Cortisol the focus of 2019 IES McKenna lecture

Prof Mark Sherlock delivered this year’s McKenna Lecture at the 2019 IES Annual Meeting, which took place in the Ardilaun Hotel, Co Galway, from 11-12 October.

His lecture was titled ‘The Ups and Downs of Cortisol: From Endocrinology to Intracrinology’.

Speaking to the Medical Independent (MI), Prof Sherlock, Consultant Endocrinologist, Beaumont Hospital, Dublin, said that his research work was focused on studies that he carried out in Birmingham, UK, and then later studies in Ireland.

The lecture concerned “mortality due to glucocorticoid excess, tissue-specific regulation of glucocorticoid action, the role of cortisol in obesity and insulin resistance, and the effects of hydrocortisone replacement therapy on metabolism, and also on quality-of-life and cardiovascular risk,” he said.

In the lecture, Prof Sherlock asked “could the hydrocortisone treatment we are giving our patients be leading to adverse effects?”

“It certainly could,” he told MI.

“It depends on dose; it depends on a number of different issues, but I think it’s something we need to be aware of in our clinical practice.”

He referred to a research presentation made during the meeting by Dr Rosemary Dineen, titled ‘Modified-Release Hydrocortisone Improves Cardiovascular Risk Profile in Patients with Primary and Secondary Adrenal Insufficiency’.

“She found when she put a large cohort of patients on this medication, this new Plenadren modified-release hydrocortisone, that the blood pressure was lower, their weight went down. Again, the question you would always worry about in patients with adrenal insufficiency is, could they have been hypo-adrenal? But actually, their quality-of-life improved in nearly every questionnaire,” he said.

“One-hundred per cent of them decided at the end of the study if they had the option — not that they do, because it’s not reimbursed at the moment — they would stay on the modified-release hydrocortisone because they felt better in general… a lot of these studies have really been about trying to balance between the morbidity and mortality we see in patients on hydrocortisone and with cortisol excess, and I think with studies looking at large patient populations trying to phenotype these patients very clearly, we may be getting towards a balance between under- and over-placement,” he concluded.

Speaking about the state of the specialty in general, Prof Sherlock said: “I think endocrinology in Ireland is really strong at the moment. I think we have a fantastic group of consultants, of researchers, of trainees coming through, so I think it’s in a really healthy state — we’ve been really lucky over the last couple of years to be able to get people who have been in overseas centres to come back to our hospitals and back to our research institutes to work, so it’s in a really healthy, optimistic state.”

He also feels positive about the future of endocrinology, both within and outside Ireland.

“There’s a European Rare Disease Network for Endocrinology. That is a call from the European Union; we’re hoping that Ireland will get in on that call… that’s happening in the next year, hopefully. I think just [it is important] to continue all the good work that the society for endocrinology does with its members, particularly trainees coming through, and trying to get more and more people involved in research… that and looking after patients — you can really improve the healthcare system by combining the two of those.”