Endocrinology encompasses extremely prevalent pathologies accounting for both direct and indirect health economic costs. I am referring, for instance, to obesity and Diabetes Mellitus and corresponding co-morbidities and/or complications, which over the past years have put endocrinology in the public eye. Besides the importance of treatment, preventing these pathologies from occurring would lead to a significant reduction of cardiovascular death, which is the main cause of death in the so-called developed countries.

Thyroid pathology is also responsible for another large group of patients seen at this specialist unit, due to its high prevalence. Some studies indicate that up to 70% of adult population has thyroid nodules!

Some endocrine pathologies are less frequent, such as supra-renal insufficiency, but patients’ lives still depend on their diagnosis and treatment. Other endocrine pathologies do not endanger the lives of patients, but do interfere on their daily relationships, as happens in the majority of cases of hirsutism, hypogonadism or low stature, for instance.

An interesting and gratifying aspect of endocrinology is that there are effective therapies to treat most of these pathologies.

Santa Maria Hospital’s Endocrinology Unit is the only one in the country that simultaneously provides assistance in multiple sub-speciality clinical appointments, hospitalization, day hospital, and specialist emergency services 24 hours a day. Besides doctors and nurses, there is a group of distinct nutritionists, dieticians and psychologists working at the unit.

From an educational viewpoint, the Endocrinology University Clinic is involved in post-graduate training, teaching the following subjects: Endocrinology and Metabolic Diseases, Endocrinology as an elective, the Diabetes free course and the supervision of final course projects in the Integrated Master Degree in Medicine. Several members of staff are equally involved in the Medicine II practical classes, thus contributing to maintaining a close relationship with Internal Medicine. The Endocrinology and Diabetes University Clinic and the Unit also participate in postgraduate training, including teaching annual endocrinology postgraduate courses, as well as diabetes, obesity and osteoporosis clinical practice. Renowned members of staff also teach in the Master and Doctoral Degrees in Metabolic and Metabolism Diseases. In the case of the latter, I have the opportunity to be involved as a student.

In terms of research, several members of staff from the Unit and University Clinic work on distinct topics. I have been actively involved in clinical research for over ten years collaborating with Professor J. Martin Martins, not only in the evaluation of clinical practice results, such as Diabetes Mellitus and obesity, but above all in the field of behavioural endocrinology, and investigating endocrine mechanisms in hypertension. For instance, we have found distinct aspects that characterize each of the pathologies studied – obesity, hypertension, hirsutism, immune-mediated diseases – and have found endocrine mechanisms in over 85% of patients with “inappropriate hypertension”.

Still in the context of behavioural endocrinology, in the last years we have started to investigate DHEAS, a hormone that abounds in the peripheral circulation but whose purpose is, to a large extent, little understood. We have studied the correlation between DHEAS and reactivity of the hypophysis-suprarenal axis and personality. We have noted that higher levels of that hormone are related to a lower increase of cortisol following administrating CRH, which suggests a protective effect of the excessive reaction of cortisol to stress. In addition, we have found a connection between the reactivity of DHEAS following the administration of CRH and personality – a direct relationship between the reactivity of DHEAS and behavioural and type A personality disorders.

As a doctor, I find working in a Unit and University Clinic stimulating, as I can combine medical, teaching and research activities. However, in order to be able to carry out the last two, the collaboration of the hospital is crucial.

As an increasingly relevant medical field in contemporary society (given the pathologies it covers), I believe that endocrinology will play an even more important role in medical education and practice. I am equally convinced it will undergo major advances in terms of research and acquisition of new knowledge.
Sónia do Vale
Endocrinology Temporary Assistant, Endocrinology, Diabetes and Metabolism Unit Santa Maria Hospital
Endocrinology/Medicine II Guest Assistant, Endocrinology University Clinic, Faculty of Medicine of Lisbon
soniavale@net.sapo.pt