the increased morbidity and mortality associated with these conditions.

Dr le Roux will be speaking at Obesity Update 2018, in the debate ‘Will metabolic surgery replace pharmacotherapy for the treatment of type 2 diabetes?’ Ahead of the event, we interviewed him to find out more about his career path, research interests and his position in the upcoming debate.  

 Q: Tell us more about your background and career highlights so far?

I am a metabolic medicine physician with an interest in obesity; specifically in how bariatric surgery and pharmacotherapy can improve patient outcomes.  I graduated from the University of Pretoria and completed my specialist training in Metabolic Medicine at St Bartholomew’s Hospital and Imperial College. I was awarded a Wellcome Clinical Research Fellowship and completed my PhD at Imperial College. I then received an NIHR Clinician Scientist Award, which enabled me to set up the Imperial Weight Centre, and was then offered a Chair at the Diabetes Complications Research Centre at University College Dublin. The proudest moment of my career was receiving the President of Ireland Young Research Award at Áras an Uachtaráin.

Q: What are you currently working on?

My research investigates using a combined approach of bariatric surgery with pharmacotherapy to reverse the complications of diabetes. We are aiming to treat people with diabetic complications, e.g. diabetic kidney, renal, neural or cardiovascular disease, with both surgery and medication to put these symptoms into remission and stop the development of the disease.

Q: What most excites you about your work and the contribution you can make?

I am most excited about the opportunity to hear what obese patients report about their disease, and applying this knowledge together with basic and clinical science to pursue these symptoms and understand the mechanisms of obesity. I am also excited about the progress we have made in the field; for example, the discovery that obesity is a subcortical brain disease opens up new treatment options, while also reducing the discrimination that patients suffer.

Q: The theme of the 2018 Obesity Update debate is whether surgery is more effective than pharmacotherapy in the treatment of type 2 diabetes. Can you tell us why there is a difference of opinion on this?

Until recently, bariatric surgery – that is gastric by-pass or sleeve surgery – was not considered to be a viable treatment for patients with type 2 diabetes. However, a systematic review of 11 randomised controlled trials, published in 2013, showed that those who undergo surgery do better and outperform patients on pharmacotherapy for weight loss, glycaemic and blood pressure control. This, of course, has great implications for type 2 diabetes patients.

Given the aforementioned trials and their results the question becomes: should every type 2 diabetes patient be offered surgery as a treatment? However, the issue here is not really whether or not we should use surgery – but if and when bariatric surgery is the best strategy to follow.

Q: You will argue that surgery cannot replace pharmacotherapy but, if surgery is so successful, why not?

The main issue is that not all patients with diabetes are the same – the risks of morbidity or diabetic complications are extremely varied and thus, their treatment options should accommodate these differences and find a balance between the risks and gains of bariatric surgery vs. pharmacotherapy.

Although the risks associated with surgery are very low, they still aren’t as low as those associated with medication. Considering this, patients at high risk of diabetic complications for whom best medical treatment is not sufficient may hugely benefit from surgery. On the other hand, for those patients who respond positively to pharmacotherapy there is little value in offering surgery as well.

Additionally, we must not forget that pharmacotherapy is constantly improving. Due to such advances, if we had a randomised controlled trial today that compared outcomes between surgery and medical care, it would be very difficult to imagine that surgery would have any additional benefits beyond best medical care when it comes to mortality. We’d love to say that if you have an operation you’re going to live longer but we simply don’t have that evidence. However, we do have evidence to say that using drugs, such as a sodium-glucose co-transport inhibitor or a GLP-1 analogue, will help diabetes patients to live longer.

Q: In your opinion, when would bariatric surgery be appropriate?

We should offer surgery when it adds value to the patients – helping them to lose weight, and achieve better glycaemic and blood pressure control – and to facilitate the work of diabetologists that treat these patients. It’s not about surgery against medicine, it’s about how surgery can make medicine better. This is precisely what’s done in cancer therapy – we use surgery to control the disease, then chemo or radiotherapy to keep it in remission. We don’t expect surgery to be sufficient on its own – after surgery we still follow the patient and make sure to control all the other consequences of the surgery.

In summary, the model should shift to actually using surgery as an add-on therapy to pharmacotherapy. This way, the benefit of using surgery is that patients need much lower doses of medication. It may allow someone who needs insulin to control type 2 diabetes to move on to requiring only metformin or other oral medications. That would be a massive improvement for the patient’s quality of life. Taking it a step further, a patient with fully controlled diabetes on oral medication could use surgery to put diabetes into remission, and then use a lower dose of metformin to keep the diabetes in remission.

Q: How do you think this debate be resolved?

I think we will all agree that more surgery should be offered to patients; and that we need to use this combined treatment model more frequently in patients with diabetes, especially for those that would benefit most. However, it is how this cohort of patients will be defined that will provoke further debate.

Q: What do you enjoy doing in your spare time?

I have recently started sailing Flying Fifteens and am currently training to qualify for the World Championships in 2019.

Q: Who do you admire most and why?

Rodin – as a sculpture artist he was able to communicate very complex concepts using the human body, but he did so in a simplistic way that influenced how people thought, thus moving civilization forward.

Obesity Update 2018, an event sponsored by the Society for Endocrinology and the Association for the Study of Obesity, will be held in London, 1 February 2018. Register now to attend.