metricas
covid
Buscar en
Endocrinología, Diabetes y Nutrición
Toda la web
Inicio Endocrinología, Diabetes y Nutrición Genetic Testing in Pituitary Adenomas: What, How, and In Whom?
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Editorial
Genetic Testing in Pituitary Adenomas: What, How, and In Whom?
Genética en adenomas hipofisarias: ¿qué, cómo y a quién?
Adrian F. Daly
Autor para correspondencia
adrian.daly@ulg.ac.be

Autor para correspondencia.
, Albert Beckers
Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège University, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium
Leído
5011
Veces
se ha leído el artículo
843
Total PDF
4168
Total HTML
Compartir estadísticas
 array:22 [
  "pii" => "S2530016419300047"
  "issn" => "25300164"
  "doi" => "10.1016/j.endinu.2019.01.001"
  "estado" => "S300"
  "fechaPublicacion" => "2019-02-01"
  "aid" => "878"
  "copyright" => "SEEN y SED"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Endocrinol Diabetes Nutr. 2019;66:71-3"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 583
    "formatos" => array:2 [
      "HTML" => 355
      "PDF" => 228
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2530016418302702"
    "issn" => "25300164"
    "doi" => "10.1016/j.endinu.2018.10.009"
    "estado" => "S300"
    "fechaPublicacion" => "2019-02-01"
    "aid" => "873"
    "copyright" => "SEEN y SED"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Endocrinol Diabetes Nutr. 2019;66:74-82"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 397
      "formatos" => array:2 [
        "HTML" => 292
        "PDF" => 105
      ]
    ]
    "es" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Caracter&#237;sticas de profesionalidad de los especialistas y ventajas de los equipos multidisciplinares en c&#225;ncer de tiroides&#58; resultados de una encuesta de opini&#243;n nacional"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "74"
          "paginaFinal" => "82"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Characteristics of professionalism of specialists and advantages of multidisciplinary teams in thyroid cancer&#58; results of a national opinion survey"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Juan J&#46; D&#237;ez, Juan Carlos Galofr&#233;, Amelia Oleaga, Enrique Grande, Mercedes Mitjavila, Pablo Moreno"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Juan J&#46;"
              "apellidos" => "D&#237;ez"
            ]
            1 => array:2 [
              "nombre" => "Juan Carlos"
              "apellidos" => "Galofr&#233;"
            ]
            2 => array:2 [
              "nombre" => "Amelia"
              "apellidos" => "Oleaga"
            ]
            3 => array:2 [
              "nombre" => "Enrique"
              "apellidos" => "Grande"
            ]
            4 => array:2 [
              "nombre" => "Mercedes"
              "apellidos" => "Mitjavila"
            ]
            5 => array:2 [
              "nombre" => "Pablo"
              "apellidos" => "Moreno"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2530018019300241"
        "doi" => "10.1016/j.endien.2018.10.008"
        "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/S2530018019300241?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016418302702?idApp=UINPBA00004N"
    "url" => "/25300164/0000006600000002/v1_201901250635/S2530016418302702/v1_201901250635/es/main.assets"
  ]
  "es" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Genetic Testing in Pituitary Adenomas&#58; What&#44; How&#44; and In Whom&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "71"
        "paginaFinal" => "73"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Adrian F&#46; Daly, Albert Beckers"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Adrian F&#46;"
            "apellidos" => "Daly"
            "email" => array:1 [
              0 => "adrian&#46;daly&#64;ulg&#46;ac&#46;be"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Albert"
            "apellidos" => "Beckers"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Endocrinology&#44; Centre Hospitalier Universitaire de Li&#232;ge&#44; Li&#232;ge University&#44; Domaine Universitaire du Sart Tilman&#44; 4000&#44; Li&#232;ge&#44; Belgium"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Gen&#233;tica en adenomas hipofisarias&#58; &#191;qu&#233;&#44; c&#243;mo y a qui&#233;n&#63;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Clinically diagnosed pituitary adenomas have a prevalence of approximately 1 per 1000 in the general population in Europe and are therefore encountered regularly by clinical endocrinologists in everyday practice<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Currently&#44; it is believed that most pituitary adenomas arise from a clonal expansion derived from a somatic mutation in a single cell&#46; For instance&#44; a somatic mutation in <span class="elsevierStyleItalic">GNAS</span> is found in up to 40&#37; of somatotropinomas in patients with acromegaly&#44; while somatic <span class="elsevierStyleItalic">USP8</span> mutations are now known to account for many cases of Cushing&#39;s disease<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Such pituitary level mutations are only discovered <span class="elsevierStyleItalic">post hoc</span> following tumor resection&#44; cannot readily be predicted in advance and are not inheritable&#46; Germline mutations in genes associated with pituitary adenomas are quite rare&#44; and overall&#44; pituitary adenomas occurring in an inheritable or familial setting account for about 5&#37; of cases<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; As they are rare&#44; generalized screening of pituitary adenoma patient populations to identify genetic mutation carriers is not currently a scientifically or economically valid approach&#46; Most of these genetic causes are associated with a clinical presentation that differs from other pituitary adenomas&#44; and these characteristics can be used to refine screening significantly&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In general&#44; when considering genetic analyses in pituitary adenoma patients a good first step is to determine if the tumor is isolated to the pituitary or forms part of a multi-organ tumor syndrome&#46; Pituitary adenomas can form part of classical endocrine tumor syndromes&#44; such as&#44; multiple endocrine neoplasia types 1 &#40;MEN1&#41; and 4 &#40;MEN4&#41;&#44; Carney complex and McCune-Albright syndrome &#40;MAS&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; The initial clinical investigation of the patient with a pituitary adenoma should include a detailed personal and family history about tumors and pathologies at other sites&#44; particularly in endocrine tissues<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Similarly&#44; the family history should specifically search for related individuals with pituitary adenomas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The focus for genetic testing in pituitary adenomas should primarily be on three main groups&#58; pediatric-adolescent patients&#44; those with a family history of pituitary adenomas and patients with a personal&#47;family history suggestive of an endocrine tumor syndrome&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Pediatric and adolescent patients are a particularly important population&#44; as certain genetic abnormalities leading to pituitary adenomas present more often in the young&#46; For example&#44; in MEN1&#44; pituitary adenomas can have an early age at presentation&#44; and testing guidelines recommend surveillance beginning as early as 5 years of age<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; In MEN1&#44; pituitary adenomas are generally larger and more difficult to control hormonally than non-MEN1 cases&#46; Pituitary gigantism&#44; by definition a disease that begins at an early age&#44; is a high priority for genetic testing as nearly 50&#37; of cases have a known genetic cause&#44; such as <span class="elsevierStyleItalic">AIP</span> mutations&#47;deletions &#40;29&#37;&#41;&#44; X-LAG syndrome &#40;10&#37;&#41;&#44; McCune-Albright syndrome &#40;5&#37;&#41;&#44; and MEN1 or Carney complex &#40;1&#37; each&#41; <a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Isolated pituitary adenomas can also occur in a hereditary setting as part of familial isolated pituitary adenomas &#40;FIPA&#41;&#59; FIPA is diagnosed in kindreds that have at least two pituitary adenomas in related individuals but in the absence of syndromic features in other organs&#44; such as&#44; MEN1<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Mutations in the <span class="elsevierStyleItalic">AIP</span> gene explain about 15-25&#37; of FIPA families&#46; <span class="elsevierStyleItalic">AIP</span> mutations have quite a low penetrance and about 20&#37; of mutation carriers will develop a clinically significant pituitary adenoma<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; While <span class="elsevierStyleItalic">AIP</span> mutations can lead to all subtypes of pituitary adenomas&#44; they usually cause growth hormone-secreting &#40;GH&#41; or mixed GH-prolactin secreting pituitary macroadenomas during childhood or adolescence&#46; While they most often occur in the setting of FIPA&#44; <span class="elsevierStyleItalic">AIP</span> mutation related pituitary adenomas also can occur in isolated patients with young onset&#44; large macroadenomas&#46; In acromegaly&#44; <span class="elsevierStyleItalic">AIP</span> mutated patients can be difficult to control&#44; due to high levels of hormonal secretion and poor hormonal and tumoral responses to first-generation somatostatin analogs<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">X-linked acrogigantism &#40;X-LAG&#41; syndrome is rare but has a very typical presentation as isolated GH-secreting pituitary adenoma and&#47;or hyperplasia causing overgrowth that begins usually in the first 12 months of life<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; It is due to a microduplication on chromosome Xq26&#46;3 that encompasses the gene <span class="elsevierStyleItalic">GPR101</span> and if untreated leads to very severe pituitary gigantism&#46; Diagnosis is made using array comparative genome hybridisation &#40;aCGH&#41;&#46; X-LAG syndrome can occur in rare gigantism-only FIPA families<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Also&#44; low-level somatic mosaicism is seen in male sporadic patients&#44; which can be detected using specific ddPCR assays<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Apart from MEN1 some other syndromic conditions include pituitary adenomas <a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; MEN4 is due to <span class="elsevierStyleItalic">CDKN1B</span> mutations&#44; and is a rare syndrome seen in MEN1 negative individuals and kindreds&#46; As relatively few pituitary adenomas have been described in MEN4&#44; there is no specific phenotype to direct genetic testing and <span class="elsevierStyleItalic">CDKN1B</span> mutations have not been reported in patients with isolated pituitary adenomas&#46; Carney complex is due to germline <span class="elsevierStyleItalic">PRKAR1A</span> mutations and is a multiorgan syndrome involving the adrenals&#44; skin&#44; testes and many other sites&#46; Pituitary adenomas &#40;generally GH secreting&#41; occur in 10&#37; of patients with Carney complex&#44; although many patients will have disorders of GH&#44; insulin-like growth factor 1 &#40;IGF1&#41; or prolactin on hormonal testing in the absence of a pituitary adenoma&#46; <span class="elsevierStyleItalic">MEN1</span>&#44; <span class="elsevierStyleItalic">CDKN1B</span> and <span class="elsevierStyleItalic">PRKAR1A</span> mutations are not considered to be an important cause of isolated sporadic pituitary adenomas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Mosaicism may also occur in patients with isolated and syndromic pituitary adenomas&#46; In McCune-Albright syndrome&#44; for instance&#44; a post-zygotic&#44; activating mutation in the <span class="elsevierStyleItalic">GNAS</span> gene can lead to variable proportions of mutated and wild-type cells across different tissues&#46; Traditional sequencing of <span class="elsevierStyleItalic">GNAS</span> for mutations in McCune-Albright syndrome is often negative for technical reasons due to low levels of mutated allele in blood or tumor specimens&#46; Recently&#44; droplet digital PCR &#40;ddPCR&#41; and related techniques have been validated to diagnose very low levels of the mutant <span class="elsevierStyleItalic">GNAS</span> allele in blood and tissue DNA&#44; thereby facilitating routine diagnosis<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Early genetic confirmation of MAS is important for disease surveillance in the affected individual &#40;it is not currently believed to be hereditary&#41;&#46; This is particularly true for somatotropinomas in MAS which can have an early onset&#44; exacerbate co-existing craniofacial fibrous dysplasia and are challenging to treat&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">One further syndromic situation of growing interest is the potential for a pituitary adenoma&#44; pheochromocytoma&#47;paraganglioma association &#40;3PA&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; In individuals or kindreds presenting with 3PA&#44; a number of mutated genes have been identified&#44; including the succinate dehydrogenase subunit genes &#40;SDHx&#41;&#59; recently&#44; mutations and intragenic deletions in <span class="elsevierStyleItalic">MAX</span> have also been implicated in 3PA<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The increasing number of genes associated with pituitary adenomas has also been accompanied by an expansion in the methodologies needed to correctly identify pathological variations&#46; Rather than Sanger sequencing of individual genes&#44; most reference laboratories have migrated to Next Generation Sequencing &#40;NGS&#41; panels&#44; which allow for parallel analyses of multiple potential genetic targets&#46; Other methodologies need to be considered for specific conditions&#44; such as aCGH for XLAG syndrome&#44; or digital PCR&#44; as mentioned above&#46; Also&#44; multiplex ligation dependent probe amplification &#40;MLPA&#41; kits are available to identify whole or partial gene deletions&#46; MLPA has proven useful in identifying whole or intragenic deletions in genes such as <span class="elsevierStyleItalic">MEN1</span>&#44; <span class="elsevierStyleItalic">AIP</span>&#44; <span class="elsevierStyleItalic">SDHx</span>&#44; and <span class="elsevierStyleItalic">MAX</span>&#44; in patients and families with normal sequencing results&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although rare&#44; genetic causes of pituitary adenomas are important to be aware of&#44; as their overall clinical course is often complicated by aggressive tumor characteristics and treatment is more difficult&#46; Early diagnosis of genetic causes is important to allow for proper screening for syndromic disease and to counsel and identify at-risk mutation carriers&#46; The increasing number of causative genes and emerging clinical syndromes means that clinical endocrinologists will increasingly act in partnership with clinical geneticists to optimise the management of patients with pituitary adenomas&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-01-04"
    "fechaAceptado" => "2019-01-10"
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High prevalence of pituitary adenomas&#58; A cross-sectional study in the province of Li&#232;ge Belgium"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;F&#46; Daly"
                            1 => "M&#46; Rixhon"
                            2 => "C&#46; Adam"
                            3 => "A&#46; Dempegioti"
                            4 => "M&#46;A&#46; Tichomirowa"
                            5 => "A&#46; Beckers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2006-1668"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab&#46;"
                        "fecha" => "2006"
                        "volumen" => "91"
                        "paginaInicial" => "4769"
                        "paginaFinal" => "4775"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16968795"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "cAMP in the pituitary&#58; an old messenger for multiple signals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Peverelli"
                            1 => "G&#46; Mantovani"
                            2 => "A&#46;G&#46; Lania"
                            3 => "A&#46; Spada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/JME-13-0172"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Mol Endocrinol&#46;"
                        "fecha" => "2014"
                        "volumen" => "52"
                        "paginaInicial" => "R67"
                        "paginaFinal" => "R77"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24049068"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genetics of Cushing&#39;s Syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;C&#46; Hern&#225;ndez-Ram&#237;rez"
                            1 => "C&#46;A&#46; Stratakis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ecl.2018.02.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocrinol Metab Clin North Am&#46;"
                        "fecha" => "2018"
                        "volumen" => "47"
                        "paginaInicial" => "275"
                        "paginaFinal" => "297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29754632"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chapter 21 &#8211; Genetics of Pituitary Tumor Syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;F&#46; Daly"
                            1 => "A&#46; Beckers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Pituitary"
                        "fecha" => "2017"
                        "paginaInicial" => "619"
                        "paginaFinal" => "630"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "65 YEARS OF THE DOUBLE HELIX&#58; Endocrine tumour syndromes in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Goudie"
                            1 => "F&#46; Hannah-Shmouni"
                            2 => "M&#46; Kavak"
                            3 => "C&#46;A&#46; Stratakis"
                            4 => "W&#46;D&#46; Foulkes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/ERC-18-0160"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocr Relat Cancer&#46;"
                        "fecha" => "2018"
                        "volumen" => "25"
                        "paginaInicial" => "T221"
                        "paginaFinal" => "T244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29986924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel Genetic Causes of Pituitary Adenomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Caimari"
                            1 => "M&#46; Korbonits"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1158/1078-0432.CCR-16-0452"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Cancer Res&#46;"
                        "fecha" => "2016"
                        "volumen" => "22"
                        "paginaInicial" => "5030"
                        "paginaFinal" => "5042"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27742789"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Familial isolated pituitary adenomas &#40;FIPA&#41; and mutations in the aryl hydrocarbon receptor interacting protein &#40;AIP&#41; gene"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;F&#46; Daly"
                            1 => "A&#46; Beckers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Endocrinol Metab Clin North Am&#46;"
                        "fecha" => "2015"
                        "volumen" => "44"
                        "paginaInicial" => "19"
                        "paginaFinal" => "25"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical Practice Guidelines for Multiple Endocrine Neoplasia Type 1 &#40;MEN1&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;V&#46; Thakker"
                            1 => "P&#46;J&#46; Newey"
                            2 => "G&#46;V&#46; Walls"
                            3 => "J&#46; Bilezikian"
                            4 => "H&#46; Dralle"
                            5 => "P&#46;R&#46; Ebeling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2012-1230"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab&#46;"
                        "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The causes and consequences of pituitary gigantism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Beckers"
                            1 => "P&#46; Petrossians"
                            2 => "J&#46; Hanson"
                            3 => "A&#46;F&#46; Daly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41574-018-0114-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Endocrinol&#46;"
                        "fecha" => "2018"
                        "volumen" => "14"
                        "paginaInicial" => "705"
                        "paginaFinal" => "720"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30361628"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gigantism and acromegaly due to Xq26 microduplications and GPR101 mutation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Trivellin"
                            1 => "A&#46;F&#46; Daly"
                            2 => "F&#46;R&#46; Faucz"
                            3 => "B&#46; Yuan"
                            4 => "L&#46; Rostomyan"
                            5 => "D&#46;O&#46; Larco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1408028"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2014"
                        "volumen" => "371"
                        "paginaInicial" => "2363"
                        "paginaFinal" => "2374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25470569"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "X-linked acrogigantism syndrome&#58; Clinical profile and therapeutic responses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Beckers"
                            1 => "M&#46;B&#46; Lodish"
                            2 => "G&#46; Trivellin"
                            3 => "L&#46; Rostomyan"
                            4 => "M&#46; Lee"
                            5 => "F&#46;R&#46; Faucz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/ERC-15-0038"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocr Relat Cancer&#46;"
                        "fecha" => "2015"
                        "volumen" => "22"
                        "paginaInicial" => "353"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25712922"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Somatic mosaicism underlies X-linked acrogigantism syndrome in sporadic male subjects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;F&#46; Daly"
                            1 => "B&#46; Yuan"
                            2 => "F&#46; Fina"
                            3 => "J&#46;-H&#46; Caberg"
                            4 => "G&#46; Trivellin"
                            5 => "L&#46; Rostomyan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/ERC-16-0082"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocr Relat Cancer&#46;"
                        "fecha" => "2016"
                        "volumen" => "23"
                        "paginaInicial" => "221"
                        "paginaFinal" => "233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26935837"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Using Digital Droplet Polymerase Chain Reaction to Detect the Mosaic GNAS Mutations in Whole Blood DNA or Circulating Cell-Free DNA in Fibrous Dysplasia and McCune-Albright Syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Romanet"
                            1 => "P&#46; Philibert"
                            2 => "F&#46; Fina"
                            3 => "T&#46; Cuny"
                            4 => "C&#46; Roche"
                            5 => "L&#46; Ouafik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "J Pediatr&#46;"
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The 3PAs&#58; An Update on the Association of Pheochromocytomas Paragangliomas&#44; and Pituitary Tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Xekouki"
                            1 => "A&#46; Brennand"
                            2 => "B&#46; Whitelaw"
                            3 => "K&#46; Pacak"
                            4 => "C&#46;A&#46; Stratakis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Horm Metab Res&#46;"
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pheochromocytomas and pituitary adenomas in three patients with MAX exon deletions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;F&#46; Daly"
                            1 => "E&#46; Castermans"
                            2 => "L&#46; Oudijk"
                            3 => "M&#46;A&#46; Guitelman"
                            4 => "P&#46; Beckers"
                            5 => "I&#46; Potorac"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/ERC-18-0065"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocr Relat Cancer&#46;"
                        "fecha" => "2018"
                        "volumen" => "25"
                        "paginaInicial" => "L37"
                        "paginaFinal" => "L42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29535143"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/25300164/0000006600000002/v1_201901250635/S2530016419300047/v1_201901250635/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "63842"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/25300164/0000006600000002/v1_201901250635/S2530016419300047/v1_201901250635/es/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016419300047?idApp=UINPBA00004N"
]
Información del artículo
ISSN: 25300164
Idioma original: Español
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 7 1 8
2024 Octubre 94 10 104
2024 Septiembre 86 7 93
2024 Agosto 103 4 107
2024 Julio 84 10 94
2024 Junio 57 1 58
2024 Mayo 65 6 71
2024 Abril 66 6 72
2024 Marzo 107 8 115
2024 Febrero 109 14 123
2024 Enero 122 7 129
2023 Diciembre 185 31 216
2023 Noviembre 96 13 109
2023 Octubre 103 6 109
2023 Septiembre 101 7 108
2023 Agosto 83 6 89
2023 Julio 76 3 79
2023 Junio 69 7 76
2023 Mayo 97 9 106
2023 Abril 64 8 72
2023 Marzo 74 4 78
2023 Febrero 69 2 71
2023 Enero 63 7 70
2022 Diciembre 46 4 50
2022 Noviembre 47 6 53
2022 Octubre 69 19 88
2022 Septiembre 58 24 82
2022 Agosto 59 6 65
2022 Julio 36 10 46
2022 Junio 36 13 49
2022 Mayo 48 14 62
2022 Abril 71 10 81
2022 Marzo 85 19 104
2022 Febrero 58 11 69
2022 Enero 74 12 86
2021 Diciembre 47 11 58
2021 Noviembre 49 13 62
2021 Octubre 58 17 75
2021 Septiembre 49 20 69
2021 Agosto 67 10 77
2021 Julio 32 12 44
2021 Junio 43 8 51
2021 Mayo 54 10 64
2021 Abril 147 26 173
2021 Marzo 103 14 117
2021 Febrero 54 8 62
2021 Enero 57 14 71
2020 Diciembre 63 10 73
2020 Noviembre 54 16 70
2020 Octubre 35 4 39
2020 Septiembre 22 13 35
2020 Agosto 30 20 50
2020 Julio 41 13 54
2020 Junio 40 20 60
2020 Mayo 24 13 37
2020 Abril 24 3 27
2020 Marzo 40 7 47
2020 Febrero 33 10 43
2020 Enero 35 14 49
2019 Diciembre 36 15 51
2019 Noviembre 20 8 28
2019 Octubre 31 19 50
2019 Septiembre 29 19 48
2019 Agosto 21 33 54
2019 Mayo 2 0 2
2019 Marzo 10 8 18
2019 Febrero 120 82 202
2019 Enero 31 28 59
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

es en pt

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

Are you a health professional able to prescribe or dispense drugs?

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