A View From

A View From...

...England, with Professor Martin Savage

In the final ‘View From’ article, our endocrinology Programme Director Martin Savage (Emeritus Professor at Barts and the London School of Medicine and Dentistry, UK) provides his thoughts on the same questions that all our contributors have answered over the course of this series.

  • Q. What do you like best about working at the Barts and the London School of Medicine and Dentistry?

    A. I now have an emeritus position at the Medical School. I enjoy keeping in touch with my colleagues and particularly mentoring the fellows. Barts and the London has a strong reputation for Endocrinology with excellent cooperation and good working relationships between paediatric and adult colleagues. This is certainly one of the strengths of the institution.

  • Q. Name your three favourite things about the UK?

    A. The relative lack of hierarchy in the culture, the relative lack of corruption, and the British sense of humour and our ability not to take ourselves too seriously. 

  • This is an interesting and rewarding field. It is broad, unlike many of the single-organ specialities within paediatrics. There is room within the field for each specialist to find their particular research interest. Having found that interest, my advice would be to “publish”, i.e. make a contribution to the world literature, which is the best way to learn and is genuinely appreciated by colleagues throughout the world.

    Q. What led you to focus on growth and development disorders during childhood?

    A. I decided to become a paediatric endocrinologist and problems of growth and development make up the bread-and-butter of paediatric endocrinology practice.

  • Q. If you could change any one thing to facilitate your daily clinical practice, what would it be?

    A. I am pretty philosophical about the way I practice medicine. Rather than criticise the system, i.e. the National Health Service in the UK, I think we have to work with it and be grateful for the opportunity it provides for families to obtain quality and accessible health care.

  • Q. Which achievement of your career to date are you most proud of?

    A. I successfully applied for the national funding of the salary for a colleague to be promoted to Senior Lecturer/Associate Professor grade and become a permanent member of staff in our department. In times when positions are very difficult to secure, the ability to appoint a talented person was I think my most satisfying achievement.

  • Q. Which colleague or published researcher has had the greatest effect on your career?

    A. I have always admired and respected excellence and I have been enormously fortunate to work with many talented people. The link between paediatric and adult endocrinology in the context of a large general hospital has been enormously beneficial to my personal development as a specialist. I am most grateful to the adult endocrinology team, led by Professor Michael Besser, at St Bartholomew’s for creating and fostering this harmonious and enjoyable relationship.

  • Q. What has been your most memorable patient encounter, and why?

    A. The most striking clinical encounters I have had have been with patients with genetic mutations affecting their endocrine system. I can highlight two. The first was in 1980 when I saw two brothers from Cyprus with 5-alpha reductase deficiency. They had the exact striking phenotype described shortly before by Imperato-McGinley et al. The second was a child with Laron syndrome (growth hormone resistance) who at the age of 12 years had the height of an 18-month old. Genetic mutations can seriously disturb normal endocrine function. Unfortunately the mutations themselves cannot be treated, but the endocrine consequences may be amenable to therapy, such as in the child with Laron syndrome, who was successfully treated with recombinant human IGF-1.

  • Q. What achievement or discovery do you most want to see in your field?

    A. I have had a long-standing interest in paediatric Cushing’s disease (a pituitary tumour secreting excess ACTH). I would like to see a technique for successfully eliminating the small pituitary adenoma and thereby curing the disease without the need for pituitary surgery.

  • Q. What advice would you offer to a doctor entering paediatric endocrinology?

    A. This is an interesting and rewarding field. It is broad, unlike many of the single-organ specialities within paediatrics. There is room within the field for each specialist to find their particular research interest. Having found that interest, my advice would be to “publish”, i.e. make a contribution to the world literature, which is the best way to learn and is genuinely appreciated by colleagues throughout the world.

  • Q. If you had not entered the medical profession, what would you have done instead?

    A. Difficult to say. I entered medicine late having previously studied modern languages. I would probably have been either a school teacher or a journalist. I really enjoy teaching and writing.

  • Q. If you had a time machine, when and where would you go?

    A. I am pretty happy to live in the present. Any device which enabled one to see one’s grandchildren grow up would be nice!

...Brazil, with Professor Berenice B. Mendonça

Berenice B. Mendonça is Professor of the Department of Internal Medicine of the Faculty of Medicine, University of Sao Paulo, Brazil Her research interests include endocrine tumours, congenital adrenal hyperplasia, hyper- and hypo-function of the adrenal glands, endocrine hypertension, growth hormone excess and deficiency, disorders of puberty, metabolic bone disease, and disorders of sexual development.

  • Q. What do you like best about working at the University of Sao Paulo?

    A. The possibility to have a continuous update in endocrinology knowledge with my assistants and the stimulus from my students and patients.

  • Q. Name your three favourite things about Brazil.

    A. Our music, our weather and landscape, and our people.

  • Q. What led you to focus on endocrine diseases?

    A. A wonderful teacher, Professor Walter Bloise, and the possibility to take care of patients with treatable disorders.

  • Q. If you could change any one thing to facilitate your daily clinical practice, what would it be?

    A. Fast imaging results and informatics data assessment.

  • Q. Which achievement of your career to date are you most proud of?

    A. The number of good postgraduate students I have had.

  • Q. Which colleague or published researcher has had the greatest effect on your career?

    A. Jean Wilson, Maria New, Walter Miller and Walter Bloise.

  • Q. What has been your most memorable patient encounter, and why?

    A. My first patient Claudia, a 3-year old girl with virilising CAH; she had a very virilised genitalia and use to show it when she wanted to distress her mother. 

  • Q. What achievement or discovery do you most want to see in your field?

    A. The possibility to enlarge penile length in male patients with atypical genitalia and severe microphallus.

  • Be patient, listen and pay attention to your patient, make a good history and physical examination.

    Q. What advice would you offer to a doctor entering paediatric endocrinology?

    A. Be patient, listen and pay attention to your patient, make a good history and physical examination.

  • Q. If you had not entered the medical profession, what would you have done instead?

    A. Archaeology.

  • Q. If you had a time machine, when and where would you go?

    A. I would like to be in a time without war and terrorism and poverty.

...Korea, with Professor Han-Wook Yoo

Han-Wook Yoo is Professor of Medicine at the University of Ulsan College of Medicine, and Chief of the Division of Pediatric Endocrinology, Metabolism and Genetics at the Asan Medical Center Children's Hospital. Professor Yoo’s main research interests are focused on the characterisation of molecular and functional defects of endocrine genetic disorders.

  • Q. What do you like best about working at the Asan Medical Center?

    A. Our institute is one of the Medical Centers of Excellence where patients with diverse paediatric endocrine disorders are referred. It is always challenging and stimulating.

  • Q. Name your three favourite things about Korea.

    A. The four distinct seasons, the success of our professional lady golf players and our healthy food.

  • "A new-born patient brought to emergency room because of lethargy, severe dehydration and hypoglycaemia with dark skin pigmentation was diagnosed immediately by me as congenital lipoid adrenal hyperplasia, which is a rare fatal endocrine genetic disease unless properly diagnosed and managed. She survived and now is a healthy, cheerful college student."

    Q. What led you to focus on endocrine genetic disorders?

    A. My mentor during residency training introduced and encouraged me to commit myself to this new field. 

  • Q. If you could change any one thing to facilitate your daily clinical practice, what would it be?

    A. I would like to hire more endocrine nurse practitioners.

  • Q. Which achievement of your career to date are you most proud of?

    A. I established the molecular genetic diagnostic laboratory to provide a high quality of diagnostic service.

  • Q. Which colleague or published researcher has had the greatest effect on your career?

    A. Dr Robert J. Desnick (Mount Sinai Medical Center, New York), biochemical geneticist, taught me how to do research and how to apply rapidly developing research techniques to translational research.

  • Q. What has been your most memorable patient encounter, and why?

    A. A new-born patient brought to emergency room because of lethargy, severe dehydration and hypoglycaemia with dark skin pigmentation was diagnosed immediately by me as congenital lipoid adrenal hyperplasia, which is a rare fatal endocrine genetic disease unless properly diagnosed and managed. She survived and now is a healthy, cheerful college student.  

  • Q. What achievement or discovery do you most want to see in your field?

    A. I want to see new drugs, mostly orphan drugs, to be developed for rare or ultra-rare genetic endocrine disorders.

  • Q. What advice would you offer to a doctor entering paediatric endocrinology?

    A. Patients are excellent teachers!! Always be grateful to them!!

  • Q. If you had not entered the medical profession, what would you have done instead?

    A. I might have become an artist, an oil painter.

  • Q. If you had a time machine, when and where would you go?

    A. I want to be back to my teens and to travel to Western Europe.

...Israel, with Professor Moshe Phillip

Professor Moshe Phillip is the Director of the Institute for Endocrinology and Diabetes at the National Center for Childhood Diabetes at the Schneider Children's Medical Center, and serves as Vice Dean for Research and Development, as well as a Chair of the Irene and Nicholas Marsh Fund for Endocrinology and Diabetes, at the Sackler Faculty of Medicine, Tel Aviv University, Israel. 

  • Q. How do you feel about working at the Schneider Children's Medical Center of Israel?

    A. I was lucky to get the job in a leading independent paediatric hospital which delivers the best possible multidisciplinary holistic care to children from Israel and other countries regardless of their religion or nationality.   

  • Q. Name your favourite things about Israel?

    A. Spirit of innovation and commitment to each other.

  • "It is never a single human being or a single article. It is the combination of people I met along the years and scientific work I was exposed to since medical school. But, the most significant effect on my choices over the years came from meeting with patients and their parents."

    Q. What led you to focus on paediatric endocrinology?

    A. I loved the field of endocrinology already in medical school since it is generally an optimistic field in medicine, which allows (with the correct diagnosis) to replace a hormone that is deficient or suppress elevated hormones and enable children live, grow and thrive.  

  • Q. If you could change any one thing to facilitate your daily clinical practice, what would it be?

    A. Increase the ratio of multidisciplinary care givers which will take in consideration the number of patients. 

  • Q. Which achievement of your career to date are you most proud of?

    A. The ability to lead a team of clinicians, researchers, nurses, dieticians, social workers, psychologists and administrative workers to give the best possible updated care to the patients of our centre. 

  • Q. Which colleague or published researcher has had the greatest effect on your career?

    A. It is never a single human being or a single article. It is the combination of people I met along the years and scientific work I was exposed to since medical school. But, the most significant effect on my choices over the years came from meeting with patients and their parents.  

  • Q. What achievement or discovery do you most want to see in your field?

    A. The cure and prevention of childhood diabetes, and the full true understanding of the complex mechanism of children growth and puberty. 

  • Q. What advice would you offer to a doctor entering paediatric endocrinology?

    A. Study and work hard!

  • Q. If you had not entered the medical profession, what would you be doing instead?

    A. Applying again and again.

  • Q. If you had a time machine, when and where would you go?

    A. To the medical school for more than one round if possible. 

...Chile, with Professor Fernando Cassorla.

Fernando Cassorla is a professor at the Faculty of Medicine of the University of Chile, and chief of endocrinology at the Children's Institute of Maternal and Child Research (IDIMI).
The focus of his research is growth and development disorders during childhood and adolescence.

  • Q. Name your three favourite things about Chile?

    A. My favourite things about Chile are its friendly atmosphere, its climate and its food.

  • Q. What led you to focus on growth and development disorders during childhood?

    A. My interest in this field stems from the very close relationship between the clinical phenotypes and the biochemical derangements that underlie the disorders of our patients

  • "My interest in this field stems from the very close relationship between the clinical phenotypes and the biochemical derangements that underlie the disorders of our patients"

    Q. If you could change any one thing to facilitate your daily clinical practice, what would it be?

    A. Less paperwork!

  • Q. Which achievement of your career to date are you most proud of?

    A. The training of approximately 50 pediatric endocrinology fellows from all over the world, both at the National Institutes of Health in the USA and at the University of Chile.

  • Q. Which colleague or published researcher has had the greatest effect on your career?

    A. D Lynn Loriaux [Oregon Health & Science University], a very gifted clinician, researcher and teacher.

  • Q. What has been your most memorable patient encounter, and why?

    A. A patient with androgen insensitivity, who taught me the difficult path that some of these patients must follow towards accepting their sexual identity.

  • Q. What achievement or discovery do you most want to see in your field?

    A. The success of molecular therapy for patients with as yet unresolved endocrine and genetic pathology.

  • "A patient with androgen insensitivity […] taught me the difficult path that some of these patients must follow towards accepting their sexual identity"

    Q. What advice would you offer to a doctor entering paediatric endocrinology?

    A. To embrace this fascinating field with great enthusiasm and energy, in order to enjoy a very gratifying career.

  • Q. If you had not entered the medical profession, what would you have done instead?

    A. I am a news junkie, so I believe that I would have enjoyed very much working as a journalist.

  • Q. If you had a time machine, when and where would you go?

    A. To the future with some trepidation, because I am very worried about the path that humanity is following towards impending disaster.