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All Journal Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD)
Dhinar Kemas Ariawidjaja
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Health Professions Medicine & Pharmacology Public Health

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Gynecomastia and Galactorrhoea in Male Older Patients: Distinguish Between Drug Induced or Prolactinomas? Dhinar Kemas Ariawidjaja; Mohammad Robikhul Ikhsan
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i1.42

Abstract

Finding the cause of gynecomastia and galactorrhoea can be challenging, hence one of the most important cornerstones is detailed case history. Gynecomastia is an enlargement of the breast in males due to hyperplasia of the glandular tissue. Causes: Physiological (20%) Pathological (30%) Drugs (10-20%) Idiopathic (25%). We report a case of gynecomastia with prolactin disorder and previous use of antihypertensive medication. A 68 year old man, with hypertensive heart disease, controlled on medication (low dose spironolactone 25mg/day, digoxin 0.25mg/day and diltiazem 30 mg three times a day), for the last 12 months; presented with painful swelling and discharge of bilateral breasts for the last 14 days; on examination of both breasts a firm, mobile lump was palpated under the right nipple; blood tests: BUN 12 mg/dL; Creatinine 1.1 mg/dL; TSH 0.57 μIU/ml; LH 12,0 IU/mL; Testosteron 6,41 ng/mL; Estradiol 111,8 pmol/L; Prolactin 87.5 ng/mL. Head MRI was performed; multiple chronic lacunar infarcts, intrasellar and suprasellar were normal and no mass or infection was visible. The probable cause was attributed to spironolactone and digoxin, the medications were stopped; the patient's pain and swelling improved and returned to normal after 2 months of discontinuation, prolactin was assessed at 0.193 ng/mL. Gynecomastia due to spironolactone has many mechanisms: blockade of androgen receptors, prevent binding of testosterone & dihydrotestosterone; decrease testosterone production from testes, increase estrogens by enhancing peripheral conversion of testosterone to estradiol. It has been suggested that digoxin binds to the estrogens receptor and may directly stimulate breast tissue proliferation, inducing gynecomastia. Spironolactone is known to cause gynecomastia; there are very few case reports of digoxin-induced gynecomastia. No other evidence of prolactinoma in this case. It is important for the clinician to keep this in mind; although low doses combination between spironolactone and digoxin may cause gynecomastia.
Unexpected Histological Finding of Diffuse Large B-Cell Lymphoma in a Patient with Long-standing Goiter and Hashimoto's Thyroiditis: A Case Report Dhinar Kemas Ariawidjaja; Mohammad Robikhul Ikhsan; Hemi Sinorita; Raden Bowo Pramono; Vina Yanti Susanti; Rayhani Erika Putri
‎ 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.v2i2.59

Abstract

Primary thyroid lymphoma (PTL) is an uncommon malignancy, comprising less than 5% of all thyroid cancers. Hashimoto's thyroiditis (HT) is the most significant risk factor, increasing the risk of developing PTL by 40 to 80 times. Diffuse large B-cell lymphoma (DLBCL) is the most prevalent and aggressive histological subtype, accounting for over 50% of PTL cases. The diagnosis is challenging, as the clinical and sonographic features of PTL can mimic benign thyroiditis. A 60-year-old female with a three-year history of a progressively enlarging goiter and worsening compressive symptoms presented for surgical evaluation. Initial investigations revealed severe hypothyroidism and ultrasound findings of a nodular goiter with features of thyroiditis (TI-RADS 3). She underwent a total thyroidectomy for symptomatic relief. Postoperative histopathology unexpectedly revealed a DLBCL, confirmed by CD20 positivity, coexisting with a background of classic HT. The patient was subsequently treated with six cycles of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) chemoimmunotherapy and achieved a complete clinical and radiological response. This case underscores the diagnostic challenge PTL presents, particularly in patients with preexisting HT. A high index of suspicion is crucial for clinicians managing HT patients who present with a rapidly enlarging goiter or worsening compressive symptoms. While fine-needle aspiration has limitations, definitive diagnosis often requires a core needle or excisional biopsy to differentiate neoplastic infiltration from the benign lymphocytic infiltrate of HT.
Co-Authors Hemi Sinorita Mohammad Robikhul Ikhsan Raden Bowo Pramono Rayhani Erika Putri Vina Yanti Susanti