Univesity College Dublin
DEPARTMENT OF ENDOCRINOLOGY
St. Vincent's Hospital, Elm Park, Dublin 4, Ireland.
Telephone: +353-1-209 4407 Fax: +353-1-209 4981

Research Interests

The Department runs basic science and clinical research programmes. These include examination of the normal control and functioning of the endocrine glands, evaluation of disease mechanisms, their diagnosis and their treatment.

Control of Adrenal Steroid Biosynthesis
Polycystic Ovary Syndrome
Evaluation of Adrenal Function
Diabetes Mellitus

Control of Adrenal Steroid Biosynthesis

The control of adrenal steroid production has been a long term interest of this Department. Original observations have been made, particularly in the area of the control of aldosterone and androgen secretion. A study is under way which examines the mechanisms by which hormones derived from the pituitary gland interact to stimulate the production of androgens from the adrenal gland. Clinically the importance of androgens arising from the adrenal gland is that they may be involved in the development of polycystic ovary syndrome which is responsible for approximately 20% of infertility. Studies are on-going and use human adrenal cells to probe the mechanisms whereby peptides derived from the large parent molecule pro-opiomelanocortin (POMC) interact at the level of the adrenal to differentially control cortisol and androgen secretion.

Polycystic Ovary Syndrome

This Department has an international reputation in investigating underlying causes of polycystic ovary syndrome and its management. A recent original observation reported by Dr. Tarek Fiad is that progesterone given in a manner which achieves similar blood levels to these in normally ovulating subjects will correct the abnormal pituitary secretion of LH seen in this disorder. This finding raised the possibility that abnormal gonadotropin secretion is not primary to the development of polycystic ovary syndrome but occurs as a secondary event. The possibility was raised that other typical features of polycystic ovary syndrome, e.g. insulin resistance and excess adrenal androgen secretion, could also be secondary to progesterone deficiency. Ongoing clinical studies are exploring all of these areas.

Evaluation of Adrenal Function

This Department has made major contributions to the investigation of adrenal disorders with particular emphasis on simplicity and cost effectiveness and on Out-Patient testing. This has included devising the aldosterone/ plasma renin activity ratio useful in investigating all disorders of aldosterone production. The overnight metyrapone test is a test particularly useful in the evaluation of possible secondary adrenal insufficiency. The widest reported experience comes from this Department. Additional original observations have been made on the investigation of adrenal over-activity.

Diabetes Mellitus

A very extensive evaluation of the development of complications in diabetic patients has looked particularly at the role of smoking and high blood pressure as causes of coronory artery disease, cerebral vascular disease, peripheral vascular disease, retinopathy and nephropathy. Early indications from this study suggest that subjects who smoke cigarettes or subjects who have high blood pressure have a 2-3 fold greater incidence of these complications than those occurring in diabetic subjects who do not smoke. The coincidence of hypertension and smoking causes a further increase in these complications. This study has also examined the impact of a cessation of smoking. The pernicious impact of smoking is long lasting and tends to continue in diabetic subjects for much longer than reported in non-diabetic subjects. While no definite beneficial effect of cessation of smoking was identified in this study, it is likely that even more prolonged cessation of smoking than that examined would be associated with a benefit. However, this has not been unequivocally demonstrated.