Our research

""The research conducted in CEDAM covers a wide spectrum of topics and methodologies reflecting the background experiences of the CEDAM principal investigators. This spectrum extends from experimental research, to epidemiological studies to randomised controlled studies. There is also focus on pharmacological and device-related research in CEDAM.

A main theme of the CEDAM research is its translational nature as the work aims to bring early discoveries to clinical bed-side practice and improve patients care. In addition, the CEDAM investigators have wide and strong links with other institutions within the University of Birmingham, and beyond in the UK and internationally which further strengthen the CEDAM research output and impact. 

Endocrine genetics and genomics

CEDAM is a core partner in the growing clinical and research endocrine genetic expertise in the West Midlands. The endocrine genetic service (adult and paediatric) provides the widest range of such multi-disciplinary clinics in the UK, supported by medical consultant and clinical nurse specialists. Individuals from the extended team are collectively members of all the different working groups of the Rare Endocrine and Bone ERN working group.

The West Midlands Regional genetics service is the lead for the new West Midlands, Oxford and Wessex Genomics Laboratory Hub (WOW GLH ) which is the largest single GLH in England, and one of only three to provide specialist endocrine genetic testing. To support the integration of genomic testing into regular endocrine service, where indicated, a partnership of CEDAM, endocrinology services, clinical genetics and the GLH has established an endocrine genomics network to deliver a practical patient pathway supported by educational, interpretive and research opportunities supported by virtual MDT’s. 

Endocrine – pituitary

One of the academic endocrine themes in CEDAM focuses on pituitary disease and is led by Dr. Niki Karavitaki. It covers the areas of pathogenesis, diagnosis, management, and outcomes in pituitary disease, as well as the identification of biomarkers of diagnostic and prognostic significance with “omics” techniques”.

Our clinical and translational research is underpinned by the dynamic group of basic and clinical scientists and state-of-the-art facilities at the Institute of Metabolism and Systems Research (IMSR) and the University of Birmingham, the Birmingham Health Partners Pituitary Team a multi-disciplinary group of experts (endocrinologists, surgeons, oncologists, neuro-ophthalmologists, neuroradiologists, neuropathologists, geneticists, clinical nurse specialists) providing clinical care in a catchment area of 5.6 million population and is further expanded through national and international collaborations facilitating a protagonist role in the pituitary landscape.

Diagram of the brain which has a zoomed in area showing the anterior pituitary, posterior pituitary, thalamus, hypothalamus and infundibulum

We have very active participation in the European Reference Networks for Rare Endocrine Diseases, as well as in other relevant Networks and Societies promoting clinical and research excellence in hypothalamo-pituitary disease.

Training in the field is supported through the Academic Foundation, the NIHR Clinical Fellows and the Specialty Training programme.

We lead well recognised education/training courses (Birmingham International Pituitary Preceptorship meeting, Patient Pituitary Open Days, Patient and Family Members Steroid Education).

Endocrine – bone and mineral

Isotope bone scan and overlay SPECT-CT showing bilateral unicortical incomplete femoral fractures related to prolonged bisphosphonate therapy

From public health impacts of prevalent diseases such as osteoporosis and vitamin D deficiency through to rare metabolic problems of calcium and phosphate handling, the endocrine bone and mineral group is influential in clinical research and establishing national policies through visible leadership and partnership working. Professor Neil Gittoes and Professor Nick Shaw lead the metabolic bone group (adult and paediatric respectively) in Birmingham. 

National leadership roles and contributions to multicentre studies in osteoporosis, such as the SCOOP study, has led to consideration of new approaches to screening the population for osteoporosis.

Clinical research into rare bone and mineral diseases at the Birmingham Children’s Hospital has facilitated the rapid delivery of novel therapies for children with severe bone diseases.

CT scan showing brown tumour in lateral wall or orbit in patient with primary hyperparathyroidism

Our collaborations with others in Birmingham Health Partners (e.g. endocrinologists, head and neck surgeons, radiologists, pathologists, geneticists, clinical nurse specialists and sports and exercise scientists) provide a rich seam for advancing clinical care across a spectrum of bone and mineral diseases from a regional catchment of 5.6 million population.

We have very active participation in the European Reference Networks for Rare Endocrine Diseases (ERN-ENDO) and Rare Bone (ERN-BOND), as well as with other societies promoting clinical and research excellence in metabolic bone diseases.

We are central to the leadership and delivery of support to patient-facing charities and support groups, particularly the Royal Osteoporosis Society.

Endocrine – thyroid

The Thyroid Translational Research theme in CEDAM encompasses the pathogenesis, diagnosis and treatment of thyroid nodules and cancer as well as the management and long-term outcomes of thyroid dysfunction and thyroid diseases in pregnancy.

We conduct a large programme of research relating to a wide spectrum of thyroid diseases, ranging from cutting-edge laboratory research to systematic analysis of large detailed databases and coordination of carefully designed clinical trials.

A dynamic group of basic and clinical scientists as well as state of the art facilities at the IMSR and the University of Birmingham underpins this research. The Birmingham Health Partners Thyroid Team is a multi-disciplinary group of experts (endocrinologists, surgeons, oncologists, head and neck radiologists, obstetricians, nuclear physicists, pathologists, clinical nurse specialists and geneticists) providing clinical care to a catchment population of six million people.

We are recognised as a world leading centre in the field of thyroid disease, have established wide-ranging national and international collaborations and continue to drive the way in which patients with thyroid diseases are managed across the globe.

CEDAM vitamin D group

Birmingham is home to a broad community of clinical researchers with an interest in vitamin D and human health. This group is coordinated within CEDAM by Professor Martin Hewison, and includes prominent input from Professor Karim Raza (Director of Research and Development at Sandwell and West Birmingham Hospitals NHS Trust) for studies of vitamin D and rheumatoid arthritis, Professor Mark Kilby (Birmingham Women’s Hospital) for studies of vitamin D and pregnancy, and Dr Suma Uday (Birmingham Children’s Hospital) for studies of pediatric vitamin D deficiency.

The CEDAM Vitamin D group is also supported by interaction with the Steroid Metabolomics Analysis Core (SMAC) within the Institute of Metabolism and Systems Research at the University of Birmingham. In particular, SMAC analytical chemist Dr Carl Jenkinson has developed cutting edge liquid chromatography mass spectrometry tools for measuring vitamin D metabolites in a wide range of human tissues.

Professor Martin Hewison on the left shaking hands with Dr Carl JenkinsonDr Carl Jenkinson

Clinical Epidemiology Group

The CEDAM Clinical Epidemiology Group examines risk factors, incidence trends, outcomes and effectiveness/safety of therapies in endocrine disorders within a multidisciplinary setting of clinicians, epidemiologists, data scientists, statisticians and computer scientists.

Birmingham is home to a number of large databases, from in depth clinical data obtained from specialist clinics at University Hospitals Birmingham and well defined cohorts; to routinely collected data such as nationwide Hospital Episode Statistics and a large Primary Care database (THIN:17 million patient records). 

This group is coordinated within CEDAM by Dr Krish Nirantharakumar, and includes prominent input from the Institute of Metabolism and Systems Research Director, Professor Wiebke Arlt, Institute of Applied Health Research Director Professor KK. Cheng (Epidemiology), and Dr Abd Tahrani.

The group works closely with clinicians in diabetes and endocrinology departments in University Hospitals Birmingham NHS Trust, Sandwell and West Birmingham NHS Trust and many other Trusts in the Midlands region to enhance their research outputs, capacity and skills.

CEDAM Diabetes, Obesity and Sleep Group

Birmingham has amongst the highest rates of diabetes and obesity in the UK. The Diabetes and Obesity Group comprises a number of investigators who contribute to treatment, NHS guidelines, policy making, training and education and ultimately patient care through their basic and clinical research under the CEDAM umbrella. 

Active areas of study include:

  1. Sleep disorders and metabolic disease;
  2. Exercise, immunotherapy and type 1 diabetes;
  3. Rare childhood diabetes syndromes and type 2 diabetes in children;
  4. Adipocyte dysfunction and obesity;
  5. Stress hormones and diabetes risk; 
  6. Beta cell regeneration;
  7. Population-based studies in diabetes and obesity;
  8. Obesity management and health care delivery;
  9. The pharmacology of diabetes and obesity,
  10. The epidemiology, pathogenesis and treatment of diabetes-related microvascular complications, particularly neuropathy and nephropathy.

Work is supported through access to large public health databases, the Birmingham NIHR/Wellcome Trust Clinical Research Facility, the Birmingham Clinical Trials Unit (BCTU), as well as next generation sequencing, super-resolution imaging and drug screening platforms, the latter via interactions with the Centre for Membrane and Protein Receptors (COMPARE),  Institute of Metabolism and Systems Research (IMSR) and Institute of Applied Health Research (IAHR).

Patient recruitment to basic science and clinical research trials is supported through close collaboration across the six main hospitals in Birmingham (including Birmingham Children’s Hospital, the largest diabetes service in the UK) and through colleagues in primary care via the clinical research networks. 

Training of clinical and basic scientists in diabetes and obesity is supported through the academic foundation and NIHR Clinical fellows programme.

The diabetes unit at Birmingham children’s hospital recruits to the UK Immunotherapy in type 1 diabetes consortium, and international initiatives such as the EU-IMI funded INNODIA project and the European Reference Networks for Rare Diseases.

A wide range of education courses are led from Birmingham, including annual meetings in obesity and diabetic neuropathy as well as twice yearly Midland Endocrine and Diabetes Club (MEDC) meetings

CEDAM – Adrenal

Birmingham adrenal tumour service has a complex case mix of benign and malignant disease. We are the largest centre for adrenocortical carcinoma in the UK with 15-20 new cases reviewed annually. We have significant surgical expertise, with adrenalectomy rates in the top three in UK based on 2017 data; future applications are planned for recognition as a national centre for adrenal tumours with NHS Specialised Commissioning. 

Diagram of kidneys and adrenal glands
University Hospitals Birmingham Adrenal Clinic and Adrenal MDT logo

We adopt protocolised pathways based on international guidelines and utilise nurse-led services for adrenal incidentaloma patients and mitotane and metyrapone prescribing. An adrenal vein sampling service with rapid assay cortisol results is available, delivered in real-time to improve cannulation rates.

We have a large translational research programme, with Biobanking of serum, urine, saliva and tissue from patients with adrenal tumours. We are integral to ENSAT-linked international studies including the multi-centre EURINE-ACT project and have recently finished recruiting >2000 patients with adrenal tumours, led by IMSR team. 

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Institute of Metabolism and Systems Research logo

Separate adrenal-gonadal clinics for benign disorders of adrenal steroidogenesis (e.g. CAH) and patients with Addison’s disease are provided and we regularly engage with the Association of Multiple Endocrine Neoplasia Disorders (AMEND) and Adrenocortical Cancer Support and Information (ACC) UK patient support groups. 

Adrenocortical Cancer Support and Information UK logo
Association of Multiple Endocrine Neoplasia Disorders logo