Interview with Dr. Irina Bancos
Dr. Irina Bancos is a distinguished endocrinologist and internist based at the Mayo Clinic in Rochester, Minnesota, with specialized expertise in pituitary, adrenal, and gonadal pathology. Her clinical focus includes the diagnosis and management of adrenal disorders such as benign adrenal tumors and pheochromocytoma, conditions that pose significant diagnostic and therapeutic challenges. Dr. Bancos has played a leading role in advancing noninvasive diagnostic biomarkers to differentiate malignant from benign adrenal tumors, significantly impacting patient care by minimizing unnecessary procedures and improving treatment timing.
Her research interests are broad and vital, encompassing the development and validation of diagnostic biomarkers for adrenal disorders, the effects of endogenous and exogenous glucocorticoid excess on metabolism, bone health, cognition, and cardiovascular morbidity, as well as the management of adrenal insufficiency and congenital adrenal hyperplasia. She has led notable initiatives such as the “Transform the Adrenal Practice” program and continues to helm multidisciplinary teams that refine diagnostic and therapeutic approaches in endocrinology.
Dr. Bancos is also an active contributor to the scientific community as an editor of the European Journal of Endocrinology, a member of prominent adrenal research networks, and a past chair of the Pituitary-Gonadal-Adrenal-Neuroendocrine Taskforce at the American Association for Clinical Endocrinology. Her recent conference presentations in Georgia have addressed topics including Mild Autonomous Cortisol Secretion (MACS) and glucocorticoid-induced adrenal insufficiency and withdrawal syndromes.
In this interview, Dr. Bancos shares her expert insights into the nuances of adrenal endocrinology, emphasizing the importance of viewing endocrine disorders on a spectrum, the challenges in diagnosis, the vital role of lifestyle in patient outcomes, and the growing impact of environmental factors on hormonal health.
When it comes to adrenal pathology, I believe there’s still a great deal of uncertainty. In your experience, what’s the most commonly overlooked factor that can significantly impact outcomes but often goes unrecognized in current protocols?
Irina Bancos: Yeah, that’s a great question. I think there are many answers to this, but let me highlight one. This is mostly for clinicians and physicians. Sometimes, we doctors focus too much on assay cut-offs – for example, a specific cortisol cut-off or another hormone value – to make or dismiss a diagnosis. We need a reminder, myself included, that endocrine disorders exist on a spectrum – it’s not just black and white. There’s a lot of gray. This is why the patient’s story is so important. If we only look at numbers, we miss the insights that help us understand where the patient falls on that gray scale. So it’s not about the cut-offs, but about a continuum.
Endocrine disorders often present with symptoms mimicking other systemic diseases. What key educational strategies/tools are needed to help clinicians identify complex cases earlier?
Irina Bancos: It’s really about having an open mind and understanding the limits of our expertise – knowing when a multidisciplinary team is needed. We shouldn’t be dismissive or jump to conclusions before carefully reviewing all factors, including history, physical exam, and labs – and importantly, having thorough communication with our patients. Clinicians have a responsibility to make medical knowledge clear and understandable to patients. If patients don’t understand their condition, they are less likely to follow our advice.
Despite being well-informed and equipped with advanced technology, it’s easy to lose sight of the fundamentals. In your view, what is the true value and impact of lifestyle, nutrition, and behavioral health interventions, beyond what pharmacological treatments can offer?
Irina Bancos: Absolutely, it’s the most important and the most difficult aspect of care. Many patients look for a magic pill, an easy fix for their symptoms. Unfortunately, that usually does not exist. Even when a potential therapy is a consideration, it’s rarely sufficient by itself. Lifestyle factors – diet, exercise, mood, stress reduction, positive thinking – often have a great healing impact. But adopting those changes is very difficult. In endocrinology, especially, we need to evolve this part of healing, even though it’s challenging. It requires time – not only for patients but also for clinicians. I don’t have an easy answer – it’s just important to highlight how challenging and essential this is, including for physicians managing their own lifestyle.
Given the growing evidence on endocrine disruptors, how do you see endocrinologists’ role evolving in public health and prevention, and what strategies should the field adopt to address these environmental challenges?
Irina Bancos: The role of endocrine disruptors is clearly important and increasingly recognized. We are learning more every day. Sometimes, it feels overwhelming thinking about how many factors are beyond our control due to pollution and differing policies worldwide. One thing we can control is working with policymakers. I hope endocrinologists can have influence by providing expert opinions that governments listen to when making policies. This will depend on the country and its governance structures, but engaging in this way is crucial.
One final question for future colleagues, what key message would you offer them, given the rapid pace of advancement in the field and the challenge of staying current?
Irina Bancos: I’m very excited about endocrinology. There has never been a single moment in my career when I regretted choosing it. For any medical students thinking about their future, consider endocrinology – it is so cool! Once you get into it, you realize how much diversity there is within the field. For example, there are specialists focusing specifically on cortisol-related disorders, and I still think there are thousands of layers yet to explore. I love being in a field with so many gaps to fill and where we can truly make a difference for patients. I would encourage medical students to expose themselves to different experiences and mentors and to keep an open mind.
