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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 51 Documents
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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.
Successful Management of Antithyroid Drug-Induced Agranulocytosis Using Granulocyte Colony-Stimulating Factor: A Case Report Nur Arfah Rizki; Hendra Zufry; Krishna W Sucipto; Agustia Sukri Ekadamayanti
‎ 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.v2i1.43

Abstract

Agranulocytosis is a rare condition and occurs in all age groups. Incidence ranges from 6 to 8 cases per million population per year. About 70% of the cases are found to be involved with medication usage. The use of granulocyte colony-stimulating factor (G-CSF) is effective for ATD-induced agranulocytosis, though some patients do not respond. A 22-year-old female was diagnosed with Grave's disease (GD) three months ago and began using Methimazole (MMI) at an initial dose of 20 mg/day. She was taken to the emergency room after complaining of a fever and stomachache for a week. Laboratories: The patient had leucopenia (white blood cell count 2040/mm3) and severe neutropenia, with an absolute neutrophil count (ANC) of 122.4/μL, thyroid stimulating hormone (TSH) of 0.005 IU/mL, and free thyroxine (FT4) of 46.81 pmol/L. The patient received G-CSF, which normalized her neutrophil counts after the first injection and resolved her fever. She was recommended to quit methimazole therapy. MMI is thionamide used as a first-line treatment for GD. The most severe side effect is agranulocytosis. Agranulocytosis can have various presentations; it most frequently occurs between 2 weeks and 3 months after the initiation of treatment. If the patient recovers, granulocytes begin to reappear in the periphery within a few days to 3 weeks. This drug-induced agranulocytosis is a lethal condition but reversible if recognized early and treated accordingly. G-CSF may shorten the recovery period.
Hashitoxicosis: A Case Report Dhini Sylvana; Dharma Lindarto; Santi Syafril; Melati Silvanni Nasution; Dian Anindita Lubis; Stephen Udjung
‎ 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.v2i1.44

Abstract

Hashimoto Thyroiditis with Grave’s disease/Hashitixicosis is found in some cases, snd this case repirt describes a case of a woman with Hashitoxicosis. A 27 year old woman came to polyclinic on 18th March 2024 with complain of a lump felt, fatique, constipation and weight loss two month before she had weight gain later without any treatment. She was compomentis, BP 149/90 mmHg, HR 87x/i, Wayne index 0, Billewicz score -22. TSH 93.40 mclU/mL and FT4 0.39 ng/dL, anti-TPO >1000 Iau/mL, TRAb 2.46 IU/L. Thyroid ultrasound showed toxic diffuse struma, thyroid scintigraphy revealed enlarge lobes with high and even distribution and capture of radioactivity with conclusion Toxic Diffuse Struma, and cytologic examination showed colloid goiter. Patient was diagnosed as Hashitoxicosis and has been treated with levothyroxine 100 mg once daily. This woman was diagnosed as Hashitoxicosis based on clinical features of hypothyroidism at admission to polyclinic following clinical features of hyperthyroidism initially without any treatment, with laboratory results showed hypothyroidism with the increased of antibody for Hashimoto Thyroiditis and Grave’s disease. Treatment with levothyroxine 100 mg once daily showed the decrease of TSH and normal FT4 level. We report a case of Hashitoxicosis based on clinical features of hypothyroid following hyperthyroidism initially, laboratory, thyroid ultrasound thyroid scintigraphy, and cytologic examination result. Treatment with levothyroxine showed improvement.
Multiple Autoimmune Syndrome (Graves’ Disease, Autoimmune Hepatitis, SLE) in Young Male with ASD Secundum: A Rare Case Dinar Dewi Miftah Tyas Arum; Herlina Kusuma Dewi; Eva Niamuzisilawati; Aritantri Darmayani; Agus Joko Susanto; Astri Kurniati Martiana; Brian Wasita
‎ 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.v2i1.45

Abstract

Multiple autoimmune syndrome (MAS) is characterized by the presence of at least three autoimmune diseases, presenting complex clinical challenges due to overlapping conditions and varied manifestations. Multiple autoimmune syndrome is rarely reported in men, particularly with the combination of Graves’ disease, systemic lupus erythematosus (SLE), and autoimmune hepatitis (AIH). We report a case of a 22-year-old male who presented with symptoms of jaundice, significant weight loss, and classic signs of hyperthyroidism, including palpitations and tremors. Physical examination revealed jaundice, exophthalmos, and an enlarged thyroid gland, and he was diagnosed with Graves' disease, SLE, and AIH. Additional findings included stasis dermatitis and an atrial septal defect (ASD) with a moderate risk of pulmonary hypertension. The patient received thiamazole, propranolol, and corticosteroids, leading to clinical stabilization and symptom resolution. This rare MAS case with concurrent Graves’ disease, SLE, and AIH highlights the need for accurate diagnosis and individualized management. The immunological interplay among these diseases contributes to diverse clinical manifestations, requiring a multidisciplinary approach. Our patient’s management strategy effectively controlled hyperthyroidism, mitigated hepatic inflammation, and stabilized cardiac function, illustrating the effectiveness of comprehensive therapy. In young patients presenting with multiple autoimmune symptoms, MAS should be considered, especially with unusual combinations. Early detection and tailored treatment approaches, along with interdisciplinary collaboration, are essential to manage MAS and its associated complications.
Pituitary Macroadenoma with Hypogonadism in 30 year old Liver Cirrhosis Patient: A Case Report 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
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i1.46

Abstract

Pituitary macroadenomas can suppress pituitary hormone secretion, one of which is the gonadotropin hormone, causing hypogonadism. The condition of hypogonadism can increase the risk of NAFLD, which can then become liver cirrhosis. A 30-year-old man came to the hospital with decreased consciousness and hematemesis melena. From physical examination, laboratory, and pituitary MRI, the patient was diagnosed with pituitary macroadenoma, hypogonadotropic hypogonadism, primary hypothyroidism, acute adrenal insufficiency, and liver cirrhosis. The patient was given hydrocortisone therapy, correction of electrolyte levels, hypoglycemia protocol, levothyroxine 100 mg/day, and management of hematemesis melena. After that, Sustanon 250 mg was given every two weeks intramuscularly. The patient went home in good condition and was planned for neurosurgery consultation for transsphenoidal resection. After the injection of Sustanon, the patient experienced increased penile length and testicular volume. The condition of hypogonadism in patients with pituitary macroadenoma can be a risk factor for NAFLD, which can then progress to liver cirrhosis. NAFLD and liver cirrhosis also can cause hypogonadism in men by several mechanisms. The patient has been well-managed and experienced clinical improvement.
Varicella Zoster-Induced Severe Diabetic Ketoacidosis Asri Mukti Nanta; Agustia Sukri Ekadamayanti; Krishna Wardhana Sucipto; Hendra Zufry
‎ 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.v2i1.47

Abstract

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. There are not many cases reported relate to this case. This case report aims to present a case of DKA which is a common and potentially life-threatening complication in T1DM and can be the first sign of undiagnosed diabetes. A 36-year-old female presented with altered mental status and breathing difficulty. The patient's three children had recently contracted varicella (chickenpox). The patient was diagnosed with type 1 diabetes mellitus 8 months ago, with irregular adherence to treatment. Vital signs included a blood pressure of 84/60 mmHg on norepinephrine at 12 mcg/min, heart rate of 135 bpm, respiratory rate of 33 breaths/min, and temperature of 38.9°C. Physical examination revealed multiple lenticular, circumscribed vesicles with an erythematous base across the entire body. Laboratory results showed leukocytosis (leukocytes: 16,000 x 103/μL), hyperglycemia (random blood glucose: 273 mg/dL), severe metabolic acidosis (pH: 7.002, HCO3: 5.7 mEq/L, BE: -23.6 mEq/L), hypoxemia (pO2: 38 mmHg, SaO2: 52.8%), hypoalbuminemia (albumin: 3.48 g/dL), and stage I acute kidney injury (creatinine: 1.36 mg/dL). Urinalysis revealed the presence of ketone bodies. The patient was subsequently diagnosed with severe diabetic ketoacidosis, varicella zoster infection, septic shock with multiorgan failure, and type 1 diabetes mellitus. Despite initial treatment efforts, the patient’s condition continued to deteriorate, with no signs of clinical improvement. After 3 days, the patient deceased. In conclusion, although varicella zoster infection is an uncommon precipitant of DKA, the present case report highlights the critical role of varicella zoster vaccination and optimal glycemic control in DMT1 to prevent infection-related DKA progression.
Outcome of Graves' Disease Patients Treated with Radioactive Iodine Therapy at RSCM: Preliminary Study Nur Rusyda Kuddah; Imam Subekti; Alvita Dewi Siswoyo
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 2 (2025): InaJEMD Vol. 2, No. 2
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i2.57

Abstract

Graves’ disease (GD) constitutes 60-80% of all cases of thyrotoxicosis worldwide, typically managed with anti-thyroid drugs (ATD) as first-line therapy. If a patient failed to achieve remission after 18 months or had an ATD allergy, can continue to choose radioactive iodine (RAI131) as definitive therapy. Research on the use of RAI in GD remains limited in Indonesia, and nuclear medicine facilities are not yet widely distributed. To assess the treatment outcome of fixed-dose RAI131 10 mCi and the contributing factors involved.Methods: This was a retrospective observational study involving 10 GD patients who underwent RAI at RSCM. Secondary data were collected consecutively from medical records. The outcome study was the prevalence of hypothyroidism in the 3rd and/or 6th month following RAI. Serum free T4 and TSHs levels were evaluated at baseline, and at 3, 6, and 12 months post-RAI. Inclusion criteria consisted of GD patients who failed to achieve remission with ATD and subsequently underwent RAI at the Department of Nuclear Medicine, RSCM. At 3 months post-RAI131, 40% of subjects achieved hypothyroidism, 40% had subclinical hyperthyroidism, and 20% reached euthyroid status. At 6 months, 80% of subjects remained with subclinical hyperthyroidism, 10% experienced worsening hyperthyroidism and 10% had developed permanent hypothyroidism. No worsening of Graves’ ophthalmopathy (GO) was observed during the study period. RAI is a safe and effective definitive treatment for GD. Nevertheless, good interdisciplinary collaboration is essential to ensure the successful hypothyroidism achievement as primary therapeutic goals.
Triglyceride-Glucose Index as a Predictor of Diabetic Foot Ulcer Severity in Type 2 Diabetes Mellitus: Cross-Sectional Study Istiqomah; Fauzia Noor Liani; Mohammad Bakhriansyah
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 2 (2025): InaJEMD Vol. 2, No. 2
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i2.58

Abstract

Diabetic foot ulcers are a complication of type 2 diabetes mellitus that has a high global prevalence. Insulin resistance in type 2 DM patients tends to cause chronic wounds and can delay wound healing. TyG index is currently used as a surrogate biomarker to evaluate insulin resistance because it is easy to perform and low cost. Analytic observational research with a cross-sectional approach at Diabetic Foot Poly Ulin Hospital Banjarmasin. The study sample was all patients diagnosed with type 2 DM and undergoing wound care at the Diabetic Foot Polyclinic of Ulin Hospital Banjarmasin starting in December 2024 who met the inclusion and exclusion criteria with a total of at least 74 people. Data analysis was performed with a simple binomial logistic regression test to estimate crude Prevalence Odds Ratio (POR) with 95% confidence intervals, and multiple binomial logistic regression tests were performed to estimate adjusted POR and 95%CIs. Compared with the lowest one-third TyG Index score, study subjects with the middle one-third TyG Index score were associated with a lower risk of severe diabetic foot ulcer incidence by 85.9% (Adj POR 0.141, 95% CI: 0.011-1.802). Subjects with the highest third TyG Index value were also associated with a lower risk of diabetic foot ulcer incidence of 87.1% (Adj POR 0.129, 95%CI: 0.008-1.959). The mean value of TyG Index+SD was 4.8872 + 0.4230 at severe foot ulcers. TyG index is not a predictive factor for the severity of diabetic foot ulcers in type 2 DM patients at the Diabetic Foot Clinic of Ulin Hospital Banjarmasin (p>0.05).
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
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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.
Mixed Hyperglycemic Crisis in a Young Obese DiabeticTriggered by Hypertriglyceridemia-Induced Pancreatitis:A Case Report and Review of Pathophysiolo Teuku Mirzal Safari; Agustia Sukri Ekadamayanti; Krishna W. Sucipto; Hendra Zufry
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 2 (2025): InaJEMD Vol. 2, No. 2
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i2.60

Abstract

Mixed diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS), accompanied by hypertriglyceridemia-induced pancreatitis, represent a rare but life-threatening complication of type 2 diabetes mellitus (T2DM). This case report aimed to illustrate a young adult in whom these three critical conditions converged, highlighting the complexity of such presentations—a 28-year-old male presented with altered consciousness and Kussmaul respiration. The patient was diagnosed with T2DM two weeks earlier but had not yet initiated treatment. Physical examination revealed obesity (BMI: 31 kg/m²) and acanthosis nigricans on the neck and in the axillary regions. Laboratory results showed hyperglycemia (798 mg/dL), metabolic acidosis (pH: 7.08; anion gap: 24), ketonuria, hyperosmolarity (336 mOsm/kg), severe hypertriglyceridemia (965 mg/dL), and elevated lipase (892 U/L). A diagnosis of mixed DKA-HHS secondary to hypertriglyceridemic pancreatitis was established. Treatment included aggressive intravenous (IV) fluid resuscitation of 0.9% sodium chloride (6 L in the first 12 hours) and insulin infusion (0.1 units/kg/hour). During hospitalization, the patient developed acute kidney injury, necessitating continuous renal replacement therapy (CRRT). The patient gradually recovered and was discharged after 20 days. In obese T2DM patients, insulin resistance drives severe hyperglycemia typical of HHS. However, metabolic stress caused by acute pancreatitis induces relative insulin deficiency, triggering lipolysis, ketogenesis, and hypertriglyceridemia, leading to overlapping DKA. Severe hypertriglyceridemia exacerbates systemic inflammation, insulin resistance, and ketosis, creating a vicious cycle that worsens mixed DKA-HHS. This case report highlights the importance of recognizing that T2DM can occasionally present with atypical, life-threatening metabolic complications, necessitatingprompt diagnosis and multidisciplinary management.

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