The Endocrine Post

Phillip Yeoh is a Consultant Nurse in Endocrinology working full time and currently studying for his PhD at Kings College London. His clinical interests are in adrenal diseases, endocrine cancer, pituitary diseases, endocrine cancer. In this interview he tells us about his career, the people who have shaped his experience in endocrinology and what we can expect from his SfE BES lecture.

Could you tell us about your career?

I have worked as Consultant Nurse in Endocrinology at The London Clinic for nearly 10 years now. I started an endocrine investigation unit about 22 years ago. The service is completely nurse-led. I also manage the diabetes service with several diabetes specialist nurses. I am currently doing my PhD at Faculty of Nursing, Midwifery and Palliative Care at King’s College London, where I am at my final stage doing my data analysis. I am in a group called Federation of International Nurses in Endocrinology (F.I.N.E), of which I am the President and we are collaborating with International Society for Endocrinology for a nursing program at ICE2024 in Dubai.

“I like the complexity of it. It is such a niche area and I find looking after people with endocrine conditions so interesting”

What was it about endocrine nursing that attracted you?

I like the complexity of it. It is such a niche area and I find looking after people with endocrine conditions so interesting.

What is your career highlight, to date?

I was awarded the Betsy McClung research prize at Endocrine Nurse Society last year in Atlanta. It was such an honour. This year award for Nikki Kieffer Medal was such a surprise. I knew Nikki back in 2000 when I joined endocrinology and we sat on the Nurse Committee together. This award felt like an icing on top of the cake.

Who has had the biggest impact on your career?

I was lucky enough to have so many giants in endocrinology opening up the doors for me in the last 22 years. People like Prof Mike Besser, Prof John Monson, Prof Ashley Grossman, Prof Pierre Bouloux and Prof Marta Korbonits. I am so pleased to be working with nursing colleagues in my career, like Dr Sofia Llahana, Dr Chris Yedinak, Dr Cecilia Follin, Dr Andrew Dwyer and the endocrine nurses in UK.

“Be brave, be bold and be adventurous”

What do you consider to be the most exciting developments in endocrinology?

The Society for Endocrinology’s Competency Framework for Adult Endocrine Nursing, followed by Advanced Practice in Endocrinology Nursing Textbook. They both made such impact on the development of endocrine nursing.

What are the biggest challenges your field faces?

The lack of investment and research in endocrine nursing. Hence, I went to King’s College Faculty of Nursing, Midwifery and Palliative Care to get ideas from them. There is a wealth of nursing knowledge out there that we can learn from!

Could you tell us about your lecture for SfE BES 2023:

My lecture this year is based on my experience of looking after people with adrenocortical carcinoma (ACC) for the last 23 years and my research work at King’s for the last 6 years.

Do you have any insight to guide aspiring endocrine nurses?

Be brave, be bold and be adventurous.

You can attend Phillip Yeoh’s Nikki Kieffer Medal Lecture “Lived Experience of ACC” on Tuesday 15 November at 10:55 AM.

Take a look at the full scientific programme for SfE BES 2023.

Katherine White, early career Endocrine Specialist Nurse from Maidstone and Tunbridge Wells NHS Trust discusses her experience presenting at ENU 2023 for the first time as an Endocrine Nurse

This year’s ENU was my second time attending the event. It was important for me to attend again this year for a number of reasons: first off I really enjoyed my first conference, actually being able to take the time out of work ….and still get paid for it!! In my other working environments, it had never been possible. In addition, being supported from the Society for Endocrinology with the affordability to attend was a massive help, I would not have been able to attend otherwise. More importantly, the ability to meet other nurses, and it’s not just about the networking with my endocrine colleagues, I found it really interesting chatting with people and finding out their stories, and sharing mine with likeminded people I would never have had the opportunity to meet otherwise. Additionally, it opens up the avenues of communication and information sharing, improving knowledge and working practices, so very much a win-win.

There were a variety of speakers on a variety of subjects, which enabled me to consider where I needed to prioritise and focus my own learning, being new to Endocrinology and I found this immensely beneficial.

I was encouraged by my colleague to apply to join the Nurse Committee, which I did and my application was accepted, this has opened up further opportunities, including being asked to help at the ENU this year…..which in truth was received with a nervous yes from me! However, the support received was fantastic. It was a pleasure to work with new and different people from outside of nursing but who have a shared passion. Moreover, it gave me an insight in to how the society is working behind the scenes to improve the knowledge and understanding of endocrinology throughout the UK and internationally.

The second ENU that I attended this year, I shared presenting with a non-nurse colleague, primarily as I haven’t presented in front of a group of people for a good number of years so understandably was extremely nervous. I was unsure of what the requirements would be, along with; is my knowledge good enough, will my ‘presenting voice’ be clear enough, amongst many other internal thoughts. However, I think no matter how experienced you may be at presenting there will always be that little internal voice saying something. After I presented it felt good !! yes there was relief but also a sense of achievement, it was good to step out of my comfort zone and push my personal boundaries. It was good to not only attend, but also to attend and participate and I would recommend it to all. No matter where you are in your career journey it’s always good to try something in a familiar environment with supportive colleagues. I was able to meet many new people from different environments outside of nursing as well as in, which is always quite refreshing and it opens up different viewpoints, perspectives and approaches to situations and problem solving. I will recommend this as a really good learning tool alongside building good working relationships and improving knowledge. I am looking forwards to the next ENU and meeting everyone.

Steve Millership is a Research Fellow in the Department of Metabolism, Digestion and Reproduction at Imperial College London. Last year he volunteered to help run an activity at our Schools Outreach Event at SfE BES 2022. Read on to find out how he got involved, what he did on the day and what he got out of getting involved!

Could you tell us a little bit about your career path to date?
I did my PhD at Cardiff University surrounding synuclein biology the implications in Parkinson’s disease and adipose tissue function. My postdoctoral work at the MRC London Institute of Medical Sciences (LMS) focused on the role of a group of genes known as ‘imprinted genes’ that modulate early growth and development and are altered in metabolic disease. I have since taken up a position at Imperial College London as a Research Fellow following my award of a Wellcome Trust ISSF Fellowship and am continuing to establish my research independence alongside a module lead role for MSc Applied Genomics within our Department.

What is your specialty?
Imprinted genes and the epigenome; beta cell function and type 2 diabetes

“It [w]as a perfect opportunity to give something back to the Society that has been so supportive in recent years”

How did you first get involved with the Society for Endocrinology?
When transitioning to independence I was looking for early career grants, workshops, support and SfE really stood out. I immediately initiated my early career membership!

In what capacity were you involved in the SfE BES schools outreach?
I was already planning to attend BES 2022 and saw it as a perfect opportunity to give something back to the Society that has been so supportive in recent years.

What did you enjoy most about volunteering at the SfE BES schools outreach?
I have always found teaching and mentoring extremely rewarding – it was great to meet other scientists during our session and it was a lot of fun – we were on the ‘Cell Signalling’ table passing an electric torch from person to person to show how a signal propagates through the cell – the pupils (and teachers) really seemed to enjoy it!

How did being involved with the SfE BES schools outreach benefit you?
To help support the next generation of minds through Public Engagement was fantastic – I really enjoyed the experience!

“To get involved in Public Engagement events can often put you out of your comfort zone however it is always extremely rewarding, fun – and really helps you develop as a leader and teacher”

Would you recommend other endocrinologists to get involved with the SfE BES schools outreach day?
Certainly!

Why should members volunteer for the SfE BES schools outreach event?
To get involved in Public Engagement events can often put you out of your comfort zone however it is always extremely rewarding, fun – and really helps you develop as a leader and teacher.

If you’re attending SfE BES 2023, this year we have three opportunities where you can inspire the future generation of scientists! Find out how you can get involved.

Jeremy Turner is a consultant endocrinologist at Norfolk and Norwich University Hospitals NHS Foundation Trust specialising in calcium and metabolic bone disorders. Last year Jeremy was part of an interactive session, and acted as quiz facilitator, at our Schools Outreach Event. Read on to discover how he got involved, what he did on the day and what he got out of the day!

Could you tell us a little bit about your career path to date? 
My first job as a junior at the Royal Free in 1993 was with Pierre Bouloux, endocrinology, and the rest is history! I undertook a PhD in Oxford with Raj Thakker from 1999 – 2003, I was a BHF intermediate fellow and senior lecturer at Imperial College London 2005 – 2009, I’ve been a consultant endocrinologist at Norfolk and Norwich University Hospitals NHS since 2009, and Honorary Professor of Endocrinology Norwich medical school since 2014.

What is your specialty? 
Endocrinology, sub specialist area bone and calcium endocrinology

How did you first get involved with the Society for Endocrinology? 
As a junior Dr in 1993, Richard Quinton was the SHO and he encouraged me to join the Society for Endocrinology and go to my first SfE BES conference. I’ve been almost every year since.

“[I enjoyed] giving something back and trying to share a love of our subject with people who may potentially be tomorrow’s endocrinologists”

In what capacity were you involved in the SfE BES schools outreach? 
I participated in an interactive session which was partly about careers in endocrinology and also facilitated a quiz called “Endocrine Street View” in which the audience is asked to recognise endocrine glands from clinical photographs, diagrams or scans and there are then follow up questions about the history, function or some other aspect of that endocrine axis all with a feeble attempt at a humorous spin on the subject matter (but usually not very funny!).

What did you enjoy most about volunteering at the SfE BES schools outreach? 
The sense of giving something back and trying to share a love of our subject with people who may potentially be tomorrow’s endocrinologists!

“Give something back, share your passion and…feel like you’ve done something for the great good”

Would you recommend other endocrinologists to get involved with the SfE BES schools outreach day? 
Yes! Give something back, share your passion and feel better about yourself / feel like you’ve done something for the great good!

Why should members volunteer for the SfE Bes schools outreach event? 
Ditto (pls see above answer) 

If you’re attending SfE BES 2023, this year we have three opportunities where you can inspire the future generation of scientists! Find out how you can get involved.

Edouard Mills is a Clinical Lecturer in Endocrinology at Imperial College London, last year he volunteered to run an activity alongside his lab colleagues at our Schools Outreach Event at SfE BES 2022. Read on to find out how he got involved, what he did on the day and what he got out of getting involved!

Could you tell us a little bit about your career path to date?

I graduated from medical school in 2010 and having completed my post-graduate medical training in London, I decided to pursue my passion of Endocrinology. Since 2014, I’ve been undertaking my Specialty Training in Diabetes in and Endocrinology on the Imperial College London rotation. I completed an MRC-funded Clinical Research Training Fellowship and PhD in 2022 and I am now a Clinical Lecturer in Endocrinology at Imperial College London.

What is your specialty?

My training has been in Endocrinology, Diabetes and General Medicine. My research interests are related to neuroendocrinology and in particular how reproductive hormones (including kisspeptin) interplay with human behaviour.  

“Volunteering at the SfE BES schools outreach event was a fun and rewarding way to hopefully inspire the next generation of scientists and medics”

How did you first get involved with the Society for Endocrinology?

In 2014 I attended my first ever SfE BES as a medical SHO in Liverpool where I presented a poster on the surgical outcomes from my hospital for patients undergoing benign thyroid surgery. At that time I didn’t know the SfE BES would be such a regular event in my calendar!

In what capacity were you involved in the SfE BES schools outreach?

Alongside my colleagues from Professor Dhillo’s lab at Imperial College London, we organised an activity called ‘Now YOU are the Endocrinologist’ where groups of young people from a local school had the opportunity to be guided through a real-life training exercise where they took an endocrine history, did some investigations and practiced taking blood (on a fake arm of course), processed/centrifuged the blood samples and came up with a diagnosis and management plan.

What did you enjoy most about volunteering at the SfE BES schools outreach?

Volunteering at the SfE BES schools outreach event was a fun and rewarding way to hopefully inspire the next generation of scientists and medics. Many of the young people were also interested in talking about what life away from home at university was like. It was, therefore, a good way to build relationships with people from different generations and backgrounds.

How did being involved with the SfE BES schools outreach benefit you?

Following my involvement in the SfE BES outreach event I came to realise how much I relish the opportunities that public engagement offers. I’m now a Content Editor for the SfE You and Your Hormones platform.

“Following my involvement in the SfE BES outreach event I came to realise how much I relish the opportunities that public engagement offers. I’m now a Content Editor for the SfE You and Your Hormones platform”

Would you recommend other endocrinologists to get involved with the SfE BES schools outreach day?

Absolutely – it was incredibly rewarding, and the young people were all very engaged and eager to learn. Heather and the SfE team were extremely supportive when it came to helping us develop our outreach event, given they had a similar desire to promote outreach.

Why should members volunteer for the SfE Bes schools outreach event?

Volunteering for the SfE BES Schools Outreach Event is a great way to develop science communication, have the opportunity to share our passion for Endocrinology and what we do, meet lots of nice people and have fun with it.

If you’re attending SfE BES 2023, this year we have three opportunities where you can inspire the future generation of scientists! Find out how you can get involved.

Jo Grey (AMEND CEO)

When I was (eventually) diagnosed with MEN2A in 2000, there was absolutely nothing out there for patients except the isolation of being diagnosed with a rare genetic condition.  “It’s likely you’ll never meet another family like yours”, we were told.

How some things have changed!  Now, through AMEND, which is 20 years old this year, newly diagnosed patients and families can meet others via Zoom, or at in-person Peer Support Meetings facilitated by trained patient volunteers.  They can join in with our popular Annual Patient Information Day, or they can simply chat via one of our private social media groups.

Back in 2000, there were no patient information resources about MEN syndromes.  All I had was a photocopy of a medical textbook article to help my husband and I decide when my son should have his prophylactic thyroidectomy.  Now, not only can parents easily speak to other families who have made this decision, but our disease information resources include information on genetic testing in children, and appropriate preventative surgery.  There are even resources for the children themselves, including our popular Marvel-style comic books and beautiful cartoons.  As they grow older, our adolescents and young adults have access to their own resource section on our website that also includes films about living life with an MEN syndrome, and most recently, can join one of two age-appropriate WhatsApp chat groups, moderated by our trained Youth Volunteer, Sarah.

AMEND’s disease-scope has also expanded over the years and now includes familial paraganglioma syndromes, medullary thyroid cancer and adrenocortical cancer.  Both PGL syndrome and ACC Groups now have their own identities (Phaeo Para Support UK and ACC Support UK respectively), along with dedicated websites and social medial channels and group.  Specific information resources about the diseases and support services, including our Counselling Service are all available in the usual way for these patient communities too.

AMEND is also always happy to help our health professional colleagues, from participating in medical student training, lectures on patient perspectives to trainees or at conferences, or simply by being there in clinic to talk with patients.  We took on the Phaeo Para Crisis Card resource developed by St Bart’s and made it available to order for all clinics with phaeochromocytoma patients.  As many of you will know, if there’s a conference, we’re usually there!  These are great ways of getting to meet health professional colleagues in person to discuss upcoming projects, as well as to spread the word about our resources and services for patients.

The Society for Endocrinology (SfE) has been a great source of help over the years, offering free exhibition space at British Endocrine Society (BES) and ENU conferences, patient group travel grants to help us get there, and most recently, patient group grants to help fund projects related to the provision of information resources to patients. Currently, we are part of a SfE patient committee looking at ways to raise the profile of endocrine conditions with primary care physicians.  Affiliation with the SfE and medical advisors drawn from the SfE membership helps cement AMEND’s standing as a patient group of excellence for those with rare endocrine syndromes.

It’s safe to say that, in this, our 20^th anniversary of registration as a charity in England and Wales, we can look back with huge pride at all we have achieved.  And yet there is still so much more to do!

There are still delays in diagnosis that need to be addressed and so AMEND is working with the International Neuroendocrine Cancer Alliance (INCA), and medical societies including the Society for Endocrinology to address this over the coming years.

Behind the scenes are teams of volunteers, including our Trustee Board, who are currently setting AMEND’s strategy up to 2026. Our new Strategic Plan will highlight two themes for attention over the next few years: Sustainability and Awareness.  AMEND will be looking at sustainability of both income and personnel. Awareness covers the need to raise awareness of AMEND and the diseases we cover to help aid earlier diagnosis.  We are particularly keen to involve more Endocrine Nurses in helping us spread the word and are always happy to hear your thoughts and suggestions, as well as to have you involved in any of our projects.

This year, we are starting work on two new projects; our Rare Endocrine Tumours & Syndromes smartphone App (RETS App) which will replace our MEN Passports as a repository for patients’ personal information regarding their disease and its management, and the development of a resource for GPs about each of the diseases we cover (MEN and PGL syndromes, ACC and MTC).  We hope that this resource, that will be distributed by existing patients to their GPs, will highlight what areas of management can be achieved locally, as well as raise awareness of signs and symptoms of recurrence, or of the disease in general.  Taken together with other projects with the SfE and by organisations bigger than ours, we hope that the average time to diagnosis of patients with rare endocrine tumours and syndromes will improve.

While we celebrate our successes of the past 20 years throughout 2023, we look to the next 20 years with both positivity and realism.  A new CEO will be needed from 2026 to bring the skills and energy necessary to take AMEND into the future.  Perhaps my successor will come from the Endocrine Nursing field!  Whoever it may be, they will love working for this small but big-hearted charity.

Visit AMEND’s website to learn more about the incredible support work the charity has managed over the past two decades.

Claire Stirling is an endocrine nurse specialist, who helped to found the Gender Identity Nurse Led Clinic in Grampian Aberdeen. In November 2022 Claire attended SfE BES in Harrogate and presented her poster alongside her colleagues, and was recognised with an award. Find out about her endocrine nurse specialist journey, her new-found passion for presenting research and her joy at the endocrine nurse community.

My career in nursing began with a solid training program in all areas of nursing at Robert Gordons University Aberdeen. I reflect fondly on my nursing training. I was chosen to represent Aberdeen with a fellow nursing student to visit our sister city of Houston as part of the Houston Texas Exchange Program and visit their many wonderful medical and surgical facilities. It showed me in the early stages of my career the wider world of nursing and medicine as a whole and how fruitful the exchange of knowledge between fellow nursing colleagues within our working daily lives and across the world can be. In present day I gain so much from attending endocrine conference meetings, sharing in the exchange of knowledge as I did in my early nursing training

When I graduated from nursing I began my career path in cardio thoracic, moving to the specialty of general medicine and then diabetes and endocrinology, working for many years building solid foundations in my nursing practice. I continue to preserve my overall ward nursing skills working as a general bank nurse, as well as being an endocrine specialist nurse permanently, which I became seven years ago. I feel my experience from general medical wards compliments my daily work with my patients within the endocrinology nurse speciality.

Patients I meet from the various clinics we run as endocrine specialist nurses can be complex and have other medical issues alongside an endocrine diagnosis. I am passionate about nursing as a whole and put my patients at the very centre of my daily professional nursing role as an endocrine specialist nurse.

My entry to endocrine nursing was a natural progression in my career. Over a year ago I was given the opportunity to start a Gender Identity Nurse Led Clinic with my two consultant mentors, Dr Dymott and Dr McGeoch who have been exceptionally supportive. These consultants devised the nursing role I have, having established the GIC within Aberdeen Grampian initially themselves a few years ago.

I was motivated to showcase the nurse-led GIC at SfE BES 2022 to inspire other specialist nurses to establish and develop  such a role within their own areas of endocrinology, and was overwhelmed how well received my poster presentation was at the conference and was exceptionally honoured to receive an award. I was delighted to share my experience of my nurse-led gender identity clinic and hope it inspires other nurses to do such a poster to showcase their own hard work and share a nursing clinical framework such as I did, in order for other nurses to potentially be encouraged and inspired to mirror and utilise within their own areas.

The success of my poster presentation has certainly aided my confidence and belief in myself as a practioner, my advice to other specialist nurses is don’t be scared to shine your bright light of knowledge with others. I have received nothing but positive feedback on my work from fellow nurses.

I have found the experience truly warming. The endocrine specialist nursing community is a wonderful community of professionals who support one another. I feel so inspired to present again, I encourage other endocrine specialist nurses to share their current work, research and knowledge and shine bright at the next SfE BES!

I thank my mentors Dr Dymott and Dr McGeoch within GIC, who support me in my GIC specialist role, who encouraged me to present a poster. I must also thank Dr Abraham and Dr Graveling who have given unwavering support, encouragement and inspiration in my endocrine specialty journey for these past years alongside my wonderful fellow specialist nursing team, led by lead endocrine specialist nurse Morag Middleton who I thank for their ongoing support and encouragement also.

Here is to the next endocrine conference meeting, look forward to seeing other fellow specialist nurses sharing their knowledge there. I am delighted to say I have been kindly invited to speak at the next nurse led conference in Birmingham this April, again another opportunity to shine a light of the GIC work we are doing in Aberdeen Grampian.

Claire Stirling and her colleagues, Jane Dymott and Susan McGeoch presented their award-winning poster ‘Our Grampian experience of establishing an endocrine nurse specialist service within the Gender identity clinic’.

August Palma is the first endocrine specialist nurse from Cambridge to complete the Masters-level Module in Endocrine Nursing at Oxford Brooke’s University. He is an endocrine research/specialist nurse under the Endocrine Molecular Imaging Group of Professor Mark Gurnell at the Wolfson Diabetes & Endocrine (WDEC) Clinic at Addenbrooke’s Hospital in Cambridge, UK. His area of interests include endocrine conditions of the pituitary and adrenal glands. Read on to learn about his career journey, his experience of endocrine nurse studies and his wise words for aspiring endocrine nurse specialists.

Could you tell us about your career journey?

Before coming to the UK in 2015, I was an emergency staff nurse at a local hospital in my hometown in the Philippines. I was never particularly drawn to endocrinology back then, nor had I considered specialising in endocrine nursing. The only connection I had with endocrinology was diabetes (both parents of mine have Type 2 diabetes). Nurse specialisation in the Philippines is also very limited to certain areas only such as critical care, surgical, obstetrics and dialysis to name a few. Endocrine specialist nursing in the Philippines is unheard of even up to this day.

Fast forward to when I was searching for opportunities to apply to as a nurse abroad, I attended a national conference about endocrinology in order to comply with my annual Continuing Professional Education (CPE) credits as a requirement to renew my professional license. Representatives from Cambridge University Hospitals NHS Trust had come to the Philippines to recruit nurses – the “endocrine connection” as I call it, which started in that conference I attended a few months back, seemed to have stuck with me – as fate would have it, the interviewer told me I got the job: “Well, since we don’t have any vacancies in A&E at the moment, we would like to offer you a post in the diabetes and endocrinology ward.” Of course, I didn’t say no and the rest was history.

What inspired you to choose endocrinology?

Within two years working as a staff nurse in the diabetes and endocrinology ward, I felt like I needed to do something more and progress professionally. During my very first appraisal, I mentioned to my mentor and supervisor that I wanted to pursue research. I started looking for research posts within the Trust and an opportunity to apply as an endocrine research and specialist support nurse within the same division presented itself. I have greatly enjoyed doing research for as long as I can remember and to combine it with the complexity of the endocrine system made it even more interesting! When I trained as a nurse, endocrinology wasn’t my first love because I found it really complex to understand. However, that all changed when I became an endocrine nurse because I learnt so much about treating complicated endocrine disorders, and I feel like I make a huge difference in the lives of endocrine patients. This, and the fact that I actively participate in research to improve diagnostic and treatment modalities of various endocrine conditions, inspires me to continue my journey as an endocrine research and specialist nurse.

What motivated you to apply for the SfE Masters-level Module scholarship?

Pursuing higher education was always part of my plan after finishing university.  I never got the chance to do this because my career path involved a few twists and turns before I became a nurse. Then came the time when I had to start working to earn money, so pursuing post-graduate studies was considered a luxury rather than a priority at that time. I am grateful to the Society for Endocrinology for granting me a scholarship to do the Masters-level Module in Endocrine Nursing. At first, I was a bit hesitant to apply knowing the time and effort involved (especially for someone who works full time). I thought doing this double module with a busy four-day work week would be a difficult and challenging task. After much consideration and, with the encouragement of some of my colleagues and mentors, I took up the challenge. Another motivating factor was the endocrine project expected as part of the requirements in order to complete the module. This is a chance for endocrine nurses like me to create something that would benefit endocrine patients and improve the endocrine service, in general.

“Being part of the patients’ journey from diagnosis to treatment and somehow making a difference in their lives is something I consider a proud moment for me”

What was the journey through the module and how has this influenced your career?

The journey through the module involved long hours of reading and researching be it in the clinical library at Addenbrooke’s Hospital, or virtual trips to the e-library of Oxford Brookes University. I also had to miss out on a few weekend invitations from friends or give up personal time on my days off for a few months to focus on writing my paper. In honesty, it wasn’t a walk in the park, but in the end it was all worth it. I mainly look after a specific group of patients with primary aldosteronism (PA or Conn’s syndrome) and my endocrine project was to design a standard operating procedure (SOP) to support the running of a virtual nurse-led clinic for patients with PA. This SOP will hopefully provide a systematic approach or pathway from case detection, screening, diagnosis, management and follow-up or surveillance. There are not that many centres in the world that are considered centres of excellence in dealing with PA and this is why only less than one percent are diagnosed with this condition globally when, in fact, previous studies show that among those who have hypertension, approximately five to 15 percent of them may have PA. On a global scale, this would translate to millions of undiagnosed patients with PA. PA is a surgically curable form of endocrine hypertension if it is caused by an excessive production of aldosterone from a unilateral adrenal adenoma. Bilateral PA is managed medically.

The SOP has greatly influenced the way how I follow up patients on a regular basis from starting the initial investigations, booking dynamic and confirmatory testing, keeping track of their blood pressure readings and monitoring their response to medications, and acting as liaison between them and the endocrine doctors for any specialist concerns.

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

Apart from being the first and only nurse in our Trust to complete the module so far, I am most proud of being able to help patients with PA. I feel very happy and proud when patients tell me that their lives have changed dramatically after surgery, or that they feel so much better when a diagnosis is finally made and that the appropriate medication helps provide better BP control. Unfortunately, PA is not widely known to clinicians, especially at the primary care level, and this contributes to the low diagnostic rate. Some people with PA have severe phenotypes that are characterised by resistant, refractory or uncontrolled hypertension involving multiple antihypertensive agents and they may also experience mild to severe hypokalaemia. These patients are also at a much higher risk of cardiovascular morbidity and mortality than age-and-gender matched patients with essential hypertension. Thus, it is quite important that investigations to detect and diagnose PA are not delayed and are done in a relatively timely manner. All these issues can be worsened by the patients’ poor general quality of life with fatigue being one of the most common symptoms they report. Being part of the patients’ journey from diagnosis to treatment and somehow making a difference in their lives is something I consider a proud moment for me.

Would you recommend the module to your colleagues?

Absolutely! In fact, one of my colleagues has been accepted and is due to commence soon. I am also encouraging other members of our team to do the same.

“It wasn’t a walk in the park, but in the end it was all worth it”

Do you have any advice for aspiring endocrine nurses interested in career development but don’t know where to start?

Endocrine nursing, as a whole, is a broad field with so many opportunities to specialise in for further career development, so it’s really important for an endocrine nurse to think about which area of expertise to focus on under the guidance of the Society for Endocrinology’s Competency Framework for Adult Endocrine Nursing. I believe this is the first step that each endocrine nurse should contemplate and work on. The framework is quite useful in assessing one’s progress in their career journey and level of expertise, which will guide each endocrine nurse every step of the way.

Discussing professional development goals and objectives with your line manager during annual appraisals is another way of planning ahead and looking into progressing one’s career. This is a great chance to find out if funding and resources are available within the Trust or elsewhere, i.e. NIHR, society grants or scholarships and other external sources of funding, and if full support to undertake a course can be expected from the management.

It is also important to network with other endocrine specialist nurses, engage or participate in relevant professional meetings and events to keep up-to-date with opportunities available outside the work environment.

Have you had mentors and how has this helped you so far?

I had the opportunity to be mentored by Louise Breen, the Nurse Committee chair of the Society for Endocrinology, when I did the module. As my work-based facilitator, she provided me expert insights and ideas especially during the drafting of my learning contract for the module.

I am quite lucky to work with colleagues who are very supportive and ready to lend a hand or simply share ideas with. During my appraisals, I was never turned down nor rejected when I proposed to pursue something that will help me in my career progression. My managers – Katy Davenport and Andrea Lake – encouraged me to apply for study grants, consider starting a specialist nurse-led clinic for PA, and get more involved in the set-up phase of a new clinical trial, among other things. I am grateful to all my colleagues in the Endocrine Investigation Unit at the Wolfson Diabetes and Endocrine Clinic (WDEC) for their continued support and encouragement, and also to Dr. Russell Senanayake, Dr. Waiel Bashari, Dr. James MacFarlane and Professor Mark Gurnell for always sharing their valuable time and expertise in the field. I wouldn’t be where I am today, nor would I know anything about endocrinology and research if not for the support and guidance from all of them.

“One of my colleagues has been accepted and is due to commence soon. I am also encouraging other members of our team to do the same.”

You can find out more about the Masters-level module in Endocrine Nursing, and find out how to apply on our website.

A Society Meeting Support Grant was used to fund a focused scientific meeting on physical activity and the endocrine system at Nottingham Trent University in July 2022. John Hough and Jessica Piasecki, Senior Lecturers in Exercise Physiology, Sport, Health and Performance Enhancement (SHAPE) Research Group at Nottingham Trent University organised the one-day meeting and three oral presentations were selected to win prizes at the event. Read on to learn about the prize winners and their research.

A protocol for time restricted eating in adults with pre-diabetes: the OFFSET study

Clair Prior¹*, Christopher I Morse¹, William Ollier², Adrian H Heald³, Kelly A Bowden Davies^1
1 Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Institute of Sport, Manchester Metropolitan University, Manchester, UK.
² School of Health Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
³ Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
*Presenting Author

Introduction: Nutritional interventions play a key therapeutic role in preventing, managing, and more recently reversing Type 2 diabetes (T2D). However, over half of the people referred to the NHS Diabetes Prevention Programme do not engage. Additionally, demographics such as age, sex, ethnicity, and socio-economic status are associated with a differential response and success (Valabhji et al., 2020). More acceptable and inclusive interventions need to be developed.

Aim: To investigate the effect of a dietary intervention that restricts time of eating (time restricted eating; TRE) and drinking in people at risk of T2D.

Methods: Recruitment is inclusive based on the NIHR INCLUDE ethnicity framework (2022) and will target 34 participants, aged 18-65 years, male or female, classed as pre-diabetic (HbA1c 42-47 mmol/mol). A randomised control trial design will be used to study the effects of 12 weeks TRE (limited to a maximum 10 hrs per day; n=17) versus control (usual eating/drinking; n=17). Participants will be required to record their dietary intake as baseline, week 1, 6 and 12. Two weeks of continuous glucose monitoring (CGM) and physical activity (GENEActiv) will be obtained pre and post (i.e., study weeks -2 to 0 and 10-12). Pre and post laboratory assessments include: anthropometrics, body composition, blood pressure, fasting blood biochemistry (e,g, HbA1c, HOMA-IR) and a 2-hr oral glucose tolerance test. The primary outcome is change in mean post-prandial glycaemia (AUC) from CGM. Analysis will meet the requirements set out by international consensus (Danne et al., 2017) for 70-80% of possible CGM readings over a 2-week period.

Results: The study has been funded by Abbott Laboratories (medical device company) who supply the CGMs FreeStyle Libre 2™. Currently under ethical review. The conference provides the invaluable opportunity for peer-review comment prior to full registration of the trial and submission of the protocol manuscript.

Conclusion: A dietary intervention that specifically targets people with pre-diabetes in diverse communities is warranted. The findings may assist the development of future larger scale interventions that adopt an inclusive approach.

Intermittent loading induces an increased bone formation marker response in mice compared to continuous loading in vitro

Reece Scott¹* , Cleveland Barnett¹, Ruth James¹, Craig Sale², Livia Do Santos¹, Ian Varley^1
1 Department of Sport Science, Nottingham Trent University, Nottingham UK
² Institute of Sport Science, Manchester Metropolitan University, Manchester, UK
*Presenting Author

Weight-bearing exercise has proven effective at inducing bone formation. Rest periods between exercise bouts may have a role in optimising bone mechanosensitivity and could be an important consideration when designing exercise regimes for osteogenic effects. It is not clear how pre-osteoblast/osteoblast activity reacts when loading intensity and duration are matched, but the mode of load application is altered.

The aim of this study was to assess the pre-osteoblast response to a loading regime with and without periods of unloading.
Mouse pre-osteoblasts were cultured under cyclic loading conditions (non-loaded, continuous, intermittent) using a Flexcell bioreactor for tension (n=3). Loading conditions were matched for duration under strain (5 hrs) and intensity of strain (5000 μS at 1 Hz). The mode of applying continuous load was 5 hrs of strain followed by 19 hrs of rest whereas intermittent loading was 1 hr of strain followed by 3 hrs 48 mins of rest every 24 hrs for 1, 3 and 12 days. ARS, ALP and P1NP analyses were performed. A one-way repeated measures ANOVA compared differences between loading conditions for ARS, ALP and P1NP for each timepoint.

There were no differences between loading conditions in ARS (p>0.235). ALP activity was greater following intermittent loading on days 1, 3 and 12 (non-loaded 0.258 ± 0.028; continuous 0.313 ± 0.031; intermittent 0.440 ± 0.054 umol/min/mL; p<0.05). P1NP was greater in the intermittent condition at day 12 (ctrl 151 ± 39; conex 121 ± 61; intex 279 ± 116 ng/ml; p<0.05) but lower at 3 day (ctrl 46 ± 12; conex 66 ± 9; intex 32 ± 9 ng/ml; p<0.05) than in the non-loaded and continuous conditions.

Intermittent loading resulted in higher ALP and P1NP activity on days 1, 3 and 12. This may be due to rest periods between the bouts of loading restoring the mechanosensitivity of the pre-osteoblasts, and thus speculatively enhancing the activation of bone formation. Our findings suggest that intermittent loading is important for re-sensitising pre-osteoblast cells and should be considered when attempting to maximise the osteogenic effects from loading.

Ameliorating menstrual cycles symptoms – an education intervention in elite volleyball players

Esther Goldsmith¹* and Georgie Bruinvels¹,^2
1Orreco Ltd
²University College London, London, UK
*Presenting Author

Physiological and psychological symptoms that occur as a result of hormonal changes in the menstrual cycle may negatively affect the performance of elite female athletes. The extent to which this occurs is highly variable, and may be influenced by genetics, nutrition, sleep, travel, psychological stress, and exercise training modality and load. Furthermore, dietary and lifestyle interventions have been found to be effective in reducing symptoms of premenstrual syndrome (PMS). However, athletes are rarely educated on changes that can occur during the cycle or how they can implement changes to their diet and lifestyle to mitigate against any potentially associated negative symptoms.

Aim: To evaluate the effect that menstrual-cycle specific education and minor dietary interventions can have on elite female athletes over four months of intense competition.

Twenty elite volleyball athletes, all representing the United States internationally, were given a 60 minute education presentation regarding the menstrual cycle and sports performance. Athletes were also provided with fish oil supplements and optional dietary support. Prior to the education, all athletes completed a bespoke online questionnaire to evaluate menstrual cycle history and characteristics, experience of menstrual cycle symptoms, and key aspects of their diet and lifestyle including perceived psychological stress and sleep quality, average daily fruit and vegetable intake, average weekly fish consumption and fish oil supplementation. Menstrual symptom index (MSi) was calculated in the menstrual, late follicular (mid cycle) and premenstrual phases. After 4 months, athletes repeated the questionnaire and MSi was re-calculated.

There was a significant reduction in MSi in the menstrual phase pre- and post-between time points (p <0.05); average MSi decreased by 7.1 ± 11.5. However, there was no significant change in MSi in the mid-cycle or premenstrual phases (p=0.4041 and p=0.1827 respectively). The most frequently cited symptoms pre-education were changes in mood, cravings/increased appetite, stomach cramps, and bloating; post-education the most common symptoms were changes in mood, stomach cramps, lower back pain and breast pain/tenderness.

Targeted menstrual cycle education may be beneficial in reducing female athletes’ experience of menstrual cycle symptoms during menstruation. However, symptoms are multifactorial in nature and a more longitudinal, multi-disciplinary education approach, with targeted intervention may be necessary to create behaviour change and subsequently significantly ameliorate menstrual cycle symptoms.

Organisers, John Hough and Jessica Piasecki, have written an article reflecting on its success of the Physical activity and the endocrine system 2022 meeting and the value of the Society Meeting Support Grant. Read it in the winter 2022 issue of The Endocrinologist.