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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "287" "paginaFinal" => "291" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Isabel Martínez Cordellat" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Isabel" "apellidos" => "Martínez Cordellat" "email" => array:1 [ 0 => "ecordellat@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Doctor Peset, Valencia, Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperparatiroidismo: ¿primario o secundario?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1021 "Ancho" => 1590 "Tamanyo" => 100359 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Changes in the clinical presentation of HP.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Primary hyperparathyroidism (HP) is a disease characterized by autonomous production of parathyroid hormone (PTH), in which there is hypercalcemia, or high-normal serum calcium with elevated serum PTH or inappropriately “normal” calcium.</p><p id="par0010" class="elsevierStylePara elsevierViewall">HP occurs in about 1% of the adult population, but affects more than 2% of it after 55 years, being 2–3 times more common in women than in men.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common cause is a parathyroid adenoma (80%–85% single and double in about 4%). The remaining cases are due to hyperplasia of the parathyroid glands, or, more rarely, a parathyroid carcinoma.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Familiar forms of HP are uncommon, manifesting usually as part of multiple endocrine neoplasia (MEN), with very rare forms of presentation, primary hyperparathyroidism and familial neonatal hyperparathyroidism.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Manifestations</span><p id="par0025" class="elsevierStylePara elsevierViewall">From the description of the disease in the 1930s by Albright and Reifenstein,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> clinical expression has changed considerably<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The first clinical descriptions regarded it as an uncommon disease with significant morbidity, which usually involved bone or renal disease, or both.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Currently, due to increased use of biochemical markers, the most frequent clinical form (88%) is a mild and asymptomatic hypercalcemia with serum calcium about 1<span class="elsevierStyleHsp" style=""></span>mg/dL above normal. However, HP may present more floridly or as asymptomatic subclinical forms.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Skeletal Manifestations</span><p id="par0040" class="elsevierStylePara elsevierViewall">Due to its predominantly cortical bone expression, PTH excess can lead to osteitis fibrosa cystica (2% of cases), manifested as bone pain and fractures. The typical radiographic signs include subperiosteal resorption of the middle and distal phalanges, thinning of the distal clavicles, a mottled or “salt and pepper” skull pattern, bone cysts and brown tumors in the long bones and pelvis.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Renal Manifestations</span><p id="par0045" class="elsevierStylePara elsevierViewall">Nephrolithiasis or nephrocalcinosis can be observed in approximately 20% of patients with HP. About 5% of nephrolithiasis are secondary to HP, while the majority are due to calcium oxalate by hipercalciuria.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The most frequent finding, however, is hypercalciuria (35%–40% of cases) due to an increased filtered load of calcium, which exceeds the reabsorption capacity.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Some patients will only have decreased creatinine clearance and renal impairment.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Gastrointestinal Manifestations</span><p id="par0060" class="elsevierStylePara elsevierViewall">May present as anorexia, nausea, vomiting and constipation. Peptic ulcer is rare (unless it occurs in the context of a MEN 1). Likewise, acute pancreatitis is rarely seen due to hypercalcemia associated with HP.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Neuromuscular Manifestations</span><p id="par0065" class="elsevierStylePara elsevierViewall">Muscle weakness and fatigue, intellectual fatigue, mental disturbances, and in rare cases that present with severe hypercalcemia, coma.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Cardiovascular Manifestations</span><p id="par0070" class="elsevierStylePara elsevierViewall">HP has been associated with hypertension. Hypercalcemia can also cause ECG changes such as shortening of the QT, blockages or increased sensitivity to digitalis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the classical forms, myocardial, valvular and vascular calcifications were described in HP. Today, stiffness and a decreased vascular ventricular<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> index can be seen.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Given the nonspecific clinical and practical absence of symptoms, the diagnosis is established by laboratory studies.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the differential diagnosis screening, apart from calcium and PTH, the values of phosphorus, chlorine, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and creatinine corrected urinary calcium in 24<span class="elsevierStyleHsp" style=""></span>h urine 10 should be determined.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The diagnosis of HP is confirmed when hypercalcemia or corrected calcium is in the high-normal range in the presence of elevated or inappropriately normal PTH.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> Other laboratory data to consider are: serum phosphorus, which tends to be low or in the lower limits of normal, calciuria, which is elevated in 40% of patients, 25-hydroxyvitamin D, which is usually lower than normal and may be associated with severe disease, and metabolic acidosis with hyperchloremia secondary to an inhibition of bicarbonate reabsorption by PTH, as well as increased markers of bone turnover.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Differential Diagnosis</span><p id="par0095" class="elsevierStylePara elsevierViewall">Differential diagnosis should be established with the following entities.</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Malignancy</span><p id="par0100" class="elsevierStylePara elsevierViewall">It is important to note that HP and malignancies are the 2 most common causes of hypercalcemia (90%).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition, malignancy-associated hypercalcemia is the most prevalent cause of hypercalcemia in hospitalized patients, being serious and rapidly evolving, as it is often linked to advanced stage malignancies, and therefore a poor prognosis.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In hypercalcemia of malignancy, PTH is suppressed (except in the rare cases of PTH-producing tumors where it is elevated), and along with the clinical data, points at the diagnosis<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,16</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Familial Hypocalciuric Hypercalcemia</span><p id="par0115" class="elsevierStylePara elsevierViewall">It is a familial syndrome with autosomal dominant inheritance, a consequence of a mutation that inactivates one allele of the calcium sensing receptor in parathyroid glands in the renal<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> tubule.</p><p id="par0120" class="elsevierStylePara elsevierViewall">It is asymptomatic young adults, with mild hypercalcemia and PTH in the normal range or slightly elevated being the only laboratory findings.</p><p id="par0125" class="elsevierStylePara elsevierViewall">There is no need for its treatment.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The way to differentiate this clinical entity of HP consists of documenting a low urinary calcium in 24<span class="elsevierStyleHsp" style=""></span>h urine, and decreased calcium/creatinine clearance ratio<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15,19–21</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Drugs</span><p id="par0135" class="elsevierStylePara elsevierViewall">Two drugs that deserve special consideration when evaluating a patient with hyperparathyroidism are thiazide diuretics and lithium.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Hypercalcemia due to thiazide diuretics<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,22</span></a>: they reduce renal calcium excretion and may cause some mild hypercalcemia. Should be removed whenever possible because can mask an HP; reassess the patient at 3 months.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">Hypercalcaemia due to Lithium: Lithium may also reduce urinary calcium excretion, leading to hypocalciuria and hypercalcemia, and in a small percentage of patients, elevation of PTH.</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">The pattern to be followed is the same way, stop treatment if possible and reassess at 3 months.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Normocalcemic Primary Hyperparathyroidism</span><p id="par0155" class="elsevierStylePara elsevierViewall">It has been hypothesized whether this entity represents the first phase of HP or if it is a different disease characterized by an alteration in the regulation of PTH secretion, or a state of relative resistance to the action of PTH.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,24</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">It represents an incidental finding in a patient studied for decreased bone mineral density (BMD).</p><p id="par0165" class="elsevierStylePara elsevierViewall">Must be differentiated from secondary (SH), and essential hyperparathyroidism to determine the values of vitamin D.</p><p id="par0170" class="elsevierStylePara elsevierViewall">It requires close monitoring in order to detect symptomatic disease.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Secondary Hyperparathyroidism</span><p id="par0175" class="elsevierStylePara elsevierViewall">Clinical situation in which the parathyroid glands respond well to low extracellular calcium concentration (renal failure, poor intake, malabsorption, etc.). However, if the increase in PTH cannot correct the plasma calcium, either due to a disorder in the organs responsible for transportation or deficiencies, hypocalcemia develops. Therefore, HS may be associated with calcium concentrations that are within or below the reference range.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Laboratory findings show high or normal PTH with low calcium levels or within normal limits.</p><p id="par0185" class="elsevierStylePara elsevierViewall">It is very important to measure levels of vitamin D and 24-h urinary calcium, in order to make the differential diagnosis of vitamin D deficiency leading to HP.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">HS treatment is to correct the primary abnormality that caused hypocalcemia.</p><p id="par0195" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> details the root causes of HS.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis Tree and Differential Diagnostic Table</span><p id="par0200" class="elsevierStylePara elsevierViewall">Faced with an elevation of PTH, measurement of serum calcium, and subsequently, calciuria in 24<span class="elsevierStyleHsp" style=""></span>h urine is required. If the latter is normal, this suggests a normocalcemic HP. If, however, it is elevated, HP will be very likely.</p><p id="par0205" class="elsevierStylePara elsevierViewall">In cases where calciuria is reduced, reposition of vitamin D should be carried out before levels of serum calcium and PTH are measured. If these values are normalized, the picture is compatible with hypovitaminosis D. HS If, however, they remain high, this points to an HP with vitamin D deficiency (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> and <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Requirements of Vitamin D</span><p id="par0210" class="elsevierStylePara elsevierViewall">The daily requirement for vitamin D is 800–1000<span class="elsevierStyleHsp" style=""></span>U/day.</p><p id="par0215" class="elsevierStylePara elsevierViewall">It is noteworthy that about 90% of patients with HP have, at least, insufficient vitamin D levels.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Treatment consists in supplementing and maintaining vitamin D levels above 30<span class="elsevierStyleHsp" style=""></span>ng/ml, strictly controlling the values of calcemia, calciuria, and phosphatemia and to monitor the numbers of vitamin D every 3–6 months.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15,19,20</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Treatment of Primary Hyperparathyroidism</span><p id="par0225" class="elsevierStylePara elsevierViewall">If symptomatic, surgery is the treatment of choice.</p><p id="par0230" class="elsevierStylePara elsevierViewall">If the patient is asymptomatic, management is more controversial, and in any case, should be monitored to detect any disease progression.</p><p id="par0235" class="elsevierStylePara elsevierViewall">Current recommendations are established as the annual measurement of serum calcium and creatinine, as well as performing a bone density test every 1–2 years.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres125882" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec113176" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres125881" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec113177" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Clinical Manifestations" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Skeletal Manifestations" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Renal Manifestations" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Gastrointestinal Manifestations" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Neuromuscular Manifestations" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Cardiovascular Manifestations" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Diagnosis" ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Differential Diagnosis" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Malignancy" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Familial Hypocalciuric Hypercalcemia" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Drugs" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Normocalcemic Primary Hyperparathyroidism" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Secondary Hyperparathyroidism" ] ] ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Diagnosis Tree and Differential Diagnostic Table" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Requirements of Vitamin D" ] 10 => array:2 [ "identificador" => "sec0085" "titulo" => "Treatment of Primary Hyperparathyroidism" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-05-06" "fechaAceptado" => "2011-06-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec113176" "palabras" => array:8 [ 0 => "Primary hyperparathyroidism" 1 => "Secondary hyperparathyroidism" 2 => "Hypercalcemia" 3 => "Familial hypocalciuria hypercalcemia" 4 => "25-hydroxy vitamin D" 5 => "1,25-dihydroxy vitamin D" 6 => "Osteoporosis" 7 => "Osteopenia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec113177" "palabras" => array:8 [ 0 => "Hiperparatiroidismo primario" 1 => "Hiperparatiroidismo secundario" 2 => "Hipercalcemia" 3 => "Hipercalcemia hipocalciúrica familiar" 4 => "25-hidroxivitamina D" 5 => "1,25-dihidroxivitamina D" 6 => "Osteoporosis" 7 => "Osteopenia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary hyperparathyroidism (PHPT) is characterized by the autonomous production of parathyroid hormone (PTH), in which there is hypercalcemia or normal-high serum calcium levels in the presence of elevated or inappropriately normal serum PTH concentrations.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exceptionally in symptomatic patients, a diagnosis can be established on the basis of clinical data. PHPT must always be evaluated in patients with clinical histories of nephrolithiasis, nephrocalcinosis, osseous pain, subperiosteal resorption, and pathologic fractures, as well as in those with osteoporosis–osteopenia, a personal history of neck irradiation, or a family history of multiple endocrine neoplasia syndrome (types 1 or 2).</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagnosis of PHPT is biochemical. Asymptomatic hypercalcemia without guiding signs or symptoms is the most frequent manifestation of the disease. For differential diagnosis, PTH must be measured, as well as phosphate, chloride, 25-hydroxyvitamin D, 1,25 dyhidroxyvitamin D and calcium-to-creatinine clearance.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The diagnosis and differential diagnosis of primary hyperparathyroidism will be discussed here.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El hiperparatiroidismo primario (HP) es una entidad clínica que se caracteriza por la producción autónoma de parathormona (PTH), en la cual hay hipercalcemia o calcio sérico normal-alto, con valores de PTH elevados o inapropiadamente normales.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De forma excepcional, el diagnóstico puede establecerse a partir de la clínica en pacientes sintomáticos. El HP siempre debe ser tenido en cuenta en pacientes con historia de cálculos renales, nefrocalcinosis, dolor óseo, fracturas patológicas, resorción subperióstica o en aquéllos que presenten osteoporosis-osteopenia, antecedentes de irradiación en cuello o historia familiar de neoplasia endocrina múltiple tipo 1 o 2.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El diagnóstico del HP es bioquímico, siendo la hipercalcemia asintomática la manifestación más frecuente de la enfermedad. Para el diagnóstico diferencial, además de la PTH, debe medirse el fósforo, cloro, 25 hidroxivitamina D, 1,25 dihidroxivitamina D y calciuria.A continuación, se revisa el diagnóstico y se detallan los cuadros clínicos con los que se debería plantear el diagnóstico diferencial.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please, cite this article as: Martínez Cordellat I. Hiperparatiroidismo: ¿primario o secundario? Reumatol Clin. 2011. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2011.06.001">doi:10.1016/j.reuma.2011.06.001</span>.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1021 "Ancho" => 1590 "Tamanyo" => 100359 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Changes in the clinical presentation of HP.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3306 "Ancho" => 2083 "Tamanyo" => 294584 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagnostic tree.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">HP, primary hyperparathyroidims; PTH, parathyroid hormone.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Ca \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clinical Data \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HP 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suggestive variable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Malignant disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓Rare ↑ (T production of PTH) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212394.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HP Differential Diagnosis/Malignant Disease.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HHF, familial hypocalciuric hypercalcemia; HP, primary hyperparathyroidism.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">24<span class="elsevierStyleHsp" style=""></span>h Urine Ca \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Cl Ca/Cr \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ (>200<span class="elsevierStyleHsp" style=""></span>mg/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ (<100<span class="elsevierStyleHsp" style=""></span>mg/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212396.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HP Differential Diagnosis/HHF.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">1.</span> Renal failure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alteration in calcitriol production \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperphosphatemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">2</span>. ↓ intake of Ca \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">3.</span> Ca malabsorption \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vitamin D deficiency \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bariatric surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Celiac disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pancreatic disease (fat malabsorption) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">4.</span> Renal calcium loss \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Idiopathic hypercalciuria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Loop diuretics \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">5.</span> Inhibition of bone resorption \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Biphosphonates \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hungry bone syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212397.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Causes of Secondary Hyperparathyroidism.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">HP, primary hyperparathyroidism; HS, secondary hyperparathyroidism; PTH, parathyroid hormone.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Blood Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Urine Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Vitamin D \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HP normocalcemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal or high \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HP with vitamin D deficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal-low or low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low (<20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HS with vitamin D deficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal or low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low (<20) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212395.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Normocalcemic HP/HP With Vitamin D Deficiency/HS Due to Hypovitaminosis D.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The parathyroid glands and metabolic bone disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. 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Year/Month | Html | Total | |
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2024 November | 25 | 15 | 40 |
2024 October | 104 | 46 | 150 |
2024 September | 78 | 34 | 112 |
2024 August | 90 | 49 | 139 |
2024 July | 83 | 38 | 121 |
2024 June | 104 | 61 | 165 |
2024 May | 161 | 81 | 242 |
2024 April | 134 | 46 | 180 |
2024 March | 149 | 62 | 211 |
2024 February | 91 | 69 | 160 |
2024 January | 99 | 34 | 133 |
2023 December | 105 | 40 | 145 |
2023 November | 148 | 58 | 206 |
2023 October | 282 | 56 | 338 |
2023 September | 180 | 58 | 238 |
2023 August | 174 | 40 | 214 |
2023 July | 110 | 48 | 158 |
2023 June | 93 | 31 | 124 |
2023 May | 75 | 29 | 104 |
2023 April | 72 | 16 | 88 |
2023 March | 129 | 46 | 175 |
2023 February | 133 | 38 | 171 |
2023 January | 124 | 18 | 142 |
2022 December | 162 | 62 | 224 |
2022 November | 148 | 57 | 205 |
2022 October | 159 | 63 | 222 |
2022 September | 104 | 72 | 176 |
2022 August | 141 | 36 | 177 |
2022 July | 115 | 74 | 189 |
2022 June | 105 | 66 | 171 |
2022 May | 182 | 84 | 266 |
2022 April | 252 | 82 | 334 |
2022 March | 296 | 106 | 402 |
2022 February | 307 | 65 | 372 |
2022 January | 290 | 75 | 365 |
2021 December | 159 | 52 | 211 |
2021 November | 180 | 60 | 240 |
2021 October | 219 | 87 | 306 |
2021 September | 172 | 51 | 223 |
2021 August | 182 | 58 | 240 |
2021 July | 147 | 42 | 189 |
2021 June | 195 | 61 | 256 |
2021 May | 205 | 65 | 270 |
2021 April | 524 | 179 | 703 |
2021 March | 386 | 72 | 458 |
2021 February | 221 | 46 | 267 |
2021 January | 163 | 70 | 233 |
2020 December | 207 | 33 | 240 |
2020 November | 130 | 36 | 166 |
2020 October | 89 | 28 | 117 |
2020 September | 115 | 53 | 168 |
2020 August | 70 | 37 | 107 |
2020 July | 60 | 48 | 108 |
2020 June | 89 | 52 | 141 |
2020 May | 91 | 31 | 122 |
2020 April | 83 | 27 | 110 |
2020 March | 31 | 11 | 42 |
2020 February | 1 | 0 | 1 |
2020 January | 4 | 0 | 4 |
2019 September | 5 | 0 | 5 |
2019 June | 1 | 0 | 1 |
2019 March | 1 | 0 | 1 |
2019 January | 1 | 0 | 1 |
2018 May | 16 | 0 | 16 |
2018 April | 156 | 19 | 175 |
2018 March | 218 | 14 | 232 |
2018 February | 126 | 10 | 136 |
2018 January | 138 | 14 | 152 |
2017 December | 150 | 18 | 168 |
2017 November | 131 | 14 | 145 |
2017 October | 128 | 11 | 139 |
2017 September | 207 | 24 | 231 |
2017 August | 237 | 27 | 264 |
2017 July | 149 | 24 | 173 |
2017 June | 164 | 12 | 176 |
2017 May | 191 | 27 | 218 |
2017 April | 183 | 15 | 198 |
2017 March | 169 | 10 | 179 |
2017 February | 152 | 7 | 159 |
2017 January | 126 | 6 | 132 |
2016 December | 216 | 27 | 243 |
2016 November | 299 | 10 | 309 |
2016 October | 276 | 18 | 294 |
2016 September | 328 | 25 | 353 |
2016 August | 269 | 7 | 276 |
2016 July | 117 | 26 | 143 |
2016 May | 2 | 0 | 2 |
2016 February | 1 | 0 | 1 |
2015 December | 2 | 0 | 2 |
2015 November | 2 | 22 | 24 |
2015 October | 5 | 29 | 34 |
2015 August | 3 | 0 | 3 |
2015 July | 142 | 11 | 153 |
2015 June | 202 | 23 | 225 |
2015 May | 252 | 37 | 289 |
2015 April | 267 | 32 | 299 |
2015 March | 320 | 19 | 339 |
2015 February | 308 | 26 | 334 |
2015 January | 261 | 35 | 296 |
2014 December | 293 | 17 | 310 |
2014 November | 259 | 17 | 276 |
2014 October | 355 | 28 | 383 |
2014 September | 245 | 23 | 268 |
2014 August | 184 | 30 | 214 |
2014 July | 193 | 27 | 220 |
2014 June | 172 | 26 | 198 |
2014 May | 143 | 30 | 173 |
2014 April | 150 | 32 | 182 |
2014 March | 127 | 33 | 160 |
2014 February | 95 | 32 | 127 |
2014 January | 96 | 33 | 129 |
2013 December | 75 | 24 | 99 |
2013 November | 57 | 42 | 99 |
2013 October | 100 | 32 | 132 |
2013 September | 77 | 23 | 100 |
2013 August | 72 | 34 | 106 |
2013 July | 79 | 29 | 108 |
2013 June | 94 | 40 | 134 |
2013 May | 73 | 46 | 119 |
2013 April | 88 | 55 | 143 |
2013 March | 87 | 46 | 133 |
2013 February | 58 | 15 | 73 |
2013 January | 59 | 15 | 74 |
2012 December | 52 | 19 | 71 |
2012 November | 59 | 42 | 101 |
2012 October | 79 | 30 | 109 |