Pouneh K. Fazeli, MD, MPH, has recently been appointed as Division Chief of Endocrinology and Metabolism. She is currently an Associate Professor of Medicine, the Director of the Neuroendocrinology Unit, and the Medical Director of the Pituitary Center of Excellence at UPMC. She also serves as Chief of the Division of Endocrinology at the VA Pittsburgh Healthcare System.

We reached out to Dr. Fazeli to learn more about her current research and her vision and goals for the Division of Endocrinology and Metabolism.

What first interested you in endocrinology and metabolism? Or specifically, undernutrition, bone health, etc.?

I started out as a physics major in college. During my sophomore year, I took a core course requirement on the topic of reproductive endocrinology, taught by a biological anthropologist, Dr. Peter Ellison. I fell in love with the reproductive axis and the way in which the reproductive axis (the hypothalamic-pituitary-gonadal axis) responds to stressors such as undernutrition and over-exercise. After taking that class, I switched my major to biological anthropology. I wrote my research seminar paper on the response of the reproductive axis to states of negative energy balance (ie over-exercise/ inappropriately low caloric intake) and that is an area that my lab continues to study today.

What are you currently working on?

My main area of interest is understanding hormonal adaptations and responses to states of nutritional stress or negative energy balance. Humans are extremely well-adapted to survive prolonged periods of starvation, as we were exposed to periods of famine in our evolutionary past. Many of the adaptations that help us survive starvation, including shunting energy away from the reproductive axis, are mediated by the hypothalamic-pituitary axis which is how my research focus ties into my clinical specialty – I am a neuroendocrinologist, an endocrinologist who focuses on disorders related to the hypothalamic-pituitary axes. Our lab has focused on understanding these adaptations and the consequences of prolonged negative energy balance, including loss of bone mass. Low bone mineral density affects nearly 85% of women with anorexia nervosa, a psychiatric disorder characterized by a self-induced state of negative energy balance. Trying to prevent this bone loss has been a key research interest of mine since my endocrine fellowship.

What excites you about your current research?

For much of my career, I have focused on the negative consequences of states of undernutrition and negative energy balance, most notably the loss of bone mass. Yet today the majority of our population is overweight or obese. Now our lab, in conjunction with Matthew Steinhauser’s lab, which is based at the Aging Institute (he is a cardiologist, Associate Professor of Medicine, scientific collaborator and also my husband), is investigating possible metabolic benefits to short-term periods of fasting (ie intermittent fasting). Understanding whether short-term periods of negative energy balance may be beneficial is a very exciting area, as it may have implications for the treatment of the one of the most prevalent health challenges of our time.

What are some big questions you look forward to addressing in your own research?

Investigating whether intermittent fasting can have positive metabolic effects, even if individuals don’t lose weight, is an important unanswered question. We don’t yet know if there are metabolic benefits to fasting independent of weight loss, as the majority of studies that have been done to date have shown benefits of fasting but individuals in the studies have typically lost weight. Are there benefits to fasting even if you don’t lose weight (i.e., if you increase calories on days when you are not fasting to maintain body weight) and therefore would normal weight individuals also benefit from fasting?

What are your goals/vision for the Division?

My vision for the division consists of focusing steadfastly on the tripartite mission of clinical excellence, research excellence and training the next generation. I have been very lucky over the last five years to have had the opportunity to focus on the tripartite mission as a faculty member at Pitt/UPMC and more recently at the VA. My hope for the division is that we maintain our commitment to this mission and also foster more collaborations between our outstanding clinical faculty and research faculty. I truly believe that our sum is greater than our individual parts and working together, our already exceptional division has the potential to become even more exceptional.

What are some current hot topics in endocrinology here at Pitt and/or beyond?

Endocrinology is an extremely exciting field, and we are at the epicenter of the most important, challenging and prevalent health issues of our time. Our endocrinologists are tasked with caring for patients with obesity and diabetes mellitus and the basic, translational and clinical research in these areas are some of our strongest areas of focus. Endocrinologists are also responsible for caring for some very rare diseases, including hypophosphatasia and acromegaly. At Pitt/UPMC, we are very lucky to have strong research and clinical expertise in both the prevalent disorders, including diabetes mellitus, as well as the more rare diseases.

How does research done here at Pitt affect patient care?

The research in our division directly affects patient care. We have basic and clinical researchers focused on diabetes mellitus, obesity, thyroid disorders, adrenal disorders, pituitary disease, and osteoporosis among other disorders. We are also a site for multiple industry-sponsored treatment studies, which gives our patients access to cutting edge treatments that they wouldn’t have access to otherwise.

What sets the endocrinology program at Pitt apart from other training programs?

We have an outstanding track record for training researchers and clinicians in endocrinology at Pitt/UPMC. We are in year 49 of our T32 training award, which makes it one of the oldest (if not the oldest) T32 training grant at the University of Pittsburgh. This is a testament to our division’s long-standing excellence in training the future generation of scientists. We also have one of the largest clinical endocrinology fellowships in the country with 5 clinical fellows entering our program each year. Research and clinical fellows who train in our program have robust and outstanding exposure to all areas of endocrinology, including the rarer areas within the field.

What advice would you give to emerging scientists considering endocrinology research? What advice would you give to those considering a clinical career in endocrinology?

This is such an exciting time to be in field of endocrinology and there are an incredible number of clinical and research opportunities. Following your passion is the most important advice I can give to anyone considering a career in research or a clinical career. If you are excited by the topic you are studying or the disorder you are treating, that will carry you through even the most challenging of times.