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Zanastia Sukmayanti
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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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Diffuse Toxic Goiter Hyperthyroid with Atrial Fibrillation in Type 2 Diabetes Patient Alif Ridhani
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Abstract

Goiter is an enlargement of the thyroid gland which can occur in euthyroid, hyperthyroid, or hypothyroid. Hyperthyroidism can cause symptoms, such as palpitations, fatigue, sleep disturbances, weight loss, and heat intolerance. There are various complications and symptoms of hyperthyroidism, one of which is cardiac arrhythmia. Thyroid dysfunction can coexist with type 2 diabetes, so special attention is needed. Male, 43 years old, complaining of palpitations in the chest since 2 days ago. Complaints were accompanied by weakness, hand tremors, and lack of appetite. Patient also complained there was a lump in the neck that moved when swallowing since 5 months ago. Patient has a history of type 2 diabetes and regularly takes metformin. Physical examination found diffuse enlargement of the thyroid gland, soft consistency, indistinct borders and irregular heart rhythm. Electrocardiography showed atrial fibrillation. Ultrasound examination revealed bilateral diffuse goiter. Free T4 result is elevated. Therapy given is infusion, methimazole, beta-blockers, digoxin, and metformin. Thyroid hormones have significant effects on the heart, which include increasing resting pulse rate, blood volume, stroke volume, cardiac muscle contractility, and ejection fraction. Thyroid also causes sinus rhythm disturbances. Early thyroid treatment has a better prognosis for improvement. Treatment of hyperthyroidism can affect the condition of diabetes, so monitoring blood sugar is necessary. Early diagnosis and prompt treatment of hyperthyroidism can resolve complaints and prevent complications. Thyroxine concentrations higher than normal are more at risk of experiencing atrial fibrillation. Hyperthyroidism can occur together with type 2 diabetes so it needs special attention. 
The Comparison of X-ray Finding in Pulmonary Tuberculosis with and without Diabetes Mellitus Ida Bagus Aditya Nugraha; Wira Gotera; Made Nian Anggara
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Diabetes Mellitus patients are considered as a high-risk population for the development of Pulmonary Tuberculosis (PTB) by about three-fold. Diabetes Mellitus sufferers by glycated haemoglobin A1C (HbA1C) level. The relative risk (RR) of Tuberculosis (TB) was 3,1 (95% CI 1.6-5.9) for those with HbA1C ≥7%. There are several contradictory opinions regarding the radiological appearance of TBC sufferers with genuine effect of DM. Chest X-ray remains the primary investigation for the assessment of PTB. Pulmonary Tuberculosis is found predominantly in the lung apices. It is not clear whether DM can affect the presentation of TB. Thus, whether diabetic subjects present atypical radiological presentation of PTB is still controversial. There have been several studies with contradictory results regarding the differences in the radiological appearance of PTB patients with and without DM. Clinical studies have shown ambiguous results. Any other risk factors maybe associated with age, sex, smoking status, and nutrition status.
Tirzepatide: Dual GIP/GLP-1 Receptor Agonists, from Molecular to Clinical Practice for Treating Type-2 Diabetes and Obesity Muhammad Aron Pase
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
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Abstract

Tirzepatide is a promising drug with dual-acting glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor activation that has revolutionized the treatment of type 2 diabetes mellitus (T2DM). In phase 3 clinical trials (SURPASS 1-5), tirzepatide has been shown to achieve better glycaemic control in terms of glycosylated hemoglobin reduction (HbA1c) and improved fasting, postprandial glucose levels and weight reduction as compared to placebo and active comparators.  The SURPASS 4 clinical trial has shown positive cardiovascular outcomes in people with T2DM with elevated cardiovascular risk. Tirzepatide has acceptable side effects and is well tolerated, with a low risk of hypoglycaemia. Additionally, encouraging results from SURMOUNT trials and ongoing SURPASS-CVOT studies will shed more light on cardiovascular safety in the future. In this review, we have summarized the pharmacology, efficacy, safety, and clinical trials for potential impact for clinical treatment T2DM. 
Isolation, In Vitro Expansion, And Cryopreservation of Primary Cells Derived from Human Thyroid Carcinoma Fatimah Eliana; Sabrina Azmi; Anggi Puspa Nur Hidayati; Juhan Khalila
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
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Abstract

Thyroid carcinoma is a malignant neoplasm arising from thyroid parenchymal cells and currently ranks as the fourth most diagnosed cancer in Indonesia. This study aimed to isolate thyroid carcinoma cells for in vitro expansion and long-term preservation as a reliable cell culture stock, including cryopreservation for future research applications. In addition, we sought to identify and characterize cells derived from papillary thyroid carcinoma (PTC) tissue to evaluate the presence of mutations with potential prognostic significance. Primary cell isolation was performed via enzymatic digestion using collagenase, enabling effective separation of tumor cells from adjacent non-malignant thyroid tissue. Cell proliferation was supported using Dulbecco’s Modified Eagle Medium (DMEM) supplemented with 20% fetal bovine serum (FBS), selected for its high concentration of growth-promoting factors that enhance proliferation rates. For biobanking purposes, cryopreservation of the thyroid carcinoma-derived cells was conducted using a standard slow-freezing protocol. Molecular characterization was carried out through PCR amplification, gel electrophoresis, and Sanger sequencing of key oncogenic drivers, specifically the BRAF gene and five RAS gene targets: HRAS exon 2, NRAS exons 2 and 3, and KRAS exons 2 and 3. No pathogenic mutations were identified in the analyzed BRAF or RAS gene regions.
Clinical Inertia on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Study in Primary Healthcare Facilities Rinadhi Reza Bramantya; Laksmi Sasiarini; Rulli Rosandi
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
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Abstract

The prevalence of type 2 diabetes mellitus (T2DM) in Indonesia continues to rise, with projections estimating 28.6 million cases by 2045. This increase poses significant health and economic burdens, especially due to complications resulting from poor glycemic control. This study aimed to evaluate the proportion of T2DM patients achieving optimal glycemic control (HbA1c ≤7%) and to identify factors related to clinical inertia in primary healthcare facilities in Malang, Indonesia. A cross-sectional study design was used, incorporating secondary data from 2256 PROLANIS patients' medical records (2020) and primary data from 580 questionnaires administered to doctors, healthcare providers, and patients. Only 32% of patients achieved HbA1c ≤7%, with higher levels of HbA1c observed among male patients and those with abnormal lipid profiles and microalbuminuria. Metformin alone was associated with the highest rate of glycemic control, while combination regimens such as metformin + sulfonylurea were linked to lower control. Logistic regression identified age, sex, lipid profile, and microalbuminuria as significant factors affecting glycemic control. From the provider side, good clinical practices were associated with adherence to guidelines, moderate workloads, and sufficient patient education. However, variability in guideline availability and lack of standardized protocols in Prolanis facilities posed barriers. Patient knowledge did not correlate significantly with treatment adherence, although most patients had moderate understanding of their condition. These findings underscore the need for standardized care guidelines and targeted interventions at the patient, provider, and system levels to improve glycemic outcomes and reduce diabetes-related complications in primary care settings.
Two-Year Follow-Up of Parathyroid Hormone, Calcium, and Vitamin D Serum Levels in a Patient after Parathyroidectomy Alexander Kam; Dinda Aprilia; Eva Decroli; Syafril Syahbuddin
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
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Abstract

Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Because of the hungry bone syndrome and prolonged hypocalcemia risk, we must follow up on a patient's parathyroid hormone, calcium, and vitamin D serum after parathyroidectomy. In this case report, we reported on a parathyroidectomy patient whom we followed for two years and who, interestingly, had elevated parathyroid hormone levels. A 35-year-old male patient diagnosed with a left parathyroid tumor underwent parathyroidectomy and isthmolobectomy. The patient was treated with calcium, vitamin D, and levothyroxine supplementation. We diagnosed the patient with hungry bone syndrome on the fourth day of post-parathyroidectomy. Then, we documented calcium, vitamin D, and PTH levels in the next two years. The calcium levels are 7.2 (June 2022), 8.2 (July 2022), 8.5 (September 2022), 7.8 (October 2022), 8.1 (June 2023), 9.7 (June 2024). The PTH levels are 244.2 (June 2022), 328.3 (July 2022), 306.5 (September 2022), 457.2 (October 2022), 163.3 (June 2023), 34.4 (June 2024). The Vitamin D levels are 34.4 (July 2022), 13.4 (March 2023), 35.2 (September 2023), 50.4 (April 2024). We increased the dose of calcium and vitamin D supplementation. The patient is in good condition and has reached a normal level of these laboratory parameters in the second year post-parathyroidectomy. PTH, calcium, and vitamin D serum are needed for follow-up in patients after parathyroidectomy. Normalizing calcium and vitamin D serum is essential to maintaining a normal PTH level. Normal PTH, calcium, and vitamin D serum are the cure indications in this patient.
Hyperemesis Gravidarum with Gestational Transient Thyrotoxicosis Inducing Thyrotoxic Periodic Paralysis in Diabetes Mellitus and Hypertension: A Case Report Yovita Gotama; Dewi Catur Wulandari
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
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Abstract

Hyperemesis gravidarum (HG) is often associated with gestational transient thyrotoxicosis (GTT) due to elevated human chorionic gonadotropin (hCG) levels, affecting approximately 60% of HG patients. GTT is generally self-limiting, resolving by the first or early second trimester without requiring pharmacological treatment. We present the case of a 38-year-old pregnant woman, in her third pregnancy, who experienced severe nausea and vomiting at 6 weeks of gestation, with a Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) score of 12. Laboratory findings indicated low thyroid-stimulating hormone (TSH) and high free thyroxine (FT4), consistent with GTT, while thyroid ultrasound showed no abnormalities. The patient had a history of chronic hypertension since her first pregnancy and diabetes mellitus diagnosed a year earlier. Three weeks later, she was readmitted and diagnosed with thyrotoxic periodic paralysis (TPP) secondary to GTT. Treatment included intravenous fluids, potassium supplementation, antiemetics, vitamins, antithyroid drugs, and continued management of her diabetes and hypertension. HG, which is most common in the first trimester, is often linked to thyroid dysfunction due to hCG stimulation. While GTT is typically self-limiting, complications like TPP can arise, adding complexity to patient management, especially with coexisting conditions like diabetes and hypertension. Treatment strategies focused on symptom control, fluid rehydration, and careful adjustments of medications for thyroid, glycemic, and blood pressure management. Unfortunately, the patient did not return for follow-up, limiting further evaluation of her thyroid function in the second trimester. This case highlights the need for accurate diagnosis and timely intervention to prevent severe maternal and fetal outcomes, particularly in complex cases with multiple comorbidities.
Tertiary Hyperparathyroidism in Patient with End-Stage Chronic Renal Disease Stella Ilone; Em Yunir; Alvita Dewi S; Erwin Danil Julian
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
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Abstract

Mineral and bone disorder is frequently associated with chronic kidney disease (CKD) which starts early and worsens with renal progression. This condition depends on calcium and phosphate metabolism which will change parathyroid hormone (PTH) release. Understanding the pathophysiology of both secondary and tertiary hyperparathyroidism can reduce the development of its complications, such as renal osteodystrophy and cardiovascular disease. To describe a case of hypercalcemia patient caused by tertiary hyperparathyroidism with end-stage renal disease (ESRD) who underwent continuous ambulatory peritoneal dialysis (CAPD). A 50-years old patient was consulted for treatment of hyperparathyroidism due to mineral bone disease-related CKD. The patient has high levels of serum calcium, phosphate, and parathyroid hormone levels. She has already taken a phosphate binder and does CAPD 4 times daily. She underwent several radiology tests and knew that there was enlargement of her parathyroid glands. Based on that, she underwent parathyroidectomy with implantation. Until now, we still need to evaluate the changes in serum calcium, phosphate, and PTH level after the surgery. Hyperparathyroidism is a condition related to disturbance in calcium and phosphate homeostasis in CKD patients. Many factors contribute to the development of its progression. Early recognition and holistic treatment will be the most important thing to reduce the complication of hyperparathyroidism in CKD patients.
Detection of Small Lesion Insulinoma with 68Ga-DOTATATE PET/CT scan: A Case Report Irma Wahyuni; Tri Juli Edi Tarigan; Hendra Budiawan; Alvita Dewi; Rian Hidayatullah; Hasan Maulahela
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
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Endogenous hyperinsulinism is a rare condition characterized by inappropriate insulin secretion, with insulinoma accounting for approximately 55% of cases. A 36-year-old woman presented with recurrent hypoglycemic episodes for 4.5 years, particularly in the morning, relieved by glucose intake. Laboratory findings during a supervised fasting test revealed a blood glucose of 44 mg/dL, elevated insulin (15 μIU/mL), C-peptide (2.27 ng/mL), proinsulin (53.1 pmol/L), and suppressed beta-hydroxybutyrate (0.1 mmol/L), indicating endogenous hyperinsulinemia. Initial imaging modalities including CT, MRI, and EUS failed to localize the lesion. The patient discontinued investigation but resumed a year later with nuclear imaging studies. A 99mTc-HYNIC-TOC scan was inconclusive, but subsequent ^68Ga-DOTATATE PET/CT at Hasan Sadikin Hospital revealed a somatostatin receptor-expressing nodule at the pancreatic head, consistent with insulinoma. Given the lesion's location and imaging findings, treatment options were discussed, including Whipple’s procedure versus radiofrequency ablation. Insulinomas are typically small, with 80% under 2 cm and 40% under 1 cm, often making localization challenging. While CT and MRI have detection rates of 70% and 86% respectively, the combination of CT and EUS may reach 100% sensitivity. In cases where conventional imaging is inconclusive, ^68Ga-DOTATATE PET/CT provides a valuable alternative, capable of detecting neuroendocrine tumors as small as 6 mm. This case highlights the critical role of nuclear medicine in localizing elusive insulinomas and guiding definitive treatment.
Diagnostic Challenges of Primary Thyroid Lymphoma: A Case Report Murdia; Hendra Zufry
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
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Abstract

Primary Thyroid Lymphoma (PTL) requires a pathology confirmatory test to conclude the definitive diagnosis. Concerns arise when insufficient pathology specimen collection results in nonspecific pathological conclusion, in spite of the fact that the patient's clinical and radiological presentation strongly suggests a diagnosis of PTL. Patient with complaint of a painless lump in the neck that has been progressively getting bigger since a month ago. He also reported shortness of breath, intermittent fever, decreased appetite, weight loss of 5 kilograms, and general weakness. Physical examination showed a single and immobile palpated mass measuring ± 10x10x10 centimeters in the neck with hard consistency. Imaging concluded that the patient had a suspected malignant tumor with bilateral lymphadenopathy and cervical thoracic spondyloarthritis. Rapidly growing neck mass leads to heterogeneous diagnosis. Primary Thyroid Lymphoma (PTL) is suggested prominently in progressive thyroid mass expansion. The presented case was a male patient with clinical presentation showing a rapidly growing neck mass with an airway compression. While working on confirmatory testing of pathology examination (to define the type and immunohistochemistry characteristic of the tumor), the patient was treated adequately with supportive treatments. Supportive treatments for suspected PTL patients are important in securing airway patency, adequate fluid and nutritional intake, and prevent aspiration while working on confirmatory test. Diagnostic challenges of PTL not only limited to insufficient sample collection leading to unspecified pathologic results. Repetitive testing may result in delayed treatment and increase risk of complications.

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