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INDONESIA
Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD)
Published by Perkumpulan Endokrinologi Indonesia
ISSN : 30483271     EISSN : 30631408     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology Public Health
Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD) is an open accessed online journal and comprehensive peer-reviewed medical journal published by the Indonesian Society of Endocrinology since 2024. Our main mission is to publish and disseminate research results that are relevant to current and future scientific development needs. InaJEMD is an open accessed online journal. We are welcome authors for original articles, case report, case series, case illustration, review articles, systematic review, and clinical practice. Authors are invited to submit articles that have not been published previously and are not under consideration elsewhere. Preparations of manuscript should follow the author guidelines of InaJEMD.
Arjuna Subject : Profesi Kesehatan - Profesi Kesehatan (Lain-Lain)
Articles 36 Documents
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Management of Severe Hypertriglyceridemia Herni Basir; Andi Makbul Aman
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 1 (2024): InaJEMD Vol. 1, No. 1
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Management of Severe Hypertriglyceridemia
Comparison of Anti Thyroid Drugs, Radioactive Iodine and Surgery for Graves’ Disease: A Systematic Review and Meta-Analysis Dian Daniella; Ida Bagus Aditya Nugraha; Wira Gotera
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Selection of therapy for Graves’ Disease (GD) has always been a puzzling decision to be taken by both the patient and physician. This is due to the three modalities (Anti Thyroid Drug (ATD), Radioactive Iodine (RAI) and surgery) in with each one being just as established as the other two in being an effective treatment strategy. Therefore, this study was conducted in purpose to compare ATD, RAI and surgery for GD. The author searches from several databases such as PubMed, Directory of Open Access Journals (DOAJ), and Science Direct as well as registers, such as Cochrane Central Register of Controlled Trials (CENTRAL). The systematic review was incorporated to all of seven studies and six studies has been selected to be included in the analysis. ATD has higher risk of relapse compared to RAI (RR 2.77, 95% CI 0.99–7.75); p=0.05) and surgery (RR 6.60, 95% CI 3.76–11.58); p<0.00001). In comparison to surgery, RAI has higher risk of relapse (RR 2.52, 95% CI 0.66–9.67); p 0.18). ATD has lower success rate compared to RAI (RR 0.47, 95% CI 0.35–0.63); p<0.00001) and surgery (RR 0.44, 95% CI 0.34–0.58); p<0.00001). ATD has lower risk of hypothyroid compared to RAI (RR 0.08, 95% CI 0.02–0.27); p<0.0001) and surgery (RR 0.09, 95% CI 0.02–0.40); p=0.001). ATD has the highest risk of relapse compared to RAI and surgery. RAI and surgery did not differ significantly in risk of relapse and hypothyroid.
Secondary Hypogonadism in Recurrent Adamantinomatous Craniopharyngioma: Fertility Evaluation and Management Adeputri Tanesha Idhayu; Tri Juli Edi Tarigan; Em Yunir; Setyo Widi Nugroho; Eka Susanto
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Craniopharyngioma is an intracranial tumor with pituitary hormone deficiencies and affects 40% of gonadotropins deficiency. Gonadotropin deficiency causes secondary hypogonadism and male infertility which need to investigation for male infertility therapy options. A 22-year-old man presented with history of intermittent headaches, visual impairment, mild left- side hemiparesis, and developed erectile dysfunction. On clinical examination, there was abnormal penile and testicular size. The radiological examination showed a solid intrasellar mass with cystic lesion. The histological diagnosis was adamantinoma Tous craniopharyngioma. The hormonal evaluation showed low testosterone level, LH and FSH, and semen analysis showed azoospermia. The human chorionic gonadotropin stimulation test showed testosterone increase times from baseline, but evaluation semen test remained azoospermia. Craniopharyngioma morbidity is associated with tumor related and or treatment-related risk factors such as hormone deficiencies. Pituitary hormone deficiencies have been reported in 54–100% of patients that affect secretion of growth hormone, gonadotropin, TSH and ACTH. Gonadotropin deficiency associated with infertility in men. In this case, gonadotropin deficiency was due to the tumor because the symptoms had developed before surgery. Hypogonadism in this case occurs after puberty and he willing to have offspring. The hormonal therapy is effective in restoring spermatogenesis relates to the regulatory of the hypothalamic pituitary gonadal axis. The administration of HCG alone or combined with FSH, restores spermatogenesis of patients with hypogonadotropic hypogonadism, with reported pregnancy rates of up to 65%. Gonadotropin stimulation therapy will be planned after ruling out seminal tract obstruction and testicular fibrosis. Infertility in secondary hypogonadism can be managed with hormone therapy, but a complete investigation is required before starting treatment to determine therapy options.
Approach to Diagnosis and Management of An Elderly Female Patient with Recurrent Hypocalcemia Ida Bagus Aditya Nugraha
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Disorders of calcium metabolism are common in the everyday clinical setting. Although hypocalcemia is not as common as hypercalcemia, it can be life-threatening if not properly recognized and treated promptly. Causes of hypocalcemia can be divided into three broad categories, such as parathyroid hormone (PTH) deficiency, high PTH levels, and other causes. There is no literature that specifically discusses the incidence and prevalence of hypocalcemia in general. In general, renal failure is the most common cause of hypocalcemia. This condition is followed by vitamin D deficiency, magnesium deficiency, acute pancreatitis, and others. The clinical presentation of hypocalcemia can vary widely, from asymptomatic to life-threatening. In an emergency, unrecognized or poorly managed hypocalcemia can cause significant morbidity or mortality. Symptomatic patients with classic clinical findings of acute hypocalcemia require immediate resuscitation and evaluation. However, most cases of hypocalcemia are found based on clinical suspicion as well as appropriate laboratory testing. Treatment of hypocalcemia depends on the presence and severity of symptoms, degree of hypocalcemia, and etiology of hypocalcemia. Most cases of hypocalcemia are clinically mild and require only supportive treatment and further laboratory evaluation. Oral calcium absorption may be indicated for outpatient treatment in mild cases. In cases of severe hypocalcemia leading to seizures, tetany, refractory hypotension, or arrhythmias, a more aggressive approach may be required, including intravenous calcium infusion.  
Adrenal Cortical Adenoma Resulting from Congenital Adrenal Hyperplasia Managed with Unilateral Laparoscopic Adrenalectomy: A Case Report Didik Supriyadi Kusumo B; M. Robikhul Ikhsan
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder resulting from mutations in genes encoding enzymes involved in cortisol biosynthesis. Over 90-95% of cases are caused by 21-hydroxylase deficiency, with an incidence of 1:10,000-1:20,000 among Caucasians. This condition leads to cortisol deficiency, causing a loss of negative feedback in the pituitary gland and subsequently increased secretion of adrenocorticotropic hormone (ACTH), which in turn stimulates the production of adrenal androgens and adrenal hyperplasia. We report a 31-year-old female with classic CAH of the simple virilizing subtype and a history of genital reconstruction due to external genital ambiguity. She received glucocorticoid therapy and spironolactone to block androgen receptors. As a result, hirsutism decreased, and MRI evaluation of the adrenal glands revealed a reduction in size compared to pre-treatment (bilateral adrenal gland enlargement). No disturbances due to mineralocorticoid receptor blockade from spironolactone administration were found. In the fourth-year MRI evaluation, the left adrenal gland was larger than normal, while the right was within normal limits. A functional left adrenal gland tumor T1N0M0 was concluded, and a left laparoscopic adrenalectomy was decided upon. The patient consented to the procedure one year later. Laparoscopic adrenalectomy of sinistra was successfully performed with histopathologic examination revealed adrenal cortical adenoma. Monitoring and evaluation of clinic visits, we concluded that unilateral adrenalectomy cannot replace routine medication, but can reduce the dose requirement. Currently, the patient is still under regular control and supervision to evaluate the long-term results of the procedure whether there is a risk of adrenal crisis, whether it can overcome the effects of hyperandrogenism, and whether there is an adrenal rest tumor. 
A 59-year-old man with Riedel's Thyroiditis, Initial Suspicion of Thyroid Cancer and Improved with Tamoxifen and Corticosteroid Therapy Ika Hudayani; Himawan Sanusi
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Riedel's thyroiditis is a rare fibrotic condition involving damage to the thyroid gland and infiltration of surrounding structures. Synonyms of Riedel's thyroiditis include Riedel's goiter, fibrous goiter, ligneous goiter, or chronic invasive fibrous thyroiditis. The inflammatory thyroid condition of Riedel's thyroiditis is a local manifestation of a systemic fibrous or autoimmune process and chronic sclerosis or productive thyroiditis. A 59-year-old man came to the Endocrinology Clinic at Wahidin Sudirohusodo Hospital and was consulted by an oncology surgeon colleague with complaints of a lump in his neck for 2 years before coming to the hospital. Initially the lump was the size of a marble then it got bigger, felt hard, and not painful. The patient had a history of biopsies by surgical colleagues 2 times, the first in May 2022 Fine Needle Aspiration Biopsy with Malignancy (Papillary) results at Bhayangkara Hospital, then the patient was referred to a surgical oncology colleague at Wahidin Sudirohusodo Hospital and a 1-month incision biopsy was performed before going to the endocrine polyclinic with the results of Riedel's Thyroiditis. The patient was then given therapy with Tamoxifen 20 mg per 24 hours orally, and Methylprednisolone 16 mg per 8 hours orally with tapering doses every 7 days. In the treatment during control there were no complaints but complaints of a lump in the neck tended to shrink so the treatment was continued for 2 months then the patient returned to control with a clinical lump in the neck shrinking (Improvement). Riedel's thyroiditis is a disease characterized by an overgrowth of connective tissue that can invade surrounding structures. This connective tissue growth may extend into the recurrent laryngeal nerve. This thyroid inflammatory condition is suspected as a local manifestation of a systemic fibrotic process or an autoimmune process. Commonly used therapies such as glucocorticoids and immunosuppressant agents such as tamoxifen. Steroid treatment is usually given at a dose of 100 mg of prednisolone daily.
Parathyroid Carcinoma with Hungry Bone Syndrome Complication After Parathyroidectomy: A Case Report Muhammad Iman Pratama Putra; Nanny Natalia Mulyani Soetedjo; Maya Kusumawati; Ervita Ritonga; Yohana Azhar; Hasrayati Agustina; Hikmat Permana
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Abstract

Riedel's thyroiditis is a rare fibrotic condition involving damage to the thyroid gland and infiltration of surrounding structures. Synonyms of Riedel's thyroiditis include Riedel's goiter, fibrous goiter, ligneous goiter, or chronic invasive fibrous thyroiditis. The inflammatory thyroid condition of Riedel's thyroiditis is a local manifestation of a systemic fibrous or autoimmune process and chronic sclerosis or productive thyroiditis. A 59-year-old man came to the Endocrinology Clinic at Wahidin Sudirohusodo Hospital and was consulted by an oncology surgeon colleague with complaints of a lump in his neck for 2 years before coming to the hospital. Initially the lump was the size of a marble then it got bigger, felt hard, and not painful. The patient had a history of biopsies by surgical colleagues 2 times, the first in May 2022 Fine Needle Aspiration Biopsy with Malignancy (Papillary) results at Bhayangkara Hospital, then the patient was referred to a surgical oncology colleague at Wahidin Sudirohusodo Hospital and a 1-month incision biopsy was performed before going to the endocrine polyclinic with the results of Riedel's Thyroiditis. The patient was then given therapy with Tamoxifen 20 mg per 24 hours orally, and Methylprednisolone 16 mg per 8 hours orally with tapering doses every 7 days. In the treatment during control there were no complaints but complaints of a lump in the neck tended to shrink so the treatment was continued for 2 months then the patient returned to control with a clinical lump in the neck shrinking (Improvement). Riedel's thyroiditis is a disease characterized by an overgrowth of connective tissue that can invade surrounding structures. This connective tissue growth may extend into the recurrent laryngeal nerve. This thyroid inflammatory condition is suspected as a local manifestation of a systemic fibrotic process or an autoimmune process. Commonly used therapies such as glucocorticoids and immunosuppressant agents such as tamoxifen. Steroid treatment is usually given at a dose of 100 mg of prednisolone daily.
Adult Onset Nesidioblastosis (Non Insulinoma Pancreatogenous Hypoglycemia Syndrome): A Rare Case Rita Sriwulandari; Yulianto Kusnadi; Ratna Maila Dewi; Alwi Shahab; Anne Rivaida
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Finding the etiology of hypoglycemia in adult patients can be challenging because of the wide variety of etiologies. Ninety percent of endogenous hyperinsulinemic hypoglycemia is caused by insulinoma, the rest are caused by insulin antibodies and pancreatic β cell dysfunction (nesidioblastosis) which indicates neoformation of nesidioblasts (stem cells that form the islets of Langerhans). A 28-year-old female complained of neuroglycopenia and adrenergic symptoms that improved with drinking sugar, so she had weight gain. The 72 hours of prolonged fasting test results are C-peptide ≥0.2 mmol/L, insulin ≥21 pmol/L, insulin to C-peptide molar ratio ≤1, and negative insulin antibody. Imaging tests were normal and there is no evidence of malignancies. When blood glucose falls, the first defense mechanism to prevent hypoglycemia is decreased in insulin secretion. When this mechanism fails, insulin and C-peptide levels remain high in circulation. Confirmation of Whipple's triad is required, followed by insulin tests in hypoglycemic conditions. Imaging tests, biomarkers, and hormonal malignancies were done to rule out differential diagnoses. Nuclear diagnostics, SACST, biopsy, and histopathology are currently in capable of being carried out. The diagnosis of adult-onset Nesidioblastosis/NIPHS in this patient was made through the diagnosis of exclusion, namely by eliminating all diagnostic appeals because several examination modalities cannot be carried out. The gold standard for diagnosing Nesidioblastosis/NIPHS is SACST and histopathological examination of pancreatic tissue. The patient is well-controlled with Amlodipine 2.5 mg. 
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
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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. 
Dengue Fever and Graves’ Disease Complicated with Guillain-Barré Syndrome: A Case Report Fatimah Eliana Taufik; Juhan Khalila
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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GBS is a rare neurological autoimmune disorder in which a person’s immune system mistakenly attacks part of peripheral nervous system and the network of nerves that carries signals from the brain and spinal cord to the rest of the body. GBS is not commonly found alongside Graves’ disease or dengue fever. 35-year-old woman who have been previously diagnosed with Graves’ disease with dengue fever and GBS. On the fifth day of treatment, she showed signs of poor respiratory function, weak neck muscle power, paralyzed and was indicated for intubation. The cerebrospinal fluid analysis showed a consistent finding of GBS of albumin cytological dissociation with an increased level of protein of 80 mg/dL, glucose 50 mg/dL, and a normal lymphocytes cell count of 4/cmm without polymorphs. She was ventilated for three days and began to receive the treatment of intravenous immunoglobulins (IVIG) of 0.4 g/kg/day for a total of five days and remarkable recovery and was extubated on day 3 of IVIG. The case study theorises those endogenous factors, such as gangliocytes and ICAM-1, as well as exogenous factors such as bacterial and viral infection, may play a part in the simultaneous presentation of GBS and Graves’ disease. Antibodies that formed from these factors have an affinity to GM1 and GT1A gangliosides which are typically exposed on the plasma membrane and can cause molecular mimicry as well as cytokine stimulation which is the main feature of GBS. Furthermore, it is thought that preceding infection of dengue virus may also lead to the development of GBS. Intravenous immunoglobulin therapy shows a promising result on treating a simultaneous case of GBS presenting in patient with Graves’ disease and dengue fever. 

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