Wira Gotera
Department Of Endocrinology And Metabolism, Medical Faculty, Udayana University/ Sanglah General Hospital, Denpasar, Indonesia

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PREVALENSI SINDROMA METABOLIK PADA POPULASI PENDUDUK BALI, INDONESIA Dwipayana, M Pande; Suastika, K; Saraswati, IMR; Gotera, W; Budhiarta, AAG; -, Sutanegara; Gunadi, IGN; Badjra Nadha, K; Wita, W; Rina, K; Santoso, A; Kajiwara, N; Taniguchi, H
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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An epidemiological study on metabolic syndrome (MS) in seven villages population of Bali (6 villages and 1 suburban),Indonesia have been conducted. One thousand eight hundred fourty (age, 13 " 100 year; M/F, 972/868) subjects were recruitedin the study. Criteria for obesity was based on WHO for Asia PaciÞ c population (2000) and for MS based on a joint statement ofIDF, NHLBI, AHA, WHF, and IAS (2009). The prevalence of central obesity based on waist circumference (WC) was 35% (M,27.5%; F, 43.4%) and MS was 18.2% (M, 16.6%; F, 20.0%).Waist circumference, as a central role in metabolic syndrome, hassigniÞ cant correlation with other components of metabolic syndrome, i.e. diastolic blood pressure (R = 0.129; p < 0.001), fastingblood glucose (R = 0.088; p < 0.001), HDL cholesterol (R = -0.066; p = 0.006), triglyceride (R = 0.349; p < 0.001), and totalcholesterol (R = 0.179; p < 0.001).Of the study could be concluded as follow: the prevalence of obesityand MS were relativelyhigh; Waist circumference was correlated with other components of metabolic syndrome and the best parameter for predictingmetabolic syndrome.
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 135 mmol perliter. Hyponatremia can be associated with low, normal, or high tonicity. One cause of hyponatremia is adrenalinsufficiency. Serum sodium concentration is regulated by stimulation of thirst, secretion of ADH, feedbackmechanisms of the renin-angiotensin-aldosterone system, and variations in renal handling of filtered sodium.Increases in serum osmolarity above the normal range (280-300 mOsm/kg) stimulate hypothalamicosmoreceptors, which, in turn, cause an increase in thirst and in circulating levels of ADH. ADH increases freewater reabsorption from the urine, yielding urine of low volume and relatively high osmolarity and, as a result,returning serum osmolarity to normal. Aldosterone, synthesized by the adrenal cortex, is regulated primarily byserum potassium but also is released in response to hypovolemia through the renin-angiotensin-aldosterone axis.Aldosterone causes absorption of sodium at the distal renal tubule.In this report, patient is male, 64 years old, with probable adrenal insufficiency. Patient have very lowrespond to sodium teraphy. The sodium level increased and have good respond after corticosteroid teraphy.Patient have low level of cortisol serum (18,60 ?/dl) in critically ill condition.The possibility of adrenal insufficiency is of crucial importance in critically ill patients. If the diagnosisis missed, the patient will probably die. In such patients, a blood sample for the measurement of plasma cortisoland corticotropin should be obtained, a short corticotropin test (see below) should be performed, and immediatehigh-dose cortisol therapy should be considered or instituted. A plasma cortisol value in the normal range doesnot rule out adrenal insufficiency in an acutely ill patient. On the basis of a recent study of plasma cortisolconcentrations in patients with sepsis or trauma, a plasma cortisol value of more than 25 ?g per deciliter in apatient requiring intensive care probably rules out adrenal insufficiency, but a safe cutoff value is unknown.
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Insulin is an anabolic hormone responsible for regulation of glucose metabolism and signals for storage and usage ofmany fundamental nutrients such as glucose, amino acids, and fatty acids. Its effects on cardiovascular function, reveal widerearly-known insulin actions, are based on the balance between its NO-dependent vasodilator action and endothelin-1-dependentvasocontriction action regulated by signals through phosphatidylinositole 3-kinase (PI3K) and mitogen-activated protein kinase(MAPK)-dependent pathways on vascular endothelial cells. On insulin resistance setting, signal perturbances of PI3K pathwayand enhanced signals through MAPK pathway are conditions underlying link between metabolic disorders and cardiovasculardiseases. Insulin also has antiinflammatory effects by suppressing expression of ICAM-1, MCP-1, NF-kB, MMP-9 and CRP. Onthe heart, insulin increases contractility and plays important roles in maximazing heart glucose uptake particularly in stress states.In addition, insulin plays a role in physiologic heart growth through Akt pathway. However, chronic exposure of insulin isassociated with ventricular disfunction. In term of cardiovascular function, insulin is known to increase peripheral blood flow danto decrease peripheral resistance, so that results in enhanced cardiac output without significant changes in blood pressure.Not only can improved insulin action repair glucose metabolism, but also improve risks underlying atherosclerosis andcardiovascular complications of diabetes. In 2007, European Cardiac Society (ESC) has recommended intensive insulin usage totightly control blood glucose in order to improve adult critically ill and heart surgery patient mortality and morbidity
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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The sellar region is a site of various types of tumors. Pituitary adenomas are common neoplasms of the anterior pituitarygland. They arise from epithelial pituitary cells and account for 10-15% of all intracranial tumor. The remaining one-third ofpituitary adenomas is endocrinologically silent, known as nonfunctioning pituitary adenomas, and cause symptoms or signs dueto tumor growth. Incidence of pituitary adenomas is difficult to know with certainty because they are often asymptomatic;autopsy estimates range from 2.7 to 27%. There is not a predominance in either men or women. An increasing proportion ofpituitary adenomas are recognized in the elderly, raising the question of their optimal diagnosis and management. However, theadvent of the sophistical imaging systems for the brain such as the CT and MRI scans have greatly contributed to the earlydetection of these tumors. This is our reported case the occurrence of many endocrinology disorders with a pituitary adenoma. A79 year old male with a known pituitary macroadenoma, who presented with a chief complaint shortness of breath and took adouble dose of costison a view days ago. The related symptom also decreased libido and progressive impotence, mild coldintolerance and decreased appetite. Physical exam was notable for a BP of 180/115, pulse of 120 (with significant orthostaticchanges), pallor, bilateral gynecomastia He also complained of generalized fatigue and weakness. He had history at 1988 withCVA and got euthyrox for the hypotiroidsm. In 1998 was hospitalized on Danderyds Hospital with diagnosed adenoma pituitaryfrom the CT-Scan, and got trombyl 180 mg 2 x 1 tablet, triatec 4 x 5 mg, omeprazole 4 x 20 mg, duroferon 4 x 100 mg, and alsonibido 4 ml every 4 month. On 2005 he developed a severe and sudden headache, disorientation, weakness and fever. Thelaboratory result were testosteron 15 mmol/L (10-30 mmol/L), prolaktin 17 µg/L (normal 3-13 µg/L), tyrotrhopin TSH (thyroidstimulating hormone) 0,15 mE/L (normal 0.4-3.5 mE/L), S-IGF-I 57 µ/L (normal 85-220 µ/L) TSH 0,075 mE/L (normal 0.4-3.3mE/L), FT4 9 pmol/L (normal 8-16 pmol/L), kortisol 98 nmol/L (normal, 08.00 am; 200-700 nmol/L, 10.00 pm; 50-200 nmol/L),the echocardiografi was EF(ejection fraction) 35-40%, angiografi with striktur on proximal LAD. For the second CT-scan wasfounded the increasing size of the adenoma pituitary 3 x 4 centimeter. Because of the presence and the past history also supportingwith another laboratory and rontgen examination. The diagnosis of a clinically nonfunctioning pituitary adenoma with hypogonadismtipe was made, but now with conditions acute heart failure, pleural effusion and bronchopneumonia. Nonfunctional pituitaryadenomas, also called null-cell adenomas, are the most common macroadenomas (> 1 cm). Nonfunctional adenomas usuallypresent with local mass effects (e.g., optic chiasm compression), neurologic symptoms (cranial nerve III, IV and VI palsies) andpituitary hormone deficiencies (e.g., hypogonadism). Headache, nausea, vomiting, ophthalmoplegia and reduced level ofconsciousness, can occur in patients with large pituitary adenomas who suddenly deteriorate clinically. Pituitary apoplexy, a lifethreateningsudden hemorrhage or infarction of a pituitary adenoma characterized by severe. The majority of patients with pituitary adenomas present with signs and symptoms reflecting excess hormone production. This case illustrates one of the many type frompituitary adenoma and also the another conditions that can addition severity of the disease. The professional clinical examinationshould be done for decreasing the mortality
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Obesity is rapidly becoming a global problem not only in developed countries but also in developing countries such asIndonesia. Visceral obesity (central obesity) is an importance risk for cardiovascular disease and recognition that adipose tissuecan be regarded as a large endocrine organ that secreted inflammatory and anti inflammatory molecules (adiponectin). This studyaims to know the correlation between central obesity and adiponectin in geriatric coronary heart disease (CHD) patients. Thisstudy was cross sectional analytic study of geriatric CHD at out and in patients in Sanglah hospital. Data are presented as groupmean ± SD and analyzed by t-test, chi-square, and Pearson correlation with SPSS 12 software. Forty five patients (35 males and10 females), 23 patient unstable angina pectoris, 14 patient acute myocardial infarction, and 8 patient stable angina pectoris wererecruited and examined. There was high prevalence of central obesity 51.1% (23 patients). Mean of log adiponectin weresignificantly difference between central obese and non central obese (1.80 ± 0.61 vs 1.09 ± 0.41 with p). Central obesity increasedrisk of hypoadiponectinemia 5 times than non central obesity (p=0.011, CI 95% 1.4-17.8). Waist circumference has negativecorrelation with log plasma adiponectin (R=-0.663, p<0.001). There was high prevalence of central obesity in geriatric coronaryheart disease patients. Central obesity increased risk of hypoadiponectinemia 5 times than non central obesity. Waistcircumference has negative correlation with plasma adiponectin. Increased of waist circumference will decrease of adiponectin(cardioprotective protein) and will increase risk of acute coronary syndrome in geriatric patients.
Agranulositosis sekunder karen apropylthiouraci lpada seorang penderita penyakit graves Irianto, Petrus; Gotera, Wira
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Penyakit Graves merupakan penyakit autoimun yang spesifik mengenai organ tiroid. Hipersekresi hormontiroid dari kelenjar tiroid distimulasi oleh antibodi reseptor tirotropin. Pada terapi tirotoksikosis, penggunaanpropylthiouracil (PTU)dapat menyebabkan efek samping yang fatal yaitu agranulositosis. Dilaporkankasusseorang wanita penderita penyakit graves denganbadanlemas, hangat, sukar tidur, agak cemas, berdebardebar,dan riwayat pemakaian PTU lama. Hasil laboratorium didapatkan hitung jumlah granulosit yangrendah. Pasien dirawat inapdiruang isolasi, mendapat antibiotik propilaksis, injeksi filgastrim, serta terapiPTU diganti dengan metimasol. Perawatan hari ke-7 hitung jumlah granulosit kembali normal, pasiendipulangkan.[MEDICINA.2016;50(3):1-5] Graves disease is autoimune disease that is spesific about the thyroid organ. Hypersecretion thyroid hormonefrom the thyroid gland stimulated by thyrotropin receptor antibody. In treatment of thyrotoxicosis, the use ofpropylthiouracil (PTU) can causeagranulocytosis, afatal side effects. Wereportedacase of woman withGraves' disease with body limp, warm, difficulty sleeping, a little anxiety, palpitations,and long history of theuse of PTU. The laboratory resultsfoundlowgranulocytescount. Patients treated in isolation room, receiveantibiotics prophilaksis, injection filgastrim, danPTU therapy was replaced with methimasol. Onday-7ofcare,granulocytescountreturns to normal, the patient was discharged.[MEDICINA.2016;50(3):1-5].
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA)axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of thestress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a commonand underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and managementof HPA dysfunction in the critically ill
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Diabetic Ketoasidosis (DKA) is metabolic disturbance disorder that be signed by trias hyperglycemia, acidosis, andketosis, which one of very serious acute metabolic complication of diabetes mellitus. In Indonesia the incidence was not sohigh compare than the western countries, but the mortality is still high. In young age the mortality can be prevented by earlydiagnosis, rational and prompt treatment according to it!s pathophysiology. Succesfull of DKA treatment needs correction ofdehidration, hyperglycemia, acidosis, and electrolyte disturbance, identiÞ cation of comorbid precipitation factor, and the mostimportant one was continue monitoring. The treatment were adequate of ß uid therapy, sufÞ cient insulin theraphy, therapy ofpotassium, bicarbonate, phosphat, magnesium, hyperchloremic condition, and antibiotic administration according to indication.The important one was also awarness for therapy complications so that the therapy not to make worsening condition of thepatients.
Diabetes Melitus Sebagai Faktor Risiko Tuberkulosis Ida Bagus Aditya Nugraha; Wira Gotera; Wayan Evie Frida Yustin
Jurnal Kedokteran Meditek Vol 27 No 3 (2021): SEPTEMBER - DESEMBER
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v27i3.2126


Diabetes melitus (DM) tidak hanya meningkatkan risiko tuberkulosis (TB) aktif tetapi juga memengaruhi hasil pengobatan. Beban penyakit TB, terutama di negara berkembang, tetap tinggi meskipun telah dilakukan berbagai upaya pencegahan. Diabetes melitus yang menyebabkan imunosupresi semakin diakui sebagai faktor risiko independen untuk TB. Diabetes melitus meningkatkan risiko berkembangnya TB dua hingga tiga kali lipat dan juga meningkatkan risiko kegagalan pengobatan TB, kekambuhan, dan kematian. Diabetes juga dapat menyebabkan penyakit parah, reaktivasi fokus TB yang tidak aktif, dan hasil pengobatan TB yang buruk. Beberapa obat antituberkulosis yang biasa digunakan secara terpisah dapat menyebabkan gangguan toleransi glukosa. Skrining tuberkulosis pada penderita diabetes dan skrining diabetes pada pasien tuberkulosis telah direkomendasikan. Hal ini perlu diterapkan mengingat efektivitas dan manfaatnya.
Profil Lipid Pada Pasien Diabetes Melitus Tipe 2 di RSUP Sanglah Denpasar Tahun 2019 Putu Tasha Siorcani; Ketut Suastika; Wira Gotera; I Made Pande Dwipayana
E-Jurnal Medika Udayana Vol 11 No 1 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.v11.i01.p16


Prevalensi dislipidemia dua kali lebih tinggi ditemukan pada diabetes melitus. Studi potong lintang dengan teknik consecutive sampling menggunakan data sekunder seperti data rekam medis dari pasien diabetes melitus tipe 2 di RSU Pusat Sanglah tahun 2019. Dari 138 sampel ditemukan 69.6% laki-laki dan 30.4% perempuan. Prevalensi dislipidemia pada total sampel berturut-turut yaitu hiperkolesterolemia sebesar 42%, peningkatan kolesterol LDL sebesar 75.4%, penurunan kolesterol HDL sebesar 67.4%, dan hipertrigliseridemia sebesar 54.3%. Berdasarkan analisis uji korelasi ditemukan bahwa glukosa darah puasa memiliki hubungan yang sangat lemah terhadap trigliserida (r=0.177, p=0.045), sedangkan glukosa darah puasa tidak signifikan memiliki hubungan terhadap kolesterol total, kolesterol HDL, dan kolesterol LDL (r=0.167, p=0.058; r=0.101, p=0.253; r=0.042, p=0.636). Selain itu HbA1c tidak signifikan memiliki hubungan terhadap profil lipid (r=0.050, p=0.585; r=0.080, p=0.385; r=0.048, p=0.601; r=-0.068, p=0.463). Simpulan pada penelitian ini bahwa glukosa darah puasa memiliki hubungan terhadap trigliserida, namun glukosa darah puasa tidak memiliki hubungan terhadap kolesterol total, kolesterol HDL, dan kolesterol LDL. Sementara HbA1c tidak memiliki hubungan terhadap profil lipid dari pasien diabetes melitus tipe 2 di RSU Pusat Sanglah tahun 2019. Kata kunci: Profil Lipid, Glukosa Darah Puasa, HbA1c