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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Primary hyperparathyroidism &#40;HP&#41; is a disease characterized by autonomous production of parathyroid hormone &#40;PTH&#41;&#44; in which there is hypercalcemia&#44; or high-normal serum calcium with elevated serum PTH or inappropriately &#8220;normal&#8221; calcium&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">HP occurs in about 1&#37; of the adult population&#44; but affects more than 2&#37; of it after 55 years&#44; being 2&#8211;3 times more common in women than in men&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common cause is a parathyroid adenoma &#40;80&#37;&#8211;85&#37; single and double in about 4&#37;&#41;&#46; The remaining cases are due to hyperplasia of the parathyroid glands&#44; or&#44; more rarely&#44; a parathyroid carcinoma&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Familiar forms of HP are uncommon&#44; manifesting usually as part of multiple endocrine neoplasia &#40;MEN&#41;&#44; with very rare forms of presentation&#44; primary hyperparathyroidism and familial neonatal hyperparathyroidism&#46;</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&#44;<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> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The first clinical descriptions regarded it as an uncommon disease with significant morbidity&#44; which usually involved bone or renal disease&#44; or both&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Currently&#44; due to increased use of biochemical markers&#44; the most frequent clinical form &#40;88&#37;&#41; is a mild and asymptomatic hypercalcemia with serum calcium about 1<span class="elsevierStyleHsp" style=""></span>mg&#47;dL above normal&#46; However&#44; HP may present more floridly or as asymptomatic subclinical forms&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;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&#44; PTH excess can lead to osteitis fibrosa cystica &#40;2&#37; of cases&#41;&#44; manifested as bone pain and fractures&#46; The typical radiographic signs include subperiosteal resorption of the middle and distal phalanges&#44; thinning of the distal clavicles&#44; a mottled or &#8220;salt and pepper&#8221; skull pattern&#44; bone cysts and brown tumors in the long bones and pelvis&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;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&#37; of patients with HP&#46; About 5&#37; of nephrolithiasis are secondary to HP&#44; while the majority are due to calcium oxalate by hipercalciuria&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The most frequent finding&#44; however&#44; is hypercalciuria &#40;35&#37;&#8211;40&#37; of cases&#41; due to an increased filtered load of calcium&#44; which exceeds the reabsorption capacity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Some patients will only have decreased creatinine clearance and renal impairment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Gastrointestinal Manifestations</span><p id="par0060" class="elsevierStylePara elsevierViewall">May present as anorexia&#44; nausea&#44; vomiting and constipation&#46; Peptic ulcer is rare &#40;unless it occurs in the context of a MEN 1&#41;&#46; Likewise&#44; acute pancreatitis is rarely seen due to hypercalcemia associated with HP&#46;<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&#44; intellectual fatigue&#44; mental disturbances&#44; and in rare cases that present with severe hypercalcemia&#44; coma&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;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&#46; Hypercalcemia can also cause ECG changes such as shortening of the QT&#44; blockages or increased sensitivity to digitalis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the classical forms&#44; myocardial&#44; valvular and vascular calcifications were described in HP&#46; Today&#44; stiffness and a decreased vascular ventricular<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> index can be seen&#46;</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&#44; 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and metabolic acidosis with hyperchloremia secondary to an inhibition of bicarbonate reabsorption by PTH&#44; as well as increased markers of bone turnover&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;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&#46;</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 &#40;90&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition&#44; malignancy-associated hypercalcemia is the most prevalent cause of hypercalcemia in hospitalized patients&#44; being serious and rapidly evolving&#44; as it is often linked to advanced stage malignancies&#44; and therefore a poor prognosis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In hypercalcemia of malignancy&#44; PTH is suppressed &#40;except in the rare cases of PTH-producing tumors where it is elevated&#41;&#44; and along with the clinical data&#44; points at the diagnosis<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</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&#44; 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&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">It is asymptomatic young adults&#44; with mild hypercalcemia and PTH in the normal range or slightly elevated being the only laboratory findings&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">There is no need for its treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;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&#44; and decreased calcium&#47;creatinine clearance ratio<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15&#44;19&#8211;21</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</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&#46;<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&#44;22</span></a>&#58; they reduce renal calcium excretion and may cause some mild hypercalcemia&#46; Should be removed whenever possible because can mask an HP&#59; reassess the patient at 3 months&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">Hypercalcaemia due to Lithium&#58; Lithium may also reduce urinary calcium excretion&#44; leading to hypocalciuria and hypercalcemia&#44; and in a small percentage of patients&#44; elevation of PTH&#46;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">The pattern to be followed is the same way&#44; stop treatment if possible and reassess at 3 months&#46;<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&#44; or a state of relative resistance to the action of PTH&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">It represents an incidental finding in a patient studied for decreased bone mineral density &#40;BMD&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Must be differentiated from secondary &#40;SH&#41;&#44; and essential hyperparathyroidism to determine the values of vitamin D&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">It requires close monitoring in order to detect symptomatic disease&#46;<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 &#40;renal failure&#44; poor intake&#44; malabsorption&#44; etc&#46;&#41;&#46; However&#44; if the increase in PTH cannot correct the plasma calcium&#44; either due to a disorder in the organs responsible for transportation or deficiencies&#44; hypocalcemia develops&#46; Therefore&#44; HS may be associated with calcium concentrations that are within or below the reference range&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Laboratory findings show high or normal PTH with low calcium levels or within normal limits&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">It is very important to measure levels of vitamin D and 24-h urinary calcium&#44; in order to make the differential diagnosis of vitamin D deficiency leading to HP&#46;<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&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> details the root causes of HS&#46;</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&#44; measurement of serum calcium&#44; and subsequently&#44; calciuria in 24<span class="elsevierStyleHsp" style=""></span>h urine is required&#46; If the latter is normal&#44; this suggests a normocalcemic HP&#46; If&#44; however&#44; it is elevated&#44; HP will be very likely&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In cases where calciuria is reduced&#44; reposition of vitamin D should be carried out before levels of serum calcium and PTH are measured&#46; If these values are normalized&#44; the picture is compatible with hypovitaminosis D&#46; HS If&#44; however&#44; they remain high&#44; this points to an HP with vitamin D deficiency &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> and <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</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&#8211;1000<span class="elsevierStyleHsp" style=""></span>U&#47;day&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">It is noteworthy that about 90&#37; of patients with HP have&#44; at least&#44; insufficient vitamin D levels&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Treatment consists in supplementing and maintaining vitamin D levels above 30<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#44; strictly controlling the values of calcemia&#44; calciuria&#44; and phosphatemia and to monitor the numbers of vitamin D every 3&#8211;6 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15&#44;19&#44;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&#44; surgery is the treatment of choice&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">If the patient is asymptomatic&#44; management is more controversial&#44; and in any case&#44; should be monitored to detect any disease progression&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Current recommendations are established as the annual measurement of serum calcium and creatinine&#44; as well as performing a bone density test every 1&#8211;2 years&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span></span>"
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          "identificador" => "xpalclavsec113176"
          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "xres125881"
          "titulo" => "Resumen"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Clinical Manifestations"
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            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"
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        6 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Diagnosis"
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          "titulo" => "Differential Diagnosis"
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            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Malignancy"
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            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Familial Hypocalciuric Hypercalcemia"
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            2 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Drugs"
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            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"
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        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"
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    "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&#44;25-dihydroxy vitamin D"
            6 => "Osteoporosis"
            7 => "Osteopenia"
          ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec113177"
          "palabras" => array:8 [
            0 => "Hiperparatiroidismo primario"
            1 => "Hiperparatiroidismo secundario"
            2 => "Hipercalcemia"
            3 => "Hipercalcemia hipocalci&#250;rica familiar"
            4 => "25-hidroxivitamina D"
            5 => "1&#44;25-dihidroxivitamina D"
            6 => "Osteoporosis"
            7 => "Osteopenia"
          ]
        ]
      ]
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary hyperparathyroidism &#40;PHPT&#41; is characterized by the autonomous production of parathyroid hormone &#40;PTH&#41;&#44; in which there is hypercalcemia or normal-high serum calcium levels in the presence of elevated or inappropriately normal serum PTH concentrations&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exceptionally in symptomatic patients&#44; a diagnosis can be established on the basis of clinical data&#46; PHPT must always be evaluated in patients with clinical histories of nephrolithiasis&#44; nephrocalcinosis&#44; osseous pain&#44; subperiosteal resorption&#44; and pathologic fractures&#44; as well as in those with osteoporosis&#8211;osteopenia&#44; a personal history of neck irradiation&#44; or a family history of multiple endocrine neoplasia syndrome &#40;types 1 or 2&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagnosis of PHPT is biochemical&#46; Asymptomatic hypercalcemia without guiding signs or symptoms is the most frequent manifestation of the disease&#46; For differential diagnosis&#44; PTH must be measured&#44; as well as phosphate&#44; chloride&#44; 25-hydroxyvitamin D&#44; 1&#44;25 dyhidroxyvitamin D and calcium-to-creatinine clearance&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The diagnosis and differential diagnosis of primary hyperparathyroidism will be discussed here&#46;</p>"
      ]
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        "titulo" => "Resumen"
        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El hiperparatiroidismo primario &#40;HP&#41; es una entidad cl&#237;nica que se caracteriza por la producci&#243;n aut&#243;noma de parathormona &#40;PTH&#41;&#44; en la cual hay hipercalcemia o calcio s&#233;rico normal-alto&#44; con valores de PTH elevados o inapropiadamente normales&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De forma excepcional&#44; el diagn&#243;stico puede establecerse a partir de la cl&#237;nica en pacientes sintom&#225;ticos&#46; El HP siempre debe ser tenido en cuenta en pacientes con historia de c&#225;lculos renales&#44; nefrocalcinosis&#44; dolor &#243;seo&#44; fracturas patol&#243;gicas&#44; resorci&#243;n subperi&#243;stica o en aqu&#233;llos que presenten osteoporosis-osteopenia&#44; antecedentes de irradiaci&#243;n en cuello o historia familiar de neoplasia endocrina m&#250;ltiple tipo 1 o 2&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El diagn&#243;stico del HP es bioqu&#237;mico&#44; siendo la hipercalcemia asintom&#225;tica la manifestaci&#243;n m&#225;s frecuente de la enfermedad&#46; Para el diagn&#243;stico diferencial&#44; adem&#225;s de la PTH&#44; debe medirse el f&#243;sforo&#44; cloro&#44; 25 hidroxivitamina D&#44; 1&#44;25 dihidroxivitamina D y calciuria&#46;A continuaci&#243;n&#44; se revisa el diagn&#243;stico y se detallan los cuadros cl&#237;nicos con los que se deber&#237;a plantear el diagn&#243;stico diferencial&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please&#44; cite this article as&#58; Mart&#237;nez Cordellat I&#46; Hiperparatiroidismo&#58; &#191;primario o secundario&#63; Reumatol Clin&#46; 2011&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2011.06.001">doi&#58;10&#46;1016&#47;j&#46;reuma&#46;2011&#46;06&#46;001</span>&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Changes in the clinical presentation of HP&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">HP&#44; primary hyperparathyroidims&#59; PTH&#44; parathyroid hormone&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">PTH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">HP 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Suggestive variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Malignant disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8595;Rare &#8593; &#40;T production of PTH&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HHF&#44; familial hypocalciuric hypercalcemia&#59; HP&#44; primary hyperparathyroidism&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Cl Ca&#47;Cr&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8593; &#40;&#62;200<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#62;0&#46;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">HHF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8595; &#40;&#60;100<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8804;0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">PTH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Blood Calcium&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Normal or high&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">HP with vitamin D deficiency&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Normal-low or low&nbsp;\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
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                  \t\t\t\t">Low &#40;&#60;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HS with vitamin D deficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                    0 => array:2 [
                      "titulo" => "The parathyroid glands and metabolic bone disease"
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                        0 => array:2 [
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                          "autores" => array:2 [
                            0 => "F&#46; Albright"
                            1 => "E&#46;C&#46; Reifenstein"
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                    0 => array:1 [
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                        "fecha" => "1984"
                        "editorial" => "Williams &#38; Wilkins"
                        "editorialLocalizacion" => "Baltimore"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time to reconsider current clinical decision paradigms&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; El-Hajj Fuleihan"
                            1 => "Hyperparathyroidism&#58;"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2008-1305"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2008"
                        "volumen" => "93"
                        "paginaInicial" => "3302"
                        "paginaFinal" => "3304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18772461"
                            "web" => "Medline"
                          ]
                        ]
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary hyperparathyroidism&#58; incidence&#44; morbidity&#44; and potential economic impact in a community"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Heath III"
                            1 => "S&#46;F&#46; Hodgson"
                            2 => "M&#46;A&#46; Kennedy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198001243020402"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1980"
                        "volumen" => "302"
                        "paginaInicial" => "189"
                        "paginaFinal" => "193"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7350459"
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                0 => array:1 [
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                    0 => array:1 [
                      "Revista" => array:8 [
                        "titulo" => "Proceedings of the NIH consensus development conference on diagnosis and management of asymptomatic primary hyperparathyroidism"
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "1991"
                        "volumen" => "6"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "2"
                        "editores" => "J&#46;T&#46;PottsJr&#46;J&#46;E&#46;FradkinG&#46;D&#46;AurbachJ&#46;P&#46;BilezikianL&#46;G&#46;Raisz"
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                      "titulo" => "Skeletal disease in primary hyperparathyroidism"
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                          "autores" => array:6 [
                            0 => "S&#46;J&#46; Silverberg"
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                            3 => "D&#46;W&#46; Dempster"
                            4 => "F&#46; Feldman"
                            5 => "D&#46; Seldin"
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                      "doi" => "10.1002/jbmr.5650040302"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "1989"
                        "volumen" => "4"
                        "paginaInicial" => "283"
                        "paginaFinal" => "291"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2763869"
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Longitudinal changes in bone mineral density and bone turnover in postmenopausal women with primary hyperparathyroidism"
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                          "etal" => false
                          "autores" => array:5 [
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                            3 => "A&#46;M&#46;A&#46; Assiri"
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                    0 => array:2 [
                      "doi" => "10.1210/jcem.81.10.8855790"
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                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1996"
                        "volumen" => "81"
                        "paginaInicial" => "3487"
                        "paginaFinal" => "3491"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8855790"
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                    0 => array:2 [
                      "titulo" => "Primary hyperparathyroidism and the risk of fracture&#58; a population based study"
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                          "etal" => false
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                            0 => "S&#46; Khosla"
                            1 => "L&#46;J&#46; Melton III"
                            2 => "R&#46;A&#46; Wermers"
                            3 => "C&#46;S&#46; Crowson"
                            4 => "W&#46;M&#46; O&#8217;Fallon"
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                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "1999"
                        "volumen" => "14"
                        "paginaInicial" => "1700"
                        "paginaFinal" => "1707"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10491217"
                            "web" => "Medline"
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              "identificador" => "bib0040"
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                    0 => array:2 [
                      "titulo" => "Nephrolithiasis and bone involvement in primary hyperparathyroidism"
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "E&#46; Shane"
                            2 => "T&#46;P&#46; Jacobs"
                            3 => "E&#46;S&#46; Siris"
                            4 => "F&#46; Gartenberg"
                            5 => "D&#46; Seldin"
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                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1990"
                        "volumen" => "89"
                        "paginaInicial" => "327"
                        "paginaFinal" => "333"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2393037"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0045"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery&#58; a controlled historical follow up study"
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                          "etal" => false
                          "autores" => array:6 [
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                            3 => "L&#46; Mosekilde"
                            4 => "P&#46; Christiansen"
                            5 => "M&#46; Blichert-Toft"
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                        "tituloSerie" => "BMJ"
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                        "paginaFinal" => "810"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12376441"
                            "web" => "Medline"
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              "identificador" => "bib0050"
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                    0 => array:2 [
                      "titulo" => "Disorders of calcium homeostasis"
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                          "etal" => false
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                            2 => "E&#46; Daci"
                            3 => "C&#46; Maes"
                            4 => "R&#46; Bouillon"
                          ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Endocrinol Metab"
                        "fecha" => "2003"
                        "volumen" => "17"
                        "paginaInicial" => "529"
                        "paginaFinal" => "546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14687587"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0055"
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                      "titulo" => "Neuromuscular involvement in mild&#44; asymptomatic primary hyperparathyroidism"
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                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Turken"
                            1 => "M&#46; Cafferty"
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                            3 => "L&#46; De la Cruz"
                            4 => "C&#46; Cimino"
                            5 => "D&#46;J&#46; Lange"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1989"
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                        "paginaInicial" => "553"
                        "paginaFinal" => "557"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2816971"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychologic symptoms before and after parathyroid surgery"
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                            0 => "B&#46;L&#46; Solomon"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1994"
                        "volumen" => "96"
                        "paginaInicial" => "101"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8109593"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular aspects of primary hyperparathyroidism"
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                          "autores" => array:2 [
                            0 => "M&#46;D&#46; Walker"
                            1 => "S&#46;J&#46; Silverberg"
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "J Endocrinol Invest"
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                        "volumen" => "31"
                        "paginaInicial" => "925"
                        "paginaFinal" => "931"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19092300"
                            "web" => "Medline"
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              "identificador" => "bib0070"
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                    0 => array:2 [
                      "titulo" => "American College of Endocrinology and American Association of Clinical Endocrinologists position statement on patient safety and medical system errors in diabetes and endocrinology"
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                          "etal" => true
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                        "tituloSerie" => "Endocr Pract"
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                        "paginaInicial" => "197"
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                          0 => array:2 [
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              "identificador" => "bib0075"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Primary hyperparathyroidism"
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                      "titulo" => "Hypercalcemia associated with cancer"
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                        "fecha" => "2005"
                        "volumen" => "352"
                        "paginaInicial" => "373"
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                        "link" => array:1 [
                          0 => array:2 [
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              "identificador" => "bib0085"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Familiar benign hypocalcyiuc hypercalcemia"
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                            0 => "Gel-H&#46; Fuleiham"
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                      "titulo" => "Molecular genetic analysis of the calcium sensing receptor gene in patients clinically suspected to have familiar hypocalciuric hypercalcemia&#58; phenotypic variation and mutation spectrum in a Danish population"
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                        "volumen" => "92"
                        "paginaInicial" => "4373"
                        "link" => array:1 [
                          0 => array:2 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asymptomatic primary hyperparathyroidism"
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                        "link" => array:1 [
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                      "titulo" => "Familial benign hypocalciuric hypercalcemia and neonatal primary hyperparathyroidism"
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                      "titulo" => "Non parathyroid hypercalcemia"
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Continuing Medical Education
Hyperparathiroidism: Primary or Secondary Disease?
Hiperparatiroidismo: ¿primario o secundario?
Isabel Martínez Cordellat
Servicio de Reumatología, Hospital Universitario Doctor Peset, Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Primary hyperparathyroidism &#40;HP&#41; is a disease characterized by autonomous production of parathyroid hormone &#40;PTH&#41;&#44; in which there is hypercalcemia&#44; or high-normal serum calcium with elevated serum PTH or inappropriately &#8220;normal&#8221; calcium&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">HP occurs in about 1&#37; of the adult population&#44; but affects more than 2&#37; of it after 55 years&#44; being 2&#8211;3 times more common in women than in men&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common cause is a parathyroid adenoma &#40;80&#37;&#8211;85&#37; single and double in about 4&#37;&#41;&#46; The remaining cases are due to hyperplasia of the parathyroid glands&#44; or&#44; more rarely&#44; a parathyroid carcinoma&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Familiar forms of HP are uncommon&#44; manifesting usually as part of multiple endocrine neoplasia &#40;MEN&#41;&#44; with very rare forms of presentation&#44; primary hyperparathyroidism and familial neonatal hyperparathyroidism&#46;</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&#44;<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> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The first clinical descriptions regarded it as an uncommon disease with significant morbidity&#44; which usually involved bone or renal disease&#44; or both&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Currently&#44; due to increased use of biochemical markers&#44; the most frequent clinical form &#40;88&#37;&#41; is a mild and asymptomatic hypercalcemia with serum calcium about 1<span class="elsevierStyleHsp" style=""></span>mg&#47;dL above normal&#46; However&#44; HP may present more floridly or as asymptomatic subclinical forms&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;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&#44; PTH excess can lead to osteitis fibrosa cystica &#40;2&#37; of cases&#41;&#44; manifested as bone pain and fractures&#46; The typical radiographic signs include subperiosteal resorption of the middle and distal phalanges&#44; thinning of the distal clavicles&#44; a mottled or &#8220;salt and pepper&#8221; skull pattern&#44; bone cysts and brown tumors in the long bones and pelvis&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;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&#37; of patients with HP&#46; About 5&#37; of nephrolithiasis are secondary to HP&#44; while the majority are due to calcium oxalate by hipercalciuria&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The most frequent finding&#44; however&#44; is hypercalciuria &#40;35&#37;&#8211;40&#37; of cases&#41; due to an increased filtered load of calcium&#44; which exceeds the reabsorption capacity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Some patients will only have decreased creatinine clearance and renal impairment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Gastrointestinal Manifestations</span><p id="par0060" class="elsevierStylePara elsevierViewall">May present as anorexia&#44; nausea&#44; vomiting and constipation&#46; Peptic ulcer is rare &#40;unless it occurs in the context of a MEN 1&#41;&#46; Likewise&#44; acute pancreatitis is rarely seen due to hypercalcemia associated with HP&#46;<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&#44; intellectual fatigue&#44; mental disturbances&#44; and in rare cases that present with severe hypercalcemia&#44; coma&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;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&#46; Hypercalcemia can also cause ECG changes such as shortening of the QT&#44; blockages or increased sensitivity to digitalis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the classical forms&#44; myocardial&#44; valvular and vascular calcifications were described in HP&#46; Today&#44; stiffness and a decreased vascular ventricular<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> index can be seen&#46;</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&#44; the diagnosis is established by laboratory studies&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the differential diagnosis screening&#44; apart from calcium and PTH&#44; the values of phosphorus&#44; chlorine&#44; 25-hydroxyvitamin D&#44; 1&#44;25-dihydroxyvitamin D and creatinine corrected urinary calcium in 24<span class="elsevierStyleHsp" style=""></span>h urine 10 should be determined&#46;</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&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> Other laboratory data to consider are&#58; serum phosphorus&#44; which tends to be low or in the lower limits of normal&#44; calciuria&#44; which is elevated in 40&#37; of patients&#44; 25-hydroxyvitamin D&#44; which is usually lower than normal and may be associated with severe disease&#44; and metabolic acidosis with hyperchloremia secondary to an inhibition of bicarbonate reabsorption by PTH&#44; as well as increased markers of bone turnover&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;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&#46;</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 &#40;90&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition&#44; malignancy-associated hypercalcemia is the most prevalent cause of hypercalcemia in hospitalized patients&#44; being serious and rapidly evolving&#44; as it is often linked to advanced stage malignancies&#44; and therefore a poor prognosis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In hypercalcemia of malignancy&#44; PTH is suppressed &#40;except in the rare cases of PTH-producing tumors where it is elevated&#41;&#44; and along with the clinical data&#44; points at the diagnosis<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</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&#44; 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&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">It is asymptomatic young adults&#44; with mild hypercalcemia and PTH in the normal range or slightly elevated being the only laboratory findings&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">There is no need for its treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;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&#44; and decreased calcium&#47;creatinine clearance ratio<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15&#44;19&#8211;21</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</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&#46;<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&#44;22</span></a>&#58; they reduce renal calcium excretion and may cause some mild hypercalcemia&#46; Should be removed whenever possible because can mask an HP&#59; reassess the patient at 3 months&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">Hypercalcaemia due to Lithium&#58; Lithium may also reduce urinary calcium excretion&#44; leading to hypocalciuria and hypercalcemia&#44; and in a small percentage of patients&#44; elevation of PTH&#46;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">The pattern to be followed is the same way&#44; stop treatment if possible and reassess at 3 months&#46;<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&#44; or a state of relative resistance to the action of PTH&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">It represents an incidental finding in a patient studied for decreased bone mineral density &#40;BMD&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Must be differentiated from secondary &#40;SH&#41;&#44; and essential hyperparathyroidism to determine the values of vitamin D&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">It requires close monitoring in order to detect symptomatic disease&#46;<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 &#40;renal failure&#44; poor intake&#44; malabsorption&#44; etc&#46;&#41;&#46; However&#44; if the increase in PTH cannot correct the plasma calcium&#44; either due to a disorder in the organs responsible for transportation or deficiencies&#44; hypocalcemia develops&#46; Therefore&#44; HS may be associated with calcium concentrations that are within or below the reference range&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Laboratory findings show high or normal PTH with low calcium levels or within normal limits&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">It is very important to measure levels of vitamin D and 24-h urinary calcium&#44; in order to make the differential diagnosis of vitamin D deficiency leading to HP&#46;<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&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> details the root causes of HS&#46;</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&#44; measurement of serum calcium&#44; and subsequently&#44; calciuria in 24<span class="elsevierStyleHsp" style=""></span>h urine is required&#46; If the latter is normal&#44; this suggests a normocalcemic HP&#46; If&#44; however&#44; it is elevated&#44; HP will be very likely&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In cases where calciuria is reduced&#44; reposition of vitamin D should be carried out before levels of serum calcium and PTH are measured&#46; If these values are normalized&#44; the picture is compatible with hypovitaminosis D&#46; HS If&#44; however&#44; they remain high&#44; this points to an HP with vitamin D deficiency &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> and <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</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&#8211;1000<span class="elsevierStyleHsp" style=""></span>U&#47;day&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">It is noteworthy that about 90&#37; of patients with HP have&#44; at least&#44; insufficient vitamin D levels&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Treatment consists in supplementing and maintaining vitamin D levels above 30<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#44; strictly controlling the values of calcemia&#44; calciuria&#44; and phosphatemia and to monitor the numbers of vitamin D every 3&#8211;6 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15&#44;19&#44;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&#44; surgery is the treatment of choice&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">If the patient is asymptomatic&#44; management is more controversial&#44; and in any case&#44; should be monitored to detect any disease progression&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Current recommendations are established as the annual measurement of serum calcium and creatinine&#44; as well as performing a bone density test every 1&#8211;2 years&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span></span>"
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          "titulo" => "Keywords"
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          "titulo" => "Introduction"
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          "titulo" => "Clinical Manifestations"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Skeletal Manifestations"
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            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"
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        6 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Diagnosis"
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        7 => array:3 [
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          "titulo" => "Differential Diagnosis"
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            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Malignancy"
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            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Familial Hypocalciuric Hypercalcemia"
            ]
            2 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Drugs"
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            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"
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    "fechaRecibido" => "2011-05-06"
    "fechaAceptado" => "2011-06-17"
    "PalabrasClave" => array:2 [
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        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&#44;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 hipocalci&#250;rica familiar"
            4 => "25-hidroxivitamina D"
            5 => "1&#44;25-dihidroxivitamina D"
            6 => "Osteoporosis"
            7 => "Osteopenia"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary hyperparathyroidism &#40;PHPT&#41; is characterized by the autonomous production of parathyroid hormone &#40;PTH&#41;&#44; in which there is hypercalcemia or normal-high serum calcium levels in the presence of elevated or inappropriately normal serum PTH concentrations&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exceptionally in symptomatic patients&#44; a diagnosis can be established on the basis of clinical data&#46; PHPT must always be evaluated in patients with clinical histories of nephrolithiasis&#44; nephrocalcinosis&#44; osseous pain&#44; subperiosteal resorption&#44; and pathologic fractures&#44; as well as in those with osteoporosis&#8211;osteopenia&#44; a personal history of neck irradiation&#44; or a family history of multiple endocrine neoplasia syndrome &#40;types 1 or 2&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagnosis of PHPT is biochemical&#46; Asymptomatic hypercalcemia without guiding signs or symptoms is the most frequent manifestation of the disease&#46; For differential diagnosis&#44; PTH must be measured&#44; as well as phosphate&#44; chloride&#44; 25-hydroxyvitamin D&#44; 1&#44;25 dyhidroxyvitamin D and calcium-to-creatinine clearance&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The diagnosis and differential diagnosis of primary hyperparathyroidism will be discussed here&#46;</p>"
      ]
      "es" => array:2 [
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El hiperparatiroidismo primario &#40;HP&#41; es una entidad cl&#237;nica que se caracteriza por la producci&#243;n aut&#243;noma de parathormona &#40;PTH&#41;&#44; en la cual hay hipercalcemia o calcio s&#233;rico normal-alto&#44; con valores de PTH elevados o inapropiadamente normales&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De forma excepcional&#44; el diagn&#243;stico puede establecerse a partir de la cl&#237;nica en pacientes sintom&#225;ticos&#46; El HP siempre debe ser tenido en cuenta en pacientes con historia de c&#225;lculos renales&#44; nefrocalcinosis&#44; dolor &#243;seo&#44; fracturas patol&#243;gicas&#44; resorci&#243;n subperi&#243;stica o en aqu&#233;llos que presenten osteoporosis-osteopenia&#44; antecedentes de irradiaci&#243;n en cuello o historia familiar de neoplasia endocrina m&#250;ltiple tipo 1 o 2&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El diagn&#243;stico del HP es bioqu&#237;mico&#44; siendo la hipercalcemia asintom&#225;tica la manifestaci&#243;n m&#225;s frecuente de la enfermedad&#46; Para el diagn&#243;stico diferencial&#44; adem&#225;s de la PTH&#44; debe medirse el f&#243;sforo&#44; cloro&#44; 25 hidroxivitamina D&#44; 1&#44;25 dihidroxivitamina D y calciuria&#46;A continuaci&#243;n&#44; se revisa el diagn&#243;stico y se detallan los cuadros cl&#237;nicos con los que se deber&#237;a plantear el diagn&#243;stico diferencial&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please&#44; cite this article as&#58; Mart&#237;nez Cordellat I&#46; Hiperparatiroidismo&#58; &#191;primario o secundario&#63; Reumatol Clin&#46; 2011&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2011.06.001">doi&#58;10&#46;1016&#47;j&#46;reuma&#46;2011&#46;06&#46;001</span>&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Changes in the clinical presentation of HP&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">HP&#44; primary hyperparathyroidims&#59; PTH&#44; parathyroid hormone&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">PTH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">HP 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8593;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8593;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Suggestive variable&nbsp;\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&nbsp;\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">&#8595;Rare &#8593; &#40;T production of PTH&#41;&nbsp;\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">&#8593;&#8593;&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab212394.png"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HP Differential Diagnosis&#47;Malignant Disease&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HHF&#44; familial hypocalciuric hypercalcemia&#59; HP&#44; primary hyperparathyroidism&#46;</p>"
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            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">&nbsp;\t\t\t\t\t\t\n
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                  \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&nbsp;\t\t\t\t\t\t\n
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                  \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&#47;Cr&nbsp;\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
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                  \t\t\t\t">HP&nbsp;\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
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                  \t\t\t\t">&#8593; &#40;&#62;200<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&nbsp;\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">&#62;0&#46;02&nbsp;\t\t\t\t\t\t\n
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                  \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&nbsp;\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">&#8595; &#40;&#60;100<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&nbsp;\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">&#8804;0&#46;01&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HP Differential Diagnosis&#47;HHF&#46;</p>"
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              "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
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                  \t\t\t\t"><span class="elsevierStyleItalic">1&#46;</span> Renal failure&nbsp;\t\t\t\t\t\t\n
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                  \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&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperphosphatemia&nbsp;\t\t\t\t\t\t\n
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                  \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>&nbsp;\t\t\t\t\t\t\n
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                  \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>&#46; &#8595; intake of Ca&nbsp;\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>&nbsp;\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&#46;</span> Ca malabsorption&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\t\t\t\t\t\t\n
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                  \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 &#40;fat malabsorption&#41;&nbsp;\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>&nbsp;\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&#46;</span> Renal calcium loss&nbsp;\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&nbsp;\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&nbsp;\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>&nbsp;\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&#46;</span> Inhibition of bone resorption&nbsp;\t\t\t\t\t\t\n
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                  \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&nbsp;\t\t\t\t\t\t\n
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                  \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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">HP&#44; primary hyperparathyroidism&#59; HS&#44; secondary hyperparathyroidism&#59; PTH&#44; parathyroid hormone&#46;</p>"
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            0 => array:2 [
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                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">&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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 &#40;&#60;20&#41;&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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 &#40;&#60;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab212395.png"
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Normocalcemic HP&#47;HP With Vitamin D Deficiency&#47;HS Due to Hypovitaminosis D&#46;</p>"
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    ]
    "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&#46; Albright"
                            1 => "E&#46;C&#46; Reifenstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1984"
                        "editorial" => "Williams &#38; Wilkins"
                        "editorialLocalizacion" => "Baltimore"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time to reconsider current clinical decision paradigms&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; El-Hajj Fuleihan"
                            1 => "Hyperparathyroidism&#58;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2008-1305"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
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                        "paginaFinal" => "3304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18772461"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0015"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary hyperparathyroidism&#58; incidence&#44; morbidity&#44; and potential economic impact in a community"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            2 => "M&#46;A&#46; Kennedy"
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                      "doi" => "10.1056/NEJM198001243020402"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1980"
                        "volumen" => "302"
                        "paginaInicial" => "189"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7350459"
                            "web" => "Medline"
                          ]
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                    0 => array:1 [
                      "Revista" => array:8 [
                        "titulo" => "Proceedings of the NIH consensus development conference on diagnosis and management of asymptomatic primary hyperparathyroidism"
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "1991"
                        "volumen" => "6"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "2"
                        "editores" => "J&#46;T&#46;PottsJr&#46;J&#46;E&#46;FradkinG&#46;D&#46;AurbachJ&#46;P&#46;BilezikianL&#46;G&#46;Raisz"
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              "identificador" => "bib0025"
              "etiqueta" => "5"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skeletal disease in primary hyperparathyroidism"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;J&#46; Silverberg"
                            1 => "E&#46; Shane"
                            2 => "L&#46; De la Cruz"
                            3 => "D&#46;W&#46; Dempster"
                            4 => "F&#46; Feldman"
                            5 => "D&#46; Seldin"
                          ]
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                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "1989"
                        "volumen" => "4"
                        "paginaInicial" => "283"
                        "paginaFinal" => "291"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2763869"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Longitudinal changes in bone mineral density and bone turnover in postmenopausal women with primary hyperparathyroidism"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
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                            1 => "W&#46;E&#46;G&#46; Thomas"
                            2 => "A&#46;W&#46; Al-Dehaimi"
                            3 => "A&#46;M&#46;A&#46; Assiri"
                            4 => "R&#46; Eastell"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jcem.81.10.8855790"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1996"
                        "volumen" => "81"
                        "paginaInicial" => "3487"
                        "paginaFinal" => "3491"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8855790"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary hyperparathyroidism and the risk of fracture&#58; a population based study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Khosla"
                            1 => "L&#46;J&#46; Melton III"
                            2 => "R&#46;A&#46; Wermers"
                            3 => "C&#46;S&#46; Crowson"
                            4 => "W&#46;M&#46; O&#8217;Fallon"
                            5 => "B&#46;L&#46; Riggs"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1359/jbmr.1999.14.10.1700"
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                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "1999"
                        "volumen" => "14"
                        "paginaInicial" => "1700"
                        "paginaFinal" => "1707"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10491217"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nephrolithiasis and bone involvement in primary hyperparathyroidism"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;J&#46; Silverberg"
                            1 => "E&#46; Shane"
                            2 => "T&#46;P&#46; Jacobs"
                            3 => "E&#46;S&#46; Siris"
                            4 => "F&#46; Gartenberg"
                            5 => "D&#46; Seldin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1990"
                        "volumen" => "89"
                        "paginaInicial" => "327"
                        "paginaFinal" => "333"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2393037"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery&#58; a controlled historical follow up study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;L&#46; Mollerup"
                            1 => "P&#46; Vestergaard"
                            2 => "V&#46;G&#46; Fr&#248;kj&#230;r"
                            3 => "L&#46; Mosekilde"
                            4 => "P&#46; Christiansen"
                            5 => "M&#46; Blichert-Toft"
                          ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
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                        "volumen" => "325"
                        "paginaInicial" => "807"
                        "paginaFinal" => "810"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12376441"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0050"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Disorders of calcium homeostasis"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Carmeliet"
                            1 => "S&#46; Van Cromphaut"
                            2 => "E&#46; Daci"
                            3 => "C&#46; Maes"
                            4 => "R&#46; Bouillon"
                          ]
                        ]
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                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Endocrinol Metab"
                        "fecha" => "2003"
                        "volumen" => "17"
                        "paginaInicial" => "529"
                        "paginaFinal" => "546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14687587"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0055"
              "etiqueta" => "11"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Neuromuscular involvement in mild&#44; asymptomatic primary hyperparathyroidism"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Turken"
                            1 => "M&#46; Cafferty"
                            2 => "S&#46;J&#46; Silverberg"
                            3 => "L&#46; De la Cruz"
                            4 => "C&#46; Cimino"
                            5 => "D&#46;J&#46; Lange"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1989"
                        "volumen" => "87"
                        "paginaInicial" => "553"
                        "paginaFinal" => "557"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2816971"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychologic symptoms before and after parathyroid surgery"
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                          "autores" => array:3 [
                            0 => "B&#46;L&#46; Solomon"
                            1 => "M&#46; Schaaf"
                            2 => "R&#46;C&#46; Smallridge"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1994"
                        "volumen" => "96"
                        "paginaInicial" => "101"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8109593"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular aspects of primary hyperparathyroidism"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;D&#46; Walker"
                            1 => "S&#46;J&#46; Silverberg"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF03346443"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Endocrinol Invest"
                        "fecha" => "2008"
                        "volumen" => "31"
                        "paginaInicial" => "925"
                        "paginaFinal" => "931"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19092300"
                            "web" => "Medline"
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              "identificador" => "bib0070"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "American College of Endocrinology and American Association of Clinical Endocrinologists position statement on patient safety and medical system errors in diabetes and endocrinology"
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                            5 => "P&#46;S&#46; Jellinger"
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                        "tituloSerie" => "Endocr Pract"
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                        "paginaInicial" => "197"
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                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary hyperparathyroidism"
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                      "titulo" => "Hypercalcemia associated with cancer"
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                          "autores" => array:1 [
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                        "paginaInicial" => "373"
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                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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              "identificador" => "bib0085"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Familiar benign hypocalcyiuc hypercalcemia"
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                          "autores" => array:1 [
                            0 => "Gel-H&#46; Fuleiham"
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                        "paginaInicial" => "N51"
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              "identificador" => "bib0090"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Molecular genetic analysis of the calcium sensing receptor gene in patients clinically suspected to have familiar hypocalciuric hypercalcemia&#58; phenotypic variation and mutation spectrum in a Danish population"
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                        "link" => array:1 [
                          0 => array:2 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asymptomatic primary hyperparathyroidism"
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                        "link" => array:1 [
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                      "titulo" => "Familial benign hypocalciuric hypercalcemia and neonatal primary hyperparathyroidism"
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ISSN: 21735743
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