Website of the week
There are some excellent sites on offer this week, and almost any one of them could be my first choice. The reason I made it this one is because I was seduced by the imagery. The site is a strange mixture, with simple terminology and highly graphic and technical images. And of course it is the pictures that grab you. I've always marvelled that neurosurgeons can go rummaging around at the base of your brain through a hole above your top lip. There are MRIs of various types of micro and macro-adenomas, and full-colour drawings of the anatomy. There are links to other parts of the site that you have to follow in order to see everything. And I advise that you don't look at the picture of the sublabial approach before breakfast.
Why go there: it is fascinating to look at.
Downside: difficult to navigate.
Information from: Otolaryngology Houston.
Address: www.ghorayeb.com/PituitaryMRI.html
Causes of hypopituitarism
This page is excellent. Clear, bullet-pointed tables, without any unnecessary extras, give a succinct version of the causes of this complex condition.
There are seven headings, ranging from intrasellar and extrasellar tumours to a small miscellaneous group.
This site functions well as an aide-memoire if you are considering the diagnosis, but will be even better used as an educational aid for GP registrars, or medical student. I'm sure they will all find this presentation helpful.
Why go there: to the point.
Downside: none.
Information from: EndocrineSurgeon.
Address: www.endocrinesurgeon.co.uk/pituitary/pituitary3-2.html
Diagnosing hypopituitarism
Here is another article that confines itself to just one aspect of this multi-faceted disease, this time concentrating on diagnosis.
As the introduction points out, the relevant hormonal deficiencies may be partial and may take years to develop. So it is, as is often the case, for GPs to try and make sense of the subtle features that make up the clinical picture.
But it is the possibility of picking up something unusual that makes the job so rewarding.
We see so many cases of ‘tired all the time' that we lose count after a few months into our careers, but pick up a case of hypopituitarism that turns out to be a pituitary microadenoma and you will remember it for the rest of your professional life.
I like the way this article uses a case history to take us through all the possible scenarios, which are much more complicated than you might think from the basic history and investigations.
Why go there: interesting and informative.
Downside: poor presentation.
Information from: Postgraduate Medicine online.
Address: http://www.postgradmed.com/issues/1998/07_98/schmidt.htm
Growth hormone replacement
Growth hormone is frequently in the news, often for the wrong reasons. This article covers all the issues in about 900 words, with clearly defined headings and lists. Who to consider for treatment, quality-of-life issues, the process of growth hormone replacement, and possible problems are all covered.
Bookmark this page - one day it might come in handy.
Why go there: all you need to know.
Downside: could look better.
Information from: Endocrinology.org
Address: http://http://www.endocrinology.org/education/resource/summerschool/2003/ss03/ss03sha.htm
Information for patients
This 20-page PDF has excellent content and style. The pages are not densely packed, with never more than a few paragraphs on each.
Why go there: hard to do better than this.
Downside: none.
Information from: The Pituitary Foundation.
Address: http://www.pituitary.org.uk/images/ stories/leaflets/Hypo%20&%20Replacement.pdf
Dr Barnard is a former GP in Fareham, Hampshire
