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All Journal Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD)
Zaki Mita Kusumaadhi
Unknown Affiliation
Health Professions Medicine & Pharmacology Public Health

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Paraparesis and Bipolar Affective Disorder Episodes of Depression in Graves’ Patient with Thyroid Cancer Yohana Prima Ceria Anindita; Zaki Mita Kusumaadhi; Tania Tedjo Minuljo; K. Heri Nugroho HS; Suryadi; Alifiati Fitrikasari; Subiyakto; Dik Puspasari
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v1i2.19

Abstract

Thyroid nodules in Graves' disease raise awareness of thyroid cancer. Thyrotoxicosis in patients with thyroid cancer suggests extensive metastases or large tumours. Hyperthyroidism or thyrotoxicosis can exacerbate symptoms of anxiety, depression, mood lability, and insomnia in patients with bipolar disorder. We present a rare case, a 29-year-old woman with a history of Graves' variant nodule and bipolar affective disorder since the age of 17, was admitted to the hospital for paraparesis within a month. Patients also complain of sleeplessness, hopelessness, and fatigue. The patient has been taking Thiamazole 10 mg twice daily, Propranolol 20 mg twice daily, Alprazolam 0.5 mg trice daily, Haloperidol 5 mg nightly, Trihexyphenidyl 2 mg daily, Lamotrigine 100 mg twice daily but not routinely. History of partial thyroidectomy 10 years ago with pathology results was said to be benign. Neurological examination: bilateral lower extremity motor weakness with a value of 2/5 muscle function. MRI of the spine with contrast: changes in signal intensity in the vertebral bodies C.2, C.4, C.5, Th.2 - tend to bone metastases. Thyrotoxicosis thyroid function test results (free T4 = 66.71 pmol/L (N = 10.6 – 19.4); TSHs < 0.05 uIU/mL (0.51 – 4.94 uIU/mL) and thyroid scintigraphy showed toxic multinodular goiter (cold nodule) with high thyroid uptake. A total thyroidectomy was performed, and the pathology result revealed papillary thyroid cancer. Thyroid cancer can occur together with Graves' disease. Graves’ disease-associated cancers were more often metastatic to distant sites such as spinal metastases that significantly increases morbidity and mortality. Thyrotoxicosis was associated with regional metabolic changes of limbic structures that mediate affect in patients with bipolar affective disorder. 
Recurrent Severe Hypoglycemia in a 43 Year Old Extreme Obese Woman with Insulinoma: A Case Report Zaki Mita Kusumaadhi; Farah Hendara Ningrum; Bambang Satoto; Titik Yuliastuti; Y. F. Rahmat Sugianto; Etisa Adi Murbawani; Didik Indiarso; Erik Prabowo; Tania Tedjo Minuljo; Yohana Prima Ceria Anindita; K. Heri Nugroho HS; Meira Dewi Kusuma Astuti
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 2 (2025): InaJEMD Vol. 2, No. 2
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i2.66

Abstract

Insulinomas are very rare neuroendocrine tumors (4 cases per million individuals per year) leading to insulin hypersecretion and occurring more often in women at any age. A 43 year old extreme obese woman was referred to Dr Kariadi General Hospital with complaints history of repeated unconsciousness due to recurrent episodes of symptomatic severe hypoglycaemia (previously been hospitalized several times in regional hospitals in last six years). Physical examination: Body Mass Index Class II obesity (Asia-Pacific). Laboratory: recurrent hypoglycaemia (random blood glucose range 30-50 mg/dL), Fasting Blood Glucose 105 mg/dL (n: 80-109), 2 hours Postprandial Blood Glucose 44 mg/dL (n: 80- 140), C-peptide levels (taken during hypoglycaemia) 13.59 ng/ml (n:1.1-4.4). Abdominal Ultrasonography : grade 2 fatty liver, Fibroscan: no fibrosis or steatosis, Plain Head MSCT: no visible abnormalities, contrast abdominal magnetic resonance imaging: solid lesion in the body of pancreas (AP 1.2 x LL 1.2 x CC 1.3 cm) tends to be a picture of insulinoma. Patient underwent distal pancreatectomy with immunohistochemical results of an insulinoma. Post surgery the patient never had hypoglycaemia. We described a 43 year old extreme obese woman with recurrent episodes of symptomatic severe hypoglycaemia. Laboratory (low random blood glucose, high C-peptide) and imaging examinations (solid lesion in the body of the pancreas on Contrast Abdominal MRI) support the diagnosis of insulinoma. Surgery is the treatment of choice for insulinomas. Patients with recurrent severe hypoglycemia, increase in C-peptide levels and solid lesion in pancreas are clinical manifestations of Insulinoma.
Co-Authors Alifiati Fitrikasari Bambang Satoto Didik Indiarso Dik Puspasari Erik Prabowo Etisa Adi Murbawani Farah Hendara Ningrum K. Heri Nugroho HS Meira Dewi Kusuma Astuti Subiyakto Suryadi Tania Tedjo Minuljo Titik Yuliastuti Y. F. Rahmat Sugianto Yohana Prima Ceria Anindita