array:24 [ "pii" => "S2387020620302539" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.04.055" "estado" => "S300" "fechaPublicacion" => "2020-07-24" "aid" => "4852" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2020;155:84-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775319302957" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.04.003" "estado" => "S300" "fechaPublicacion" => "2020-07-24" "aid" => "4852" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2020;155:84-5" "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 científica</span>" "titulo" => "Tríada de Whipple como comienzo del síndrome MEN 1 en la adolescencia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "84" "paginaFinal" => "85" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Whipple's Disease as Initial Presentation in Multiple Endocrine Neoplasia Type 1 in Adolescence" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz Febrero, Pedro Segura, José M. Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Febrero" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Segura" ] 2 => array:2 [ "nombre" => "José M." "apellidos" => "Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020620302539" "doi" => "10.1016/j.medcle.2019.04.055" "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/S2387020620302539?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319302957?idApp=UINPBA00004N" "url" => "/00257753/0000015500000002/v1_202007120611/S0025775319302957/v1_202007120611/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S238702062030259X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.05.002" "estado" => "S300" "fechaPublicacion" => "2020-07-24" "aid" => "5190" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;155:86-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Research during SARS-CoV-2 pandemic: To “Preprint” or not to “Preprint”, that is the question" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "86" "paginaFinal" => "87" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Investigación durante la pandemia de SARS-CoV-2: “Preprint” o no “Preprint”, esa es la cuestión" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Mayo-Yánez" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mayo-Yánez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775320302682" "doi" => "10.1016/j.medcli.2020.05.002" "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/S0025775320302682?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062030259X?idApp=UINPBA00004N" "url" => "/23870206/0000015500000002/v1_202007190713/S238702062030259X/v1_202007190713/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020620302527" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.03.046" "estado" => "S300" "fechaPublicacion" => "2020-07-24" "aid" => "4819" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2020;155:83-4" "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">Scientific letter</span>" "titulo" => "Clinical experience with tolvaptan in patients with polycystic kidney disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "83" "paginaFinal" => "84" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Experiencia clínica con tolvaptán en pacientes con poliquistosis renal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1562 "Ancho" => 2555 "Tamanyo" => 250567 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Progression of kidney function during monthly follow-up. Average levels of plasma creatinine (Cr; mg/dl) and glomerular filtration rate (GFR measured by CKD-EPI; ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>) during the monthly follow-up of the patients.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Covadonga López del Moral Cuesta, Gema Fernández Fresnedo, Luis Martín Penagos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Covadonga" "apellidos" => "López del Moral Cuesta" ] 1 => array:2 [ "nombre" => "Gema" "apellidos" => "Fernández Fresnedo" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Martín Penagos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775319302143" "doi" => "10.1016/j.medcli.2019.03.011" "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/S0025775319302143?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620302527?idApp=UINPBA00004N" "url" => "/23870206/0000015500000002/v1_202007190713/S2387020620302527/v1_202007190713/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Whipple's disease as initial presentation in multiple endocrine neoplasia type 1 in adolescence" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "84" "paginaFinal" => "85" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Beatriz Febrero, Pedro Segura, José M. Rodríguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Beatriz" "apellidos" => "Febrero" "email" => array:1 [ 0 => "beatrizfebrero@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pedro" "apellidos" => "Segura" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José M." "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Cirugía Endocrina, Servicio de Cirugía General, Instituto Murciano de Investigación Biomédica (IMIB), Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Endocrinología, Instituto Murciano de Investigación Biomédica (IMIB), Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tríada de Whipple como comienzo del síndrome MEN 1 en la adolescencia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The most common cause of hypoglycaemia at an early age is congenital hyperinsulinism. However, in adolescence it is uncommon, and may be due to alcohol, hypoglycaemic drugs or hormonal causes (hyperinsulinism), taking into account that insulinoma is uncommon in this age group. In this sense, despite the fact that insulinoma is associated with multiple endocrine neoplasia (MEN) type 1 in 4% of cases, the presentation at an early age should make us suspect of this syndrome.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Most MEN1 cases initially present with primary hyperparathyroidism (PHPT) (67%), while pancreatic neuroendocrine tumours (PNET) are less common as initial presentation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 16-year-old male who presented with predominantly morning sickness that improved after ingestion. The patient was morbidly obese. A laboratory test was performed: glucose 47<span class="elsevierStyleHsp" style=""></span>mg/dl (74–109), calcaemia 11.8<span class="elsevierStyleHsp" style=""></span>mg/dl (8.6–10). The laboratory test was repeated, with hypoglycaemia persisting with insulin levels of 71.2<span class="elsevierStyleHsp" style=""></span>μUI/ml (2–25) and C-peptide of 8.86<span class="elsevierStyleHsp" style=""></span>ng/ml (0.5–3.2). The fasting test confirmed the diagnosis of insulinoma. An abdominal computed tomography (CT) was performed, which showed a 1<span class="elsevierStyleHsp" style=""></span>cm lesion in the pancreatic head.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the suspicion of PHPT, PTH was determined, confirming the diagnosis (PTH 113<span class="elsevierStyleHsp" style=""></span>pg/ml [9–65]). Bone densitometry showed lumbar osteopenia and hip osteoporosis. He had no nephrolithiasis. A MIBI scintigraphy showed uptake in the left upper and lower parathyroid glands. A genetic study for MEN1 was carried out, confirming the diagnosis. The study was completed, ruling out pituitary disease and/or PNET at other levels.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient underwent surgery, carrying out a subtotal parathyroidectomy with thymectomy. Subsequently, a subcostal incision was made with a bimanual intraoperative ultrasound examination of the pancreas, showing multiple nodules in body and tail. Distal pancreatectomy was performed with removal of the nodule located in the head. Histology confirmed several chromogranin and synaptophysin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>(Ki-67<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2%) tumours. During the first year, the patient remained asymptomatic, with normal controls. But one year later, he began with dizziness, hypoglycaemia and elevation of insulinemia. A CT was performed, observing a new 2<span class="elsevierStyleHsp" style=""></span>cm nodule in the pancreatic head, prompting surgical re-intervention; this time a tumour enucleation was performed. Histology confirmed the diagnosis of NET. Subsequently, the patient remained asymptomatic, with no evidence of recurrence after 10 years of follow-up. Five years after the re-intervention, he required starting insulin treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Insulinoma may correspond to the initial manifestation of MEN1 in 10% of cases, taking into account that when an insulinoma is diagnosed, only 4% will correspond to MEN1.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> This case involved an adolescent with elevated blood glucose, which made us suspect of a possible PHPT and this syndrome.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although insulinoma may occur as a single lesion, it can be multisite, as in our case, being more common in MEN1 syndrome than in sporadic ones. Often, they also develop before the age of 40, and even before the age of 20. On the contrary, sporadic ones usually appear from the age of 40.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the signs and symptoms, these patients commonly present hypoglycaemic symptoms that develop after fasting or after exertion, manifesting with dizziness, stupor or even loss of consciousness, improving after glucose administration (Whipple's triad). The most reliable analytical test is the prolonged 72-h fasting test.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> On the other hand, apart from CT, ultrasound endoscopy and/or intraoperative ultrasound are recommended as localization studies due to the possibility a multisite development of small tumors.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Regarding treatment, surgery is the treatment of choice.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> Although some authors describe enucleation as treatment in MEN1<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>, in general, it is recommended to perform a distal pancreatectomy, in order to remove the possibility of other concomitant tumours and minimize the risk of recurrence.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> When possible, an enucleation will also be performed if there is a tumour in the pancreatic head, if the enucleation is not feasible, a total pancreatectomy will need to be performed.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, Whipple's triad as an initial presentation in adolescence should make us think of an insulinoma and suspect a MEN1 syndrome. The multisite character of this type of tumours is an aspect to consider for the therapeutic strategy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Febrero B, Segura P, Rodríguez JM. Tríada de Whipple como comienzo del síndrome MEN 1 en la adolescencia. Med Clin (Barc). 2020;155:84–85.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of endocrine disease: a clinical update on tumor-induced hypoglycemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Iglesias" 1 => "J.J. Diez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Endocrinol" "fecha" => "2014" "volumen" => "170" "paginaInicial" => "147" "paginaFinal" => "157" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple endocrine neoplasia syndrome type 1: institution, management, and data analysis of a nationwide multicenter patient database" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Giusti" 1 => "L. Cianferotti" 2 => "F. Boaretto" 3 => "F. Cetani" 4 => "F. Cioppi" 5 => "A. Colao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12020-017-1234-4" "Revista" => array:7 [ "tituloSerie" => "Endocrine" "fecha" => "2017" "volumen" => "58" "paginaInicial" => "349" "paginaFinal" => "359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28132167" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2213716518302273" "estado" => "S300" "issn" => "22137165" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN 1)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.V. Thakker" 1 => "P.J. Newey" 2 => "G.V. Walls" 3 => "J. Bilezikian" 4 => "H. Dralle" 5 => "P.R. Ebeling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2012-1230" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2012" "volumen" => "97" "paginaInicial" => "2990" "paginaFinal" => "3011" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22723327" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Falconi" 1 => "B. Eriksson" 2 => "G. Kaltsas" 3 => "D.K. Bartsch" 4 => "J. Capdevila" 5 => "M. Caplin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000443171" "Revista" => array:6 [ "tituloSerie" => "Neuroendocrinology" "fecha" => "2016" "volumen" => "103" "paginaInicial" => "153" "paginaFinal" => "171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26742109" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term results of the surgical management of insulinoma patients with MEN1: A Groupe d’étude des Tumeurs Endocrines (GTE) retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Vezzosi" 1 => "C. Cardot-Bauters" 2 => "N. Bouscaren" 3 => "M. Lebras" 4 => "M. Bertholon-Grégoire" 5 => "P. Niccoli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/EJE-14-0878" "Revista" => array:6 [ "tituloSerie" => "Eur J Endocrinol" "fecha" => "2015" "volumen" => "172" "paginaInicial" => "309" "paginaFinal" => "319" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25538206" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000002/v1_202007190713/S2387020620302539/v1_202007190713/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000002/v1_202007190713/S2387020620302539/v1_202007190713/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620302539?idApp=UINPBA00004N" ]
Journal Information
Share
Download PDF
More article options
Scientific letter
Whipple's disease as initial presentation in multiple endocrine neoplasia type 1 in adolescence
Tríada de Whipple como comienzo del síndrome MEN 1 en la adolescencia
a Unidad de Cirugía Endocrina, Servicio de Cirugía General, Instituto Murciano de Investigación Biomédica (IMIB), Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
b Servicio de Endocrinología, Instituto Murciano de Investigación Biomédica (IMIB), Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain