array:24 [ "pii" => "S2387020623004187" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.10.002" "estado" => "S300" "fechaPublicacion" => "2023-11-10" "aid" => "6329" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;161:410-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775323003743" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.06.013" "estado" => "S300" "fechaPublicacion" => "2023-11-10" "aid" => "6329" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;161:410-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Síndrome de Cushing como presentación de un carcinoma medular de tiroides" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "410" "paginaFinal" => "411" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cushing's syndrome as the debut of a medullary thyroid carcinoma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan José Ruiz-Manzanera, Beatriz Febrero, José Manuel Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Juan José" "apellidos" => "Ruiz-Manzanera" ] 1 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Febrero" ] 2 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020623004187" "doi" => "10.1016/j.medcle.2023.10.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623004187?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323003743?idApp=UINPBA00004N" "url" => "/00257753/0000016100000009/v1_202310301537/S0025775323003743/v1_202310301537/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020623004199" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.06.015" "estado" => "S300" "fechaPublicacion" => "2023-11-10" "aid" => "6331" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;161:411-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Acute respiratory distress syndrome secondary to talc pleurodesis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "411" "paginaFinal" => "412" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de distrés respiratorio agudo secundario a pleurodesis con talco" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2886 "Ancho" => 3341 "Tamanyo" => 481257 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) Chest X-ray with complete left pneumothorax. b) Complete re-expansion of the pneumothorax after thoracic drainage. c) Bilateral diffusely distributed alveolar-interstitial infiltrates in the context of talc pleurodesis ARDS. d) Radiological improvement after initiation of systemic corticosteroids.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ignacio Boira, Marta Galán Negrillo, Alejandro Gañán Boscá" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Boira" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Galán Negrillo" ] 2 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Gañán Boscá" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775323003755" "doi" => "10.1016/j.medcli.2023.06.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323003755?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623004199?idApp=UINPBA00004N" "url" => "/23870206/0000016100000009/v1_202311081401/S2387020623004199/v1_202311081401/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020623004205" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.06.016" "estado" => "S300" "fechaPublicacion" => "2023-11-10" "aid" => "6335" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;161:409-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Multiple brown tumors in a patient on hemodialysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "409" "paginaFinal" => "410" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Múltiples tumores pardos en una paciente en tratamiento con hemodiálisis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1428 "Ancho" => 2508 "Tamanyo" => 238923 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left: extensive bone involvement with superscan pattern of metabolic origin in scintigraphy, in the context of SHPT. Right: multiple osteolytic/mixed excrescent lesions in the upper jaw.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena Hernández García, Ana Delgado Ureña, Miriam Barrales Iglesias" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elena" "apellidos" => "Hernández García" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Delgado Ureña" ] 2 => array:2 [ "nombre" => "Miriam" "apellidos" => "Barrales Iglesias" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775323003792" "doi" => "10.1016/j.medcli.2023.06.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323003792?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623004205?idApp=UINPBA00004N" "url" => "/23870206/0000016100000009/v1_202311081401/S2387020623004205/v1_202311081401/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Cushing’s syndrome as the debut of a medullary thyroid carcinoma" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "410" "paginaFinal" => "411" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan José Ruiz-Manzanera, Beatriz Febrero, José Manuel Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Juan José" "apellidos" => "Ruiz-Manzanera" ] 1 => array:4 [ "nombre" => "Beatriz" "apellidos" => "Febrero" "email" => array:1 [ 0 => "beatrizfebrero@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cirugía Endocrina, Cirugía General y del Apartado Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Cushing como presentación de un carcinoma medular de tiroides" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cushing's syndrome (CS) is an entity caused by prolonged exposure to excess glucocorticoids. Ectopic adrenocorticotropic hormone (ACTH) secretion is a rare cause of CS.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The importance of knowing the aetiology of CS associated with ectopic origin lies in its relationship with paraneoplastic syndromes, as the course of the disease may be more aggressive in these cases.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 63-year-old male, hypertensive and diabetic, who required hospital admission due to a parotid abscess. During the study, CS stigmata were evident in the physical examination, with evidence of central obesity, full moon facies, malar erythema, generalised ecchymosis, buffalo hump, cutaneous atrophy and weakness of the proximal musculature. A cortisol study was performed by measuring basal cortisol at 28 mg/dl (6–23), urinary free cortisol at 333 mcg/24 h (80–120), Nugent's test with cortisol at 33 mcg/dl (<1.8) and ACTH of 58 pg/ml (6–76) and Liddle test with cortisol of 30 mcg/dl (<1.8).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Abdominal computed tomography (CT) and brain magnetic resonance imaging did not find adrenal or pituitary disease. Cervicothoracic CT scan showed a 3 cm nodule in the right thyroid lobe with gross calcifications. Thyroid ultrasound described an enlarged thyroid at the expense of a nodule in the right lobe of 25 × 26 cm, hypoechogenic, with well-defined borders, peripheral vasculature, gross calcifications and internal microcalcifications (TIRADS 4), without cervical lymphadenopathies. Nodule biopsy revealed medullary thyroid carcinoma (MTC). The complementary study revealed that the patient had calcitonin levels of 190 pg/ml (0–10), CEA of 76 ng/dl (0–3), with normal 5 HIAA and enolase. The genetic study to rule out MEN-22 syndrome was negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">With the diagnosis of MTC, in the context of the CS study, a total thyroidectomy with central and right lateral emptying was performed. The anatomical pathology after surgery confirmed the diagnosis of MTC, finding metastatic lymphadenopathies in the central and right jugular space. Finally, the patient died of a massive infarction on the seventh postoperative day.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ectopic ACTH secretion secondary to MTC often presents with clinical features similar to those of classical CS. However, cases of ectopic CS may be associated with enhanced symptoms in the patient. After ruling out a central and adrenal origin, further work-up is indicated to identify an ectopic origin of CS. Ectopic ACTH-producing tumours include microcytic lung carcinoma, carcinoid tumours, MTC or pheochromocytoma, the latter two being uncommon.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A CT scan is necessary, as in this case, to rule out these possible entities. In our case, a normal range ACTH levels were obtained. <span class="elsevierStyleItalic">ACTH-like</span> levels, which would presumably be elevated, were not available, although an increase in cortisol levels was detected in the patient.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Among the few cases described, a prevalence of men aged 40–50 years has been reported. Most of them are usually associated with sporadic MTC. In most of the cases described, MTC precedes the diagnosis of CS by several months. In these cases, patients commonly present with advanced disease, distant metastases and association with a worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In contrast, our 63-year-old patient was initially diagnosed with CS and then imaging showed thyroid disease. Abdominal CT ruled out both adrenal involvement due to CS and liver metastases due to MTC, although our case did not have very high calcitonin levels and liver lesions are not always observed on CT.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The therapeutic approach focuses on the treatment of the tumour, in the case of MTC being thyroidectomy with lymphadenectomy.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> As this was a sporadic MTC, an ipsilateral central and lateral lymphadenectomy was performed. When thyroid surgery is not possible or sufficient to control CS, adrenalectomy for symptomatic control can be used exceptionally.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Despite surgical treatment, the patient had a poor outcome and suffered a massive infarction, probably in relation to the increased cardiovascular risk that occurs in CS.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we report a rare case of ectopic CS secondary to sporadic MTC, for which we obtained the patient's informed consent. In such cases, it is important to identify the aetiology of the syndrome and to rule out a paraneoplastic origin.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">No funding to declare.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None of the authors have a conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ectopic ACTH syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.I. Alexandraki" 1 => "A.B. Grossman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11154-010-9139-z" "Revista" => array:6 [ "tituloSerie" => "Rev Endocr Metab Disord." "fecha" => "2010" "volumen" => "11" "paginaInicial" => "117" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20544290" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medullary thyroid cancer with ectopic Cushing’s syndrome: a case report and systematic review of detailed cases from the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Corsello" 1 => "V. Ramunno" 2 => "P. Locantore" 3 => "G. Pacini" 4 => "E.D. Rossi" 5 => "F. Torino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/thy.2021.0696" "Revista" => array:6 [ "tituloSerie" => "Thyroid." "fecha" => "2022" "volumen" => "32" "paginaInicial" => "1281" "paginaFinal" => "1298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35833793" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Wells Jr" 1 => "S.L. Asa" 2 => "H. Dralle" 3 => "R. Elisei" 4 => "D.B. Evans" 5 => "R.F. Gagel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/thy.2014.0335" "Revista" => array:6 [ "tituloSerie" => "Thyroid." "fecha" => "2015" "volumen" => "25" "paginaInicial" => "567" "paginaFinal" => "610" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25810047" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cushing’s syndrome in medullary thyroid carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Mure" 1 => "C. Gicquel" 2 => "N. Abdelmoumene" 3 => "F. Tenenbaum" 4 => "C. Francese" 5 => "J.P. Travagli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF03347800" "Revista" => array:6 [ "tituloSerie" => "J Endocrinol Invest." "fecha" => "1995" "volumen" => "18" "paginaInicial" => "180" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7615903" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pronóstico del paciente tratado de síndrome de Cushing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Aulinas" 1 => "E. Valassi" 2 => "S.M. Webb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.endonu.2013.03.008" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Nutr." "fecha" => "2014" "volumen" => "61" "paginaInicial" => "52" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23831107" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016100000009/v1_202311081401/S2387020623004187/v1_202311081401/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016100000009/v1_202311081401/S2387020623004187/v1_202311081401/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623004187?idApp=UINPBA00004N" ]
Journal Information
Vol. 161. Issue 9.
Pages 410-411 (November 2023)
Share
Download PDF
More article options
Vol. 161. Issue 9.
Pages 410-411 (November 2023)
Letter to the Editor
Cushing’s syndrome as the debut of a medullary thyroid carcinoma
Síndrome de Cushing como presentación de un carcinoma medular de tiroides
Juan José Ruiz-Manzanera, Beatriz Febrero
, José Manuel Rodríguez
Corresponding author
Unidad de Cirugía Endocrina, Cirugía General y del Apartado Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Article information
These are the options to access the full texts of the publication Medicina Clínica (English Edition)
Subscriber
Subscribe
Purchase
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail