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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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Endocrine Complications in Langerhans Cell Histiocytosis: A Case of Empty Sella Syndrome with Hypopituitarism Rizqi Rifani; Tri Juli Edi Tarigan
‎ 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.v2i2.61

Abstract

Langerhans cell histiocytosis (LCH) is a rare clonal myeloid neoplasia characterized by infiltration of CD1a+/CD207+ dendritic cells, frequently affecting bones, skin, and the central nervous system. Endocrine complications, particularly involving the hypothalamic-pituitary axis, are common in multisystem disease and may result in irreversible dysfunction, impacting growth, development, and overall quality of life. Case Presentation: An 18-year-old male diagnosed with LCH at age 10 presenting with polyuria, polydipsia, and delayed puberty. He was found to have central diabetes insipidus, central hypothyroidism, hypogonadotropic hypogonadism, and a grade IV empty sella on brain MRI. The patient had a history of bone and soft tissue involvement and underwent chemotherapy for multisystem LCH. His current therapy includes desmopressin, levothyroxine, vitamin D, calcium supplementation, and planned to given testosterone replacement. This case illustrates the classic progression of endocrine complications in LCH with hypothalamic-pituitary axis involvement. Central diabetes insipidus is often the first manifestation followed by anterior pituitary hormone deficiencies. The finding of total empty sella on MRI likely reflects chronic inflammatory damage or pituitary atrophy. The combination of central diabetes insipidus (CDI), central hypothyroidism, and delayed puberty requires lifelong hormonal replacement and regular endocrine follow-up. The case also highlights the importance of addressing bone health and growth delays secondary to hormonal deficiencies and previous glucocorticoid therapy. Early identification and management of endocrine complications in LCH, particularly those involving the pituitary are essential to reduce morbidity and improve patient outcomes. Lifelong monitoring and multidisciplinary care are necessary for optimal management of LCH survivors.
Clinically Non-Functioning Pituitary Incidentaloma Presenting as Recurrent Episodes of Hypoglycemia Nobian Andre; Marco Vidor; James Marcus; Teddy Ervano
‎ 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.v2i2.62

Abstract

A pituitary adenoma is a tumor originating from the adenohypophysis. Pituitary adenomas are mostly discovered incidentally during radiological examinations performed for other purposes. Not all pituitary adenomas are functional. Non-functioning adenomas often present with symptoms due to mass effect and pituitary hormone deficiency. This case report presents a case of a 56-year-old man with type 2 diabetes mellitus who had an accidental finding of pituitary macroadenoma without overt hormone hypersecretion symptoms, but experienced recurrent hypoglycemia. Further investigation revealed low cortisol and insulin like growth hormone-1 levels, suggesting a Houssay phenomenon that leads to ‘resolution’ of diabetes due to hypopituitarism. Even in patients without overt symptoms of hormone hypersecretion, the possibility of subtle hypopituitarism due to tumor-induced pituitary dysfunction should not be overlooked. Patients with pituitary adenomas require evaluation by a multidisciplinary team involving endocrinology, neurosurgery, and ophthalmology.
Challenges in The Management of Kallmann Syndrome : A Case Report Saiful Anam; R. Bowo Pramono
‎ 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.v2i2.63

Abstract

Kallman syndrome is combined disorder of hypogonadotropic hypogonadism and anosmia. Incidence of congenital hypogonadotropic hypogonadism is 1-10:100,000 live births, and approximately 2/3 and 1/3 of cases are caused by Kallmann syndrome and idiopathic hypogonadotropic hypogonadism, respectively. We report a man, 35 years old, with complaints of small penis, small voice, impaired smell, gynecomastia, narrowing of visual field, mustache not growing, little pubic and armpit hair. Patient underwent surgery on both breasts with histopathological results of gynecomastia, no malignancy. Testicular ultrasound results showed bilateral testicular atrophy. Laboratory results showed karyotype 46XY, Follicle-stimulating hormone 1.79 mIU/mL, Luteinizing hormone 1.49 mIU/mL, testosterone <0.03 ng/mL, estradiol 5.0 pg/mL, prolactin 6.75 ng/mL and prostate-specific antigen 0.473 ng/mL. Head CT scan imaging showed bilateral otitis media, mastoiditis and sinusitis. Patient was diagnosed Kallmann syndrome, anxiety and depression symptoms (ADS) chronic tubotympanic suppurative otitis media, sinusitis, oculus dexter and sinister hemianopsia. Patient was treated with testosterone undecanoate injection 1000 mg IM every 3 months, levofloxacin 500 mg PO once daily, avamys nasal spray twice daily. Symptoms of Kallman syndrome can include absent or incomplete pubertal development, anosmia or hyposmia, and low sex steroid levels. KAL1 gene mutations cause Gonadotropin-releasing hormone (GnRH) deficiency, associated with Kallmann syndrome. Testosteron replacement is indicated for men who already have children or have no desire for children. Surgery should be considered as the last option in patients with considerable discomfort, psychological stress, cosmetic problems, long‑standing gynecomastia (>12 months) and suspected malignancy. The aim of testosterone therapy is to reverse the symptoms of hypogonadism, and surgery is last option in patients with considerable discomfort.
A Rare Coexistence of Thyrotoxic Cardiomyopathy and Asthma in Graves’ Disease: Clinical Challenges and Management Strategies: A Case Report Mutiara Lirendra; Eva Niamuzisilawati; Ega Caesaria; Brilliant Van Fitof; A Farih Raharjo; Adi Bestara
‎ 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.v2i2.64

Abstract

Graves' disease is the most common autoimmune hyperthyroid disorder. Thyrotoxic cardiomyopathy (TCM) is a rare but potentially lethal complication of thyrotoxicosis, with an incidence of <1%. Betablocker is one of the drugs of choice in treating TCM. However, in asthma patient, beta-blocker may induce bronchoconstriction. We report a rare case of a 36-year-old male presented with complaints of shortness of breath, wheezing, cough, and palpitation. The patient had a history of asthma. Physical examination revealed diffuse thyroid enlargement, exophthalmos, tremor, cardiomegaly, irregular heart sounds, rales, wheezing in both lungs, and BMI was underweight. Wayne index was 20 (hyperthyroid) and Burch Wartofsky score was 35 (impending storm). Laboratory results showed low Thyroid-stimulating hormone level and high level of Free-T3, Free-T4, Thyroid-Stimulating Hormone Receptor Antibodies, and N-terminal pro-B-type natriuretic peptide. Chest X-ray showed cardiomegaly. electrocardiogram showed atrial fibrillation RVR. Echocardiography showed segmental wall motion abnormality EF 48%. Patient was diagnosed with Graves’ disease with hyperthyroidism, acute asthma exacerbation, Heart failure with mildly reduced ejection fraction NYHA III due to thyrotoxic cardiomyopathy. Patient was treated with methimazole, shortacting beta-agonists, corticosteroid, digitalis, diuretics, anticoagulant, and angiotensin receptor blockers. During follow up, laboratory results, ECG, and clinical symptoms were improved. The management of Graves' disease with hyperthyroidism and TCM focuses primarily on controlling the thyroid hormone levels to prevent further cardiac deterioration. The complex interplay between managing thyroid hormone levels and preventing asthma exacerbation in this patient highlights the need for a multidisciplinary approach to optimize treatment outcomes. Graves' hyperthyroid patients with cardiomyopathy and asthma require holistic, comprehensive, and meticulous drug selection to prevent exacerbation.
Mitigating Hungry Bone Syndrome: Case Reports on Best Practices After Parathyroidectomy Sarah Firdausa; Luki Kusumaningtyas; Dicky L Tahapary; Wismandari Wisnu; Tri Juli Edi Tarigan
‎ 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.v2i2.65

Abstract

Severe hyperparathyroidism caused by prolonged high levels of parathyroid hormone (PTH) can be managed by removing the gland. One of the critical complications related to parathyroidectomy is hungry bone syndrome (HBS), an emergency morbidity which may be fatal if not promptly and adequately managed. HBS is defined by a rapid and profound decline in serum calcium levels following surgery, as the bones avidly uptake calcium and phosphate in the absence of high PTH levels. It may present as worsened bone pain, carpopedal spasm, severe hypocalcemia, hypophosphatemia, and hypomagnesemia. This report highlights two patients who underwent parathyroidectomy and had different postoperative outcomes for HBS. The first case involves a 19-year-old male who had a history of recurrent fractures and bone pain. In 2019, he got a fracture from a fall, and in 2020, he experienced another fall leading to shoulder dislocation and further fractures. By late 2021, he was diagnosed with severe hyperparathyroidism due to parathyroid adenoma and the gland was removed. Two days post parathyroidectomy, he developed HBS. He was treated with calcium and vitamin D supplementation. Over two years of follow-ups, his bone density and mobility improved significantly. The second case involves a 46-year-old male with uncontrolled hypertension and chronic kidney disease stage 5 on hemodialysis, presenting with bone pain and deformities. This patient had a long-standing history of bone pain and fractures. He underwent a similar surgical intervention for tertiary hyperparathyroidism but did not develop HBS postoperatively. Careful perioperative monitoring of electrolytes, vigorous supplementation of calcium and vitamin D, and the use of antiresorptive therapies before surgery had been employed. These cases underline the variety of postoperative outcomes and the importance of tailored management strategies. Early intervention, appropriate surgical management, and aggressive postoperative supplementation are crucial to prevent and manage HBS in patients with severe hyperparathyroidism. Multidisciplinary approach and the utilization of various imaging modalities and intraoperative PTH monitoring are mandatory in managing such complex cases. Applying these approaches will reduce the risk of HBS while guaranteeing excellent postoperative care for individuals following parathyroidectomy.
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
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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.
Turner Syndrome Mosaicism 46,Xx/45,X with Graves' Disease: A Case Report Faisal Rozi Sembiring; Santi Syafril
‎ 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.v2i2.67

Abstract

Turner syndrome (TS) is a condition in females missing the second sex chromosome (45,X) or parts thereof. It is a rare genetic condition with a wide range of clinical stigmata, such as short stature, delayed puberty and infertility, congenital malformations, and endocrine disorders. TS with chromosomal mosaicism (TSM) is a less severe and less frequent form of TS, who has less pronounced signs and symptoms than the classic TS. A 21-year-old woman with TSM and Graves' disease (GD) is reported. She presented with fatigue, sweating, palpitation, tremor, and the absence of menstruation or breast development. Further investigation reveals diffuse enlargement of thyroid gland and hyperthyroidism symptoms. Laboratory testing shows elevated fT4, low TSH, and elevated TSH receptor antibody levels. Previous chromosomal analysis showed a mosaicism: 46,XX,dup(X) (q28q21.2)[36]/45,X[4]. She is then treated with thiamazole and oral beta-blocker.Discussion: Thyroid abnormalities is common in TS, especially in adult females. This including Hashimoto's thyroiditis and GD. But TS presenting with hyperthyroidism is rare, with most of the cases were reported happens in adult females. Mosaicism in TS resulted in less severe signs and symptoms than the classic TS. Therefore, based on the variabilities, it is often undetected. We reported a rare case of TSM with GD. We observed that mosaicism in this TS patient resulted in less severe GD symptoms, and the response to conventional treatment with thiamazole and oral beta-blocker was satisfactory.
Fibrocalculous Pancreatic Diabetes (FCPD): A Rare Type of Pancreatogenic Diabetes Ega Caesaria Pratama Putra; Eva Niamuzisilawati; Yulia Sekarsari; Brilliant Van Fitof Songso Rhomado; Supriyanto Kartodarsono
‎ 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.v2i2.68

Abstract

FCPD is a rare form of secondary diabetes. FCPD is mainly found in the tropical region; it is characterized by diabetes, chronic abdominal pain, calcification of the pancreas, and steatorrhea. The Incidence of FCPD is often misdiagnosed with type 2 or type 1 diabetes mellitus. A 46-year-old man came with chief complaints of chronic abdominal pain. Abdominal radiography showed calcification in the pancreas. The patient was malnourished. Abdominal X-ray revealed pancreatic calcification, which was confirmed by an abdominal MSCT scan. C-Peptide decreased with an intermediate degree. The patient was given supportive therapy,and insulin was given to control his diabetes. FCPD is a morphological pancreas change caused by chronic tropical pancreatitis. The aetiology of chronic tropical pancreatitis is unknown. FCPD can be diagnosed by history taking and supporting examinations such as abdominal X-ray examination, ultrasound and abdominal CT Scan. C-peptide was examined to assess the function of pancreatic beta cells. The primary treatment for FCPD is insulin therapy; metformin or Sulfonylureas can be used in the early phase of diabetes. In reducing pain, non-steroidal analgesics are used as an option. The use of pancreatic enzyme supplementation can improve the nutritional status of patients. FCPD is a rare case, occurring mainly in tropical countries and in people who are malnourished. The primary treatment for FCPD is insulin therapy.
Evaluating the Effects of Testosterone Therapy on Cardiometabolic Health and Well-being in Men with Hypogonadism Azza Fithra Alhanifa; Nyoman Bayu Rusdyana Krisna
‎ 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.v2i2.69

Abstract

Testosterone is crucial for male health, and hypogonadism is prevalent, particularly in men with metabolic comorbidities. While Testosterone Therapy (TTh) is used to manage symptoms, itseffects on cardiometabolic health and overall well-being remain debated. This review aimed to synthesize current evidence on the impact of TTh on cardiometabolic parameters, cardiovascularsafety, and quality of life in men with hypogonadism. A literature search (2015-2025) across multiple databases identified relevant studies, including Randomized Controlled Trials (RCTs) andobservational data, which were narratively synthesized. Results show TTh consistently improves body composition (reduced fat, increased muscle) and aspects of sexual function (libido, activity).However, its effect on glucose metabolism remains controversial, with conflicting findings. While large RCTs indicate no increased risk of major adverse cardiovascular events over the medium term,TTh is associated with increased specific risks including pulmonary embolism, atrial fibrillation, acute kidney injury, and polycythemia. Benefits on mood/energy are modest, and effects on otherquality of life domains are limited. In conclusion, TTh offers clear benefits for body composition and sexual function. Clinicians must balance these with controversial glucose effects and increasedspecific adverse event risks, requiring careful patient selection and monitoring. Further long-term research is needed.
Evaluating the Effect of Fenofibrate Towards the Progression of Diabetic Retinopathy: A Systematic Review Livinia Gabriela Pontoh; Karel Pandelaki; Yuanita Asri Langi; Bisuk Parningotan Sedli; Gloria Notaria Pandelaki
‎ 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.v2i2.70

Abstract

The rising prevalence of diabetic retinopathy (DR) among diabetic patients necessitates innovative therapeutic strategies. Fenofibrate, primarily known for its lipid-loweringeffects, has gained attention for its potential role in mitigating DR progression. This study aims to evaluate the efficacy of fenofibrate in reducing the progression of diabetic retinopathy. A comprehensive search was done on three electronic databases, including PubMed, Scopus, and ProQuest up to 3 January 2025. We included all studies that are clinical trials orobservational by design published within the last 15 years. The outcome of interest in this study is the progression or worsening of DR. All eligible studies were assessed using the Cochrane riskof bias tool 2.0 for randomized clinical trials, and the risk of bias in non-randomized studies - of interventions.Result: A total of 5 studies encompassing 2 RCT and 3 retrospective cohort studies with a totalof 250.835 patients, consisting of 101.026 (40.3%) males, with an overall mean age of 64.3 ± 9.5 years old. Based on the risk of bias assessment, all five studies fall in the low to moderate risk ofbias. Four studies show that fenofibrate significantly reduces the risk of DR progression, while one study shows no significant reduction. Two studies also indicate the efficacy of fenofibrate inreducing the development of macular edema. This study solidifies the efficacy of fenofibrate in reducing the risk of DR progression and the development of macular edema.

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