Endocrine Abstracts

Reproductive endocrinology spans the interface between ‘mainstream’ endocrinology, paediatric endocrinology and gynaecology, with excursions into genetics and psychology. This subspecialty is a fertile ground for clinical research. The field of Turner syndrome – ‘Turnerology’ – is a perfect example of where an endocrinologist has a lot to contribute with knowledge of oestrogen physiology, diabetes, osteoporosis as well as cardiovascular disease, genetics and the care of individuals with long term conditions. Sex steroids form a major part of endocrine practice from hypopituitarism to gonadal dysgenesis, yet we know little of the correct dosing of replacement therapies. Oestrogen deficiency is probably under-treated in the majority of adolescents and young women. Furthermore, progesterone excess of adrenal origin in congenital adrenal hyperplasia often goes unrecognised. In both of these conditions, optimal sexual function and fertility is the casualty. Close collaboration with gynaecology and andrology is key to providing comprehensive care for a large proportion of endocrine patients. We are supremely privileged in the NHS in be able to construct truly patient centred care in our services. In comparison with other countries, we excel in the clinical expertise that arises from this structure. This is particularly evident in the care of chronic endocrine conditions. Simple clinical data collection and its analysis is essential to the understanding of our practice and should be embedded in our services. However, clinical research from an NHS post is becoming more of a challenge with the increasingly strict control over one’s time. Short term goals of optimising service capacity are often counterproductive to patient care and particularly to research. To counteract this effect job planning must prioritise and ring fence research time – if necessary with creative accounting!