Miguel Debono, consultant in endocrinology and diabetes and honorary senior lecturer at Sheffield Teaching Hospitals and the University of Sheffield, has obtained a prestigious grant from the National Institute for Health Research to assess the use of a new test to identify patients who lack the ability to produce their own natural body steroids and suffer from a condition known as adrenal insufficiency (AI).
[attach id=704008 size="medium" align="right"]Miguel Debono[/attach]
The grant of up to a quarter of a million pounds (€290,000) will fund the study that aims to roll on the test onto the NHS within the next three years and implement its use as part of everyday clinical care throughout the UK. It is estimated that the test will save the NHS around £10 million (€11.6 m) every year.
Dr Debono achieved top place, outperforming 13 other major centres in the UK in a highly competitive funding call.
The NIHR RfPB programme aims to fund research projects in health and social care to improve, expand and strengthen the way that healthcare is delivered for patients, the public and the NHS. It aims to deliver NIHR targets by improving the health and wealth of the nation through research. Patients gain access to breakthrough treatment strategies earlier and the nation keeps at the forefront of international research.
AI is when the body is unable to produce cortisol, an essential hormone for overcoming stress, including illness and injury. Low cortisol levels lead to fatigue, weakness and low blood pressure. Left untreated, the body can no longer regulate blood sugar, control blood pressure or reduce inflammation, increasing the risk of emergency admission, cardiac arrest and eventually death (if symptoms worsen).
AI occurs in patients with hormonal disorders (Addison’s and Pituitary disease) and temporarily in up to 50 per cent of patients on steroids used to treat inflammation. Up to three per cent of the population are on steroids and therefore the inability to produce one’s own steroids to overcome stress, which occurs in around 30 per cent of these patients, is a significant problem in the population.
The survey questioned factors including the need to take time off work, the need to organise childcare, difficulty finding parking, anxiety and length of visit
AI is currently diagnosed in hospital by a laborious test involving taking blood to measure cortisol before and 30 minutes after an injection. Misdiagnosis and delayed diagnosis of AI are common as symptoms are non-specific. Delayed diagnosis is potentially increased by the need for a hospital test for diagnosis.
The aim of Dr Debono’s research is to provide a patient friendly, more convenient, cheaper salivary test to reduce and replace the use of the complex tests for the majority of patients. In a pre-study survey, it was identified that 80 per cent of patients with prefer having investigations at home as opposed to having to travel to hospital.
This survey questioned factors including the need to take time off work (49 per cent say yes), the need to organise childcare (55 per cent say yes), difficulty finding parking (67 per cent say yes), anxiety during the visit (55 per cent) and the length of a visit (lasts one-two hours). These findings give scope to try and develop alternative means to investigate patients with this condition.
Dr Debono is a lead specialist in the stress steroid hormone cortisol. Over recent years, he has established himself as a worldwide expert in the area and has been invited to deliver presentations at both national and international conferences. He has also published seminal research studies in major endocrinology journals.
Dr Debono, together with Prof. Richard Ross and Prof. John Newell-Price, has established Sheffield Endocrinology Centre as one of the leading tertiary referral centres in the UK and Europe. The Department of Endocrinology in Sheffield is classified as a Neuroendocrinology Endocrine Tumour Centre of Excellence, makes part of the European Network Study of Adrenal Tumours and is the National Centre for Stereotactic Radiosurgery receiving referrals from all over the UK and Europe.
The laboratory and clinical groups are working to define the best methods for assessing and treating disorders of hormone excess and deficiency. Dr Debono’s work includes identifying ways on how to diagnose steroid disturbances, more specifically problems with cortisol rhythm and developing methods on how to restore the cortisol rhythm in patients with steroid deficiency or excess.
The Department of Endocrinology in Sheffield Teaching Hospitals achieves top place in most nationally set dashboard targets, especially in management of pituitary disease, competing with major endocrine centres among others in London, Oxford, Bristol and Manchester. Talks are in progress between Sheffield Teaching Hospitals and the University of Malta for Diabetes trainees in Malta to spend one year of their training programme in Sheffield.