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PTHrP-induced hypercalcemia in paragangliomas: Tumor dedifferentiation as sign of bad prognosis
Hipercalcemia inducida por PTHrP en paragangliomas: desdiferenciación tumoral como signo de mal pronóstico
Maria D. Alcantara-Lagunaa, Yiraldine Herrera-Martínezb, Marina E. Sánchez-Fríasc, Maria A. Gálvez-Morenoa,
Corresponding author
, Aura D. Herrera-Martíneza,
Corresponding author
aurita.dhm@gmail.com

Corresponding authors.
a Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
b Nuclear Medicine Service, Virgen del Rocio University Hospital, Seville, Spain
c Pathology Service, Reina Sofia University Hospital, Córdoba, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paraganglioma are uncommon endocrine tumors that arise from extra-adrenal autonomic paraganglia&#59; some cases are able to secrete catecholamines<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> and develop metastatic tumor spread&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The leading cause of hypercalcemia admitted to the hospital is malignancy<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a>&#59; hypercalcemia occurs in about one quarter of patients with cancer&#44; and it is based on 3 main mechanisms&#44; from which PTHrP secretion is the most frequent humoral hypercalcemia of malignancy &#40;HHM&#41;&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> In all series&#44; PTHrP secretion has been related to poor outcomes&#44; increased metastatic potential and increased death rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4&#44;5</span></a> HHM in pheochromocytomas was first described in the 1980s&#44; since then&#44; some cases have been reported&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#8211;12</span></a> but to the best of our knowledge&#44; only one patient with PTHrP producing paraganglioma has been previously described&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> Furthermore&#44; our case represents a non-catecholamine-secreting abdominal tumor with malignant transformation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 61-year-old man was diagnosed with a non-secreting paraganglioma in the head and uncinate process of the pancreas in 2010 due to an acute-onset epigastric abdominal pain&#46; Computed tomography &#40;CT&#41; and magnetic resonance imaging &#40;MRI&#41; showed a 6<span class="elsevierStyleHsp" style=""></span>cm heterogenous mass in the referred area &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; B&#41;&#59; he underwent cephalic duodenopancreatectomy nine months later &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#44; D&#41;&#46; The histopathology analysis showed a peripancreatic paraganglioma with extension to the head of the pancreas and superior mesenteric artery&#46; Tumor cells were positive for S100&#44; chromogranin-A and synaptophysin&#44; Ki-67 index was 15&#8211;20&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>L&#44; M&#41;&#46; Follow-up with CT and I<span class="elsevierStyleSup">123</span>-iodobenzylguanidine scintigraphy &#40;I<span class="elsevierStyleSup">123</span>-MIBG&#41; scans was performed&#44; later&#44; ganglia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#8211;G&#41; and then liver metastasis were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>H&#44; I&#41;&#46; A liver biopsy revealed a metastasis of paraganglioma&#44; with a ki67 of 20&#8211;30&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>N&#44; O&#41;&#46; Several chemotherapy schemes were administered with partial response and later progressive disease &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>J&#44; K&#41;&#46; Bone involvement was never evidenced and serum calcium levels were normal since diagnosis&#46; Nine years after the initial diagnosis&#44; the patient was admitted to our service after presenting one week of diarrhea&#44; behavioral disturbance&#44; motor clumsiness&#44; timing disorientation&#44; self-management deficit&#44; verbiage and mood lability&#46; Physical examination showed hypertension without tachycardia&#44; lower limbs swollen&#44; neurological assessment did not show any focal impairment or meningeal signs&#44; and his body weight was stable&#46; At his admission&#44; laboratory examinations showed hypokalemia &#40;2&#46;3<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#41;&#44; hypercalcemia &#40;12&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; hypophosphatemia &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; and slightly raised liver function enzymes&#59; kidney function&#44; magnesium and pH were normal&#46; Urinary analysis was consistent with extra-renal potassium losses&#44; calcium excretion was increased&#46; ECG showed a sinus rhythm&#44; flattened T waves&#44; inverted in V2 and V3 and non-prolonged QT interval&#46; Later blood tests evidenced normal 1&#44;25-OH-Vitamin D &#40;45<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&#44; normal range &#40;NR&#41;&#58; 18&#8211;71&#41;&#44; low 25-OH vitamin D &#40;5<span class="elsevierStyleHsp" style=""></span>ng&#47;dL&#44; NR&#58; &#62;20&#41;&#44; low PTH &#40;12&#46;3<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&#44; NR&#58; 18&#8211;88&#41;&#44; and increased PTHrP &#40;14<span class="elsevierStyleHsp" style=""></span>pmol&#47;l&#44; NR&#58; &#60;1&#46;5&#41; levels&#46; Serum fractionated metanephrines and cerebral CT scan were normal&#46; Hypercalcemia was firstly treated with hydration&#44; zoledronic acid infusion&#44; furosemide and parenteral steroids&#44; after 1 week&#44; without complete remission but clinical improvement&#44; cinacalcet was added&#59; potassium and phosphate levels were corrected using parenteral supplements&#46; On day 9 of admission he was discharged with normal calcium and potassium serum levels&#46; During the following months&#44; the general status of the patient improved&#46; He did not receive any additional treatment addressed to the tumor&#46; After 3 months he returned to the hospital after seizure and neurological deterioration&#44; he was diagnosed with brain metastases and died one day after&#46; The genetic test performed in the tumor revealed a somatic mutation p&#46;Arg161Gly in the von Hippel Lindau &#40;VHL&#41; gene&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Paraganglioma are uncommon endocrine tumors with increasing prevalence and diagnosis due to better diagnostic procedures and genetic testing for familial forms&#46; They arise from of extra-adrenal autonomic paraganglia&#44; however&#44; non all of them are diagnosed as catecholamine-secreting tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Parasympathetic and sympathetic paragangliomas differ not only in their anatomic distribution&#44; but also in their association with underlying genetic syndromes and clinical features&#46; Typically&#44; non-functional paragangliomas arise in non-chromaffin cells from parasympathetic ganglia located along the glossopharyngeal and vagal nerves in the neck and the base of the skull&#59; in contrast&#44; functional-paragangliomas originate from sympathetic ganglia&#44; usually have excess catecholamine secretion &#40;especially norepinephrine&#41; and are located predominantly in the abdomen or&#44; secondly&#44; in the thorax&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> Most paragangliomas in adults appear to be sporadic&#44; but genetic screening guided by clinical presentation is recommended&#46; Succinate dehydrogenase &#40;SDHx&#41; germline mutations&#44; VHL disease&#44; multiple endocrine neoplasia type 2 and neurofibromatosis type 1&#44; are the most frequent associated conditions&#44; and are related to worse prognosis in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The majority of paragangliomas are considered as benign tumors&#44; however&#44; a fraction shows metastatic behavior&#46; Unfortunately&#44; the only absolute criteria of malignancy is evidence of metastatic tumor spread&#59; in this context&#44; location&#44; size&#44; PASS score&#44; S100 immunoreactivity and Ki67 labeling index should be evaluated for predicting risk of malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In order to study the relation between PTHrP secretion and paragangliomas&#44; we matched various terms in the PubMed database&#46; Only one case of PTHrP-secreting paraganglioma<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> and seven cases of PTHrP-secreting pheochromocytomas<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#8211;12</span></a> have been previously described&#46; All reported pheochromocytomas were benign catecholamine-secreting tumors&#44; in which PTHrP hypersecretion resolved after surgery&#46; In contrast&#44; the reported paraganglioma&#44; as well as our case&#44; was an abdominal&#44; non-functioning&#44; metastatic tumor in a male patient&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> but some differences between both cases are notable&#44; the previously described case occurred in a young male&#44; who presented with PTHrP induced hypercalcemia and bone metastasis since the diagnosis&#59; additionally&#44; in this case&#44; tumor debulking induced calcium normalization after one month&#46; Our case would be the second report of PTHrP secreting paraganglioma and the first one managed with medical treatment for controlling hypercalcemia&#59; furthermore&#44; it represents a non-catecholamine-secreting abdominal tumor with subsequent dedifferentiation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This clinical case reveals the importance of close and long-term follow-up in patients with pheochromocytomas and&#47;or paragangliomas independently of the genetic test&#44; especially if Ki67 is elevated&#44; or if lymph node metastases are present at the diagnosis&#44; since these tumors may develop metastasis and present with PTHrP secretion&#44; which represents a sign of bad prognosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">Juan Rod&#233;s&#44; <span class="elsevierStyleGrantSponsor" id="gs1">Instituto de Salud Carlos III</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs1">JR19&#47;00050</span>&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronal and axial CT views &#40;A&#44; B&#41; show a 6<span class="elsevierStyleHsp" style=""></span>cm heterogeneous mass in the head and uncinated process of the pancreas&#44; with a necrotic cystic component and intense peripheral enhancement suggesting hypervascular behavior&#46; Coronal and axial postoperative CT views &#40;C&#44; D&#41; of the pancreatic mass&#58; after surgery&#44; complete resection was achieved&#46; Maximum intensity projection&#44; coronal and axial &#91;<span class="elsevierStyleSup">18</span>F&#93; FDG PET&#47;CT images &#40;E&#8211;G&#41;&#44; performed five years after the pancreatic surgery&#44; show a hypermetabolic retroperitoneal lymphadenopathy in the region of the surgical bed &#40;SUVmax&#58; 6&#46;9&#41;&#44; suggestive of tumor recurrence&#46; Coronal and axial &#91;<span class="elsevierStyleSup">99m</span>TC&#93; octreotride SPECT&#47;CT images &#40;H&#44; I&#41; performed 3 years after the local recurrence&#44; show expression of somatostatin receptors in the hepatic lesions and in the previously known retroperitoneal adenopathies&#46; Coronal and axial last control CT views &#40;J&#44; K&#41; showed enlargement of known liver lesions and appearance of new liver lesions&#59; these findings were compatible with progressive disease&#46; Hematoxylin eosin stain of the primary tumor &#40;20&#215;&#41; reveals well-defined nests of cuboidal cells &#40;Zellballen&#41; separated by intensely vascularized fibrous septa&#59; cells have moderately abundant&#44; basophilic and granular cytoplasm &#40;L&#41;&#44; Ki67 index was 15&#8211;20&#37; &#40;M&#41;&#46; The liver biopsy &#40;N&#41; was compatible with metastasis of paraganglioma&#59; Ki67 index was 20&#8211;30&#37; &#40;O&#41;&#46;</p>"
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pheochromocytoma&#47;paraganglioma&#58; recent updates in genetics&#44; biochemistry&#44; immunohistochemistry&#44; metabolomics&#44; imaging and therapeutic options"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Antonio"
                            1 => "M&#46;M&#46;N&#46; Valdez"
                            2 => "L&#46; Mercado-Asis"
                            3 => "D&#46; Taieb"
                            4 => "K&#46; Pacak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/gs.2019.10.25"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gland Surg"
                        "fecha" => "2020"
                        "volumen" => "9"
                        "paginaInicial" => "105"
                        "paginaFinal" => "123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32206603"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk stratification in paragangliomas with PASS &#40;pheochromocytoma of the adrenal gland scaled score&#41; and immunohistochemical markers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Kulkarni"
                            1 => "S&#46;G&#46; Khandeparkar"
                            2 => "S&#46;D&#46; Deshmukh"
                            3 => "R&#46;R&#46; Karekar"
                            4 => "V&#46;L&#46; Gaopande"
                            5 => "A&#46;R&#46; Joshi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7860/JCDR/2016/21070.8997"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Diagn Res"
                        "fecha" => "2016"
                        "volumen" => "10"
                        "paginaInicial" => "EC01"
                        "paginaFinal" => "EC4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28208861"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;A&#46; DeLellis"
                            1 => "R&#46;V&#46; Lloyd"
                            2 => "P&#46;U&#46; Heitz"
                            3 => "C&#46; Eng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "edicion" => "3rd ed&#46;"
                        "fecha" => "2004"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PTHrP-mediated hypercalcemia&#58; causes and survival in 138 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;J&#46; Donovan"
                            1 => "N&#46; Achong"
                            2 => "K&#46; Griffin"
                            3 => "J&#46; Galligan"
                            4 => "C&#46;J&#46; Pretorius"
                            5 => "D&#46;S&#46; McLeod"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2014-4250"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2015"
                        "volumen" => "100"
                        "paginaInicial" => "2024"
                        "paginaFinal" => "2029"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25719931"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parathyroid hormone-related protein &#40;PTHrP&#41;&#58; an emerging target in cancer progression and metastasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Zhang"
                            1 => "J&#46; Li"
                            2 => "G&#46; Assaker"
                            3 => "A&#46; Camirand"
                            4 => "S&#46; Sabri"
                            5 => "A&#46;C&#46; Karaplis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/978-3-030-22254-3_13"
                      "Revista" => array:6 [
                        "tituloSerie" => "Adv Exp Med Biol"
                        "fecha" => "2019"
                        "volumen" => "1164"
                        "paginaInicial" => "161"
                        "paginaFinal" => "178"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31576548"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pheochromocytoma with hypercalcemia&#58; case report and review of literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Shanberg"
                            1 => "R&#46; Baghdassarian"
                            2 => "L&#46;A&#46; Tansey"
                            3 => "D&#46; Bacon"
                            4 => "P&#46; Greenberg"
                            5 => "M&#46; Perley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0022-5347(17)48909-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "1985"
                        "volumen" => "133"
                        "paginaInicial" => "258"
                        "paginaFinal" => "259"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3968745"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pheochromocytoma associated with polyuria and hypercalcemia&#46; Effect of adrenalectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Martin Ridaura"
                            1 => "E&#46; Lazaro"
                            2 => "M&#46;A&#46; Jaunsolo"
                            3 => "J&#46;M&#46; Morales"
                            4 => "F&#46; Hawkins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "1986"
                        "volumen" => "86"
                        "paginaInicial" => "510"
                        "paginaFinal" => "512"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pheochromocytoma and hypercalcemia due to ectopic production of parathyroid hormone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Garbini"
                            1 => "M&#46; Mainardi"
                            2 => "M&#46; Grimi"
                            3 => "G&#46; Repaci"
                            4 => "G&#46; Nanni"
                            5 => "G&#46; Bragherio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "N Y State J Med"
                        "fecha" => "1986"
                        "volumen" => "86"
                        "paginaInicial" => "25"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3456508"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case of pheochromocytoma producing parathyroid hormone-related protein and presenting with hypercalcemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Kimura"
                            1 => "Y&#46; Nishimura"
                            2 => "K&#46; Yamaguchi"
                            3 => "K&#46; Nagasaki"
                            4 => "K&#46; Shimada"
                            5 => "H&#46; Uchida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jcem-70-6-1559"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1990"
                        "volumen" => "70"
                        "paginaInicial" => "1559"
                        "paginaFinal" => "1563"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2347892"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant phaeochromocytoma and hypercalcaemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Bridgewater"
                            1 => "W&#46;A&#46; Ratcliffe"
                            2 => "N&#46;J&#46; Bundred"
                            3 => "C&#46;W&#46; Owens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/pgmj.69.807.77"
                      "Revista" => array:6 [
                        "tituloSerie" => "Postgrad Med J"
                        "fecha" => "1993"
                        "volumen" => "69"
                        "paginaInicial" => "77"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8446562"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pheochromocytoma&#44; pulmonary nodule and hypercalcemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Kauppinen-Makelin"
                            1 => "P&#46; Heikkila"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Duodecim"
                        "fecha" => "1995"
                        "volumen" => "111"
                        "paginaInicial" => "644"
                        "paginaFinal" => "651"
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                    0 => array:2 [
                      "titulo" => "Parathyroid hormone-related peptide-producing non-familial pheochromocytoma in a child"
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                          "etal" => false
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                            4 => "K&#46; Takahashi"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Urol"
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                        "paginaInicial" => "673"
                        "paginaFinal" => "676"
                      ]
                    ]
                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Hypercalcemia in malignant paraganglioma due to parathyroid hormone-related protein"
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                          "etal" => true
                          "autores" => array:6 [
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                            4 => "A&#46;B&#46; Cortez"
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                        "tituloSerie" => "Horm Res"
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                        "volumen" => "50"
                        "paginaInicial" => "217"
                        "paginaFinal" => "221"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9838243"
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                  ]
                ]
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              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Familial paragangliomas"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Lips"
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                            2 => "J&#46; Hoppener"
                            3 => "R&#46; Luijt"
                            4 => "F&#46; Moll"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1186/1897-4287-4-4-169"
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                        "tituloSerie" => "Hered Cancer Clin Pract"
                        "fecha" => "2006"
                        "volumen" => "4"
                        "paginaInicial" => "169"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos