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Neurology Today:
doi: 10.1097/01.NT.0000453585.02758.c0
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INSIDE THE AAN: The AAN Section on Neuroendocrinology: A Complex Field Crossing Many Subspecialties

Shaw, Gina

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The AAN's Neuroendocrinology Section differs from many of the Academy's larger subspecialty-focused Sections, such as Movement Disorders, Neuromuscular, and Stroke and Vascular Neurology. Although some of its members have a specific clinical or research focus on neuroendocrinology, the majority practice in other subspecialties and participate in this Section because of their interest in its impact on their fields.

Noted neuroendocrine specialist Andrew Herzog, MD, director of the Harvard Neuroendocrine Unit, was the driving force behind the section's creation in 2004. Ten years later, Neuroendocrinology remains one of the smallest Sections, with a membership that has stayed consistently around 175 for several years.

“Neuroendocrinology isn't a large subspecialty, but it crosses over into many other areas of neurology, and we're trying to raise awareness of that,” said Section Chair Alison M. Pack, MD, MPH, an associate professor of neurology at Columbia University Medical Center in New York who specializes in epilepsy. “Endocrine issues and disorders affect the presentation and treatment of multiple neurologic disorders. Given the few training opportunities in neuroendocrinology specifically, we are trying to promote a general understanding of these issues among all neurologists rather than just relying on a few experts.”

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Unfortunately, said Dr. Pack, many neurologists still are not aware of the importance of endocrine issues to neurologic conditions. “It is therefore necessary that we in the neuroendocrine group at the AAN promote education at national meetings, in literature, and within our residency programs. Hopefully with better awareness and education neurologists will more routinely be called upon to, and be ready to, ‘weigh in’ on endocrine issues and disorders.”

Although the Section has been around for ten years, practically speaking, it is still getting established, said Section Vice Chair Irene Malaty, MD, an assistant professor of neurology at the University of Florida in Gainesville and medical director of its National Parkinson Foundation Center of Excellence.

“One of our first goals was to get an issue of the Continuum journal focused on neuroendocrinology published [in 2009],” she said. The edition featured articles on topics such as neurohormones and sleep, neurologic considerations in Parkinson's disease and other movement disorders, and the relationship between endocrine organs and stroke.

One of the Section's other major achievements has been the establishment of an award for neuroendocrine research, sponsored by the AAN and supported by friends of Dr. Herzog. The $500 award honors a clinical or basic scientist who has carried out important independent research focused on pathophysiology or basic mechanisms, treatment paradigms, or major comorbidities in neuroendocrinological science.

At the 2014 AAN meeting, an award was presented to Stafford Lightman, MBBChir, PhD, of the University of Bristol, who studies the mechanisms through which the brain recognizes environmental stress and disease, including the ways in which rhythmic activation of neuroendocrine response systems, such as the hypothalamo-pituitary-adrenal axis, provide signals to glucocorticoid responsive tissues throughout the body.

Many Section members have also expressed interest in publishing a primer on neuroendocrinology. “We went back to our ‘building a foundation’ phase and focused on establishing our immediate goals,” said Dr. Malaty.

These goals include strengthening the Section's website as a means for people in the field to find each other and identify research tools, such as assays that some people offer that could be useful for others' research. “People at the Section meeting were surprised to learn what others have available,” Dr. Malaty said. “We need to facilitate those connections. We also want to facilitate information about grants and other funding resources, and opportunities for collaboration, to be shared on our website or listserv.”

The Section also hopes to sponsor one to two neuroendocrinology courses at next year's AAN meeting. “We discussed having one general overview course relevant to the practicing neurologist that would review endocrinology in general and endocrine influences on neurologic disease like migraine, epilepsy, and MS,” said Dr. Malaty. “There was also interest in smaller courses on the impact of vitamin D on neurologic conditions, or the influence of reproductive hormones on neurologic disease.”

In the longer term, the Section aims to put out a larger publication — the primer discussed at the most recent meeting — and help to expand fellowship opportunities; there are currently few fellowships in neuroendocrinology.

There are many possible opportunities for neurologists to collaborate with other specialties on neuroendocrine issues, Dr. Pack pointed out. More research is needed to better define the reciprocal relationships between endocrine and neuroendocrine function, and neurologic disorders, such as the relationship between vitamin D and various neurologic disorders, including multiple sclerosis, Parkinson's disease, stroke, and epilepsy.

“We need to understand these associations and the implications for diagnosis, treatment, and ultimately prevention. Working with specialists in vitamin D metabolism is imperative in increasing our understanding,” Dr. Pack said.

“Some of our members are experts in running specific assays. This expertise could help facilitate collaborative projects with other interested members,” she added.

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Disorders of bone and mineral metabolism, which are common in the general population, are even more so among persons with various neurologic disorders. “In addition, there is a growing literature that there is likely CNS control of bone development and metabolism,” Dr. Pack said. “Collaborating with experts in bone and mineral metabolism will help promote better understanding of these relationships.”

There is also a need for more research on the reciprocal relationships between reproductive hormones and neurologic disorders. “Fluctuations in reproductive hormones can influence the presentation of neurologic disorders,” Dr. Pack noted. Conversely, neurologic disorders and their treatments can affect risk for reproductive disorders such as polycystic ovarian syndrome, sexual dysfunction, and infertility. “Working with gynecologists and experts in reproductive endocrinology is necessary to promote better awareness among all treating physicians as well as improve our knowledge about these complex relationships.”

These and other areas of neuroendocrinology offer rich possibilities for research collaborations.

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