endokrin

"
.

1
l t

dr. uswa
 4
Diabetes melitus
↳ TKGD Gang insulin
.

~,

4P
Etio & Kla Dx Penunjang
> DM tipe 1 : defek sel b pankreas 4P Polifagia :
Makan : hipoglikemia sel .
GDS : >200
DM tipe 2 : resistensi insulin
Poliuri : glukosa menarik air GDP : >126
-
: Bok '
1
DM gestasional : kehamilan
Polidipsi halls : feedback (-) ke hipotalamus .
TTGO/GD2PP : >200
DM tipe lain : tumor, infeksi, autoimun, dll
:

Penurunan BB 1
HBA1C : >6,5%

④BQlC :
Glu -
-

ent
- c peptide -

:
↳ erltroslt :3 Bulan membedakan dm tipe 1 & 2
n : 0,5 - 2
ellaluasittf
dm tipe 1 < 0,5

* dm tipe 2 > 0,5

Benedict test : glukosuria
 DM

Anak ? 2411415
Tlpelu TIP @
Gang panties resisters i insulin
Insulin 1 Insulin N
N
Iv c peptide Menarltcalran
C peptide alltandclrah -1 KGDT -1

µ t
glu INSULIN v01 plasma T
'
.

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-
f. t
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t
I KGD BAHT
'

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t
Rose gula t
Mor
Insulin : KUKI

RITU Buh MASINI

panlareas

C. peptide =
111541117 .

4 men Bedakan DM
-11pct/2
 Alur diagnosa Smartway
(-) sesuai > ulang > (-) sesuai > ttgo
1.x

gesala G) Gp gelato
" "
Renting
"
C- Isesuaif
6051200 605<200
atac, 605/-140 6125=140-199 61051=200 410179
GDP 1=126 GBP2126
GDP 100-125 1- 126 DM
GBP400 GDP
:

NORMAL TT6O/6D2pp
DM Lllangi

}
AP GDS : 215
DM
① no
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6D5< 200
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1760 /6D2pp
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way
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khat
TT%D2pp
'

Gulaisaranpuasaterganggu Tolerant gluteroonggr

4

.
 Hp Ap
sesuai tlsesuai
GDS

GBP
: 150
:/ 30
} DM

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GBP1126 GBP2126

/ }
Ap

DM along
GDS 1200
1.x
GDS :/ do

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41,919
605100

gpp.io , } -11-60--250

DM
GBP2126

JUICING } } DM
AP GDS : 210
GDS :/ 50
tt90 Ix GBP-130
app :/ og

1200
1-140 140-199
GDPT tqt DIY
gludarah Tolerant 914
puasa tercanqgv
tercanggv
 4pct
Gps = 250
} """ G 1- ✗

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) 1--160 : 180 =t¢t

4pct
GDS

GDP
:

:
100

130
} DM .

4pct
GDS
fentanyl Gpp
:

:
170
115 } 1--160--105=-16-1
 polidori 1- BB pdluri

-
"

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autumn
auto
, Gp -1 GBP1126 + Cpeptldet
-

potion
'
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smart
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that ajd 1--160

AP -11--160>200
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poll Fa919
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410
605=1 do IN )
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.

:3
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AP
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Terapi
i. :

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met
9h5 1-13 Bulan) M8dlKQMent05a
acclrbose
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joging.jalancepat.BE/2enang~TsensltMTas- insulin
1-11 :
ITGDI 250mg /dl
Igf : Metformin
f) ESYKI

penghdMBatxglokosldasetsens-IN-laslns.lt/
in H ABSORPSI 9141-1050 divots
I

ACQRBOSE

BIGHAM 'd Tlazolidinedion

1=5 :
flatus Tlnjctkinbet
,

Metformin
acarboset-5-9ang.61-iastdosls-IAKTATF.ci
plogltazop
psetresi Insulin :
edema
us
Meaghanbat setresi Glutton
Kl :
Gang Gingold gang .HepdR
.
Kl :
gang.jan-ungqgang.glnjal15-zomenitse.be/ummatlan DPPIVINHIBITOR
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911151117
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:

Sltagllptln VIDACJIIPTM
,

metformin
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,
origin
t
,

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151T Glnjol

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tanjlltkdt
HBCIIC -31341217 -

TARGET 1- 7%
① mencapai : -0110Bat
mekanlstnc
BCFBCC.la

MOM OTERQPI KOMBI nasi LOAD KOMBINASI 3 OAD 11754119+1 OOD-

✗ I Setresi insulin : sulfone

Vahid
1. HBAIC I 715% 13 Bulan → HBAIC 1- 7% 1. 3 Bulan → HBAIC 1- 7%
HBAIC <
7,5% 2 3 Bulan → ftp.aictpof
HBAIC I 9% E) 410/4 HBAIC I 9% G) 410/4 BB
.

2. BB 2.
HBAIC I 9% C) 410/4
,
BB
,
3.
,

ltldltasl Insulin
DM Tlpe I
DM gestational
E) 30dB
ITOMBINASI
ltlfetsi opera si
sires Berat :
, stroke MI
t
, ,

gang national
.

Mekons MC Aleta 01-10

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Hlpetglltetnla CHOM ,
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¢05181175411M
Met -1 Salford urea .

015
14/1-191313

40% Basal 60% prandial

o_0 B p p p
-
- -
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1-
715 1715
19,4pct 1-
9,4pct 19,4pct

HBAIC
-7% HBAIC 0% FIBAK 9,2% HBAIC 95%
1- OBAT -4101-1 9pct)
2oBat
met 31341cm 2130 Bat Insulin
zpdn .

Target
27%
715%
7,2%
E) ① Mencapai
Mencapai target
3013Gt
④ 1013Gt
Met -1911
'

3 Bulan
7,2%
27% ① mencapai
6,0% "75411M
④ Mencapai : tanju-kanzop.at
⑤ ✓ ✓
I

4171540 at

DX : DM tlpez

metformin :

000mg ( 1- 3✗ sehari
)
⑦

Flatus / Dare
+
ginjal
Tofte → USU 5
he
penqnam Bat ✗ 916101
⑧
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AHUT
Kronk : PD -

Anglo

Manford 'm ,µpj"ea1

's"

Hipoglilemia Hlpersllkemld angiopatianslopati

Hoth stroke neuropaei
HAD
PSH

garvey
nefropati
retinopati
/ Pati
 hipoglikemia 4 t, ITGD

- Etio : obat oad (su & glinid), puasa, malnutrisi

\ Dx : autonomik : lapar, berkeringat, palpitasi
neuroglikopenik : pusing, lemah, lesu, "/ kesadaran
hipoglikemia anak
.
Px : kgd < 70 mg/dL
Anak/balita KGD < 45 mg/dL
* Aterm < 72 jam KGD < 35 mg/dL
Alternatif : glukagon 1 mg IM
Ringan Preterm < 1 mgg KGD < 25 mg/dL
Berat
4 3b c-Isador
(-) Butuh bantuan dlm pemberian glukosa (+) Butuh bantuan dlm pemberian glukosa
Sadar gizi baik Gizi buruk
Sadar (-) Sadar
0 Ral 111 D10% 50 cc oral (-) sadar (-) sadar

Glukosa 15 - 20 gr (2-3 sendok makan) gula Bolus D10% 150 cc / D40% 25 cc Bolus dextrose 2 cc/bb D10% 5 cc/bb/iv
Bisa diulangi setelah 15 menit
< 2 thn : D10%
15 - 30 menit 2-12 thn : D25%

< 70 mg/dL >12 thn : D50%

KONTNI 15-30 Merit ulangi bolus

(-) respon
ULANG
> 70 mg/dL
D10% 100 cc/jam (-) respon
infus D10% 10-12 mg/bb/menit
 Anak

Sadar e) Sadar

504

Dl0%
9121
4121
130119 Borut
QCCIBB 5 CCIBB
111040
12th 10%
2- 12th 25%

112th 50%
⑨
→
Hlpo
siidap }
Ringer .

rtlsadar
④
LHIPO
9
B DX :Hlpo Berat

*
10% 40%
25 Cc
150 cc
①
a

Factor 4
Hipo + sacker C-I =
Alpo Berat

C- Isador

Sadar Dp :
flip Berat -

} 24kg
e)
BAHT
=
2 cc ✗ 4
=
on CC

BB 4000 ar 4
kg
.
: .
 3b artway
SmKAD
hiperglikemia : keton, kussmaul, ph asam
HONK : dehidrasi berat, ph normal

Isador -1 KGDT

KAD HONK/HHS
Ketonuria (t )
Dx Dx
keto : ketoneMatt
Hlperospnofar DEHIDRCISI Berat
kussmaull
:

- Ball Mattis 4590111 . dehidrasi berat ↳ Kennett pH normal

nafas bau aseton/buah segar Buch Segar
/ kesadaran
kusmauycepat.tt
'

/ kesadaran Ctsldosls Lab

HI perk
'
V :

dalam ema KGDI 550

Lab
:

kgd > 550

pH 7,3
'
: -

-
kgd > 250 . Ketonuria (+/-)
DIGBETH
-

KGD 1=250 STATE

Ketonuria/ketonemia +++ masif pH normal
:
. .

I pH darah < 7.3

REHIDRASI Nacl 1- Insulin + KOREKSI

Th
\ rehidrasi NaCl 0.9% 1 liter/jam
.
bolus IV insulin rapid acting/reguler 0,15 IU/BB → ✗ → KL 313
1-
.
koreksi asam basa & elektrolit TURDA Insulin
pH < 7,2 : natrium bikarbonat kotretsi : HCl
k < 3,5 : kcl
¥ : N → Insulin
④ I
-

ts*:¥µ¥!aLi-ion
HAD : 051150515

④ -

t Sadar + KGDT + Osmo / anta 5T

 ✓
@
TIDE 1

0 0

Hlperg like Mia

HAD
④

Kuss Maul → as Ido as u HAD -

Had 1- Insulin + toreksi

I
awal
 Dislipidemia 4
Etio Dx faktor resiko

- primer : kelainan genetik - Trigliserida : > 200

-

- sekunder : penyakit (dm, hipotiroidisme) • LDL : > 160

-
risiko berat risiko major
. HDL :leMaK Balk :0
< 40
" kolesterol total : > 200
y
panyakit PD : PJK, Atherosklerosis, DVT merokok
RPK : pjk :
keluargq

} -14
1119-1=100 TKT HDL < 40

ftp.j?Y)f1BratTLDL:l65
: 250

n -16
: 150
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171-01=130 Lk > 45 thn, pr > 55 thn
-
-

1-11-1131--35

Majors
Risiko rendah : < 1 risiko major
-
< 160 } -
so
I -11105
TKT 210 Risiko sedang : > 2 risiko major
①
Target LDL < 130
}

}Th/
:
o
so
-
-

Risiko tinggi : risiko berat < 100

pyg 220
FIBRA -1 : -161500
Beratf Risiko sangat tinggi : risiko berat + dm < 70 } -
so I
HDLTJOMB "
:

NIKO ① that
STATIN :Dhy
'
:

ptpt :( go
: KT VLDL
IHDL : 25 Statin Th

Kolesterol & LDL trigliserida > 500 HDL d)OMBIO

penguin Bot
simvastatin 5 - 40 mg - hmg coa reduktase 1st .
fibrat asam nikotinat
es : rhabdomiolisis Fenofibrat 1 x 45 - 300 mg
HCIMCUR

1 x 500 - 750 mg
-

TTOT -11-1170-1117117 : Merah

keram otot, nyeri otot, bak seperti cola, creatinin gemgibrozil
F 2 x 600 mg es : flushing (wajah merah, panas)
kinase, creatinin klirens, mioglobin 2nd .
asam nikotinat
1 x 500 - 750 mg
④

Q
:
F1 Brat .
④ ✓
PUT

512-1117

① DM
-1 LDL < 100 atorvastatin
Kel Resting gi
.

② BERAT :
Pst -1 .

⑥ 0

TTT T
Hel
HDL d son
✗ LDL N Tinggi
✗
TR p
 sindroma metabolik 4
"" *" "" """"""
HTTOBESTDM + Dlsllpld
Kriteria ATP III 2005
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- LP lk > 102 cm pr > 88 cm MGH

-
TG > 150 mg/dL obati penyakit atau kel. Metabolik
3 dari 5
.

•
TD > 130/> 85 mmhg
-

.
HDL lk < 40 pr < 50 HT -1 anti fit
GDP > 100 mg/dL
-
- DM u OAD
?⃝
 HT
②

TT
TT

Flip Idema .

HT
⑧ (

0 l
Dkllpldemla .
9.
/ GDP
dy : Sind .
Meta Bolt
 2
hormon paratiroid

hiperparatiroidism hipoparatiroidism
TPTH PTH It,pth
Tca 1,
t.ca
Tmg t Ng
ca -10-10-1
tfo Tfo
TEFBAIIK
14h15

Mg to
 hiperparatiroidism

Kla Dx Penunjang Th
Keram Primer : ca T fosfat ti Rujuk
Primer Sekunder/tersier Kaku Rehidrasi Nacl
Sekunde : ca t
.
fosfat T

Kejang Tersier : ca T fosfat T Furosemid, bifosfonat, kalsitonin

Adenoma Gagal ginjal kronik Takikardia Bedah adenoma
11110014515 ftlperparatirad
PAMER Sekllnder - ERSIER
"
HEBCIHKCINDR primer
" / lnggi
ca TT tt TT

fo It , TT TT

t CIHUT
Kronk
kelenjar
#
HIPO glnjal
 hipoparatiroidism
ptht
cat
e -110 DX penning Th
post optltnettoini KORAN
Hlpotalsettlla Cat Colston gluttons 1000mg
1 Kaku ,

leman 0-10-1
EITG :
QTMTEMIAIMEMQNJ provitamin D
Tirol ,
HIPO Magnesia Mgt
alostetsign
Trosseausign
EKG :
TORsado.de point SEUMURHIDUP
carpoped.at spasm Hlperfosfatetnld fog
← Ttosseav
SIGN

/ carpopedal
sparm
Cllostect
⑧
o

DX : flipOparatired .

pint cat .

④
o
o
-

DX fl per paranoid
:

PTH T ca t
④
0 -
~

pTÑp
-

cat
fo I
}SEHati= primer
.

lchovstet tirade Ktot

.

post

④
•

DX flipoparillroiduflipotialsen
:
 3a
hormon tiroid

hipertiroid hipotiroid
T T}
Tq It } ta
tsh
ttsh Ttsh
negative
feedback
↳ ta
 hipertiroid

INETCIBT
etio dx pemfis penunjang th
autoimun tremor lidlag : limbus (-) tertutup margo palpebra fungsi tiroid : tsh L/, ft4, ft3 / 1st metimazole 15-30 mg/hari
^

infeksi berderbar jofroy : kerut kening hilang kadar iodium / fx : menghambat sintesa t3, t4
,

/ bb
1- mobious : (-) konvergen fulling imunologi : ig TSI aman bumil trimester 2,3
nafsu makan / stell wag : jarang kedip EKG : atrial fibrilasi 2nd ptu 3 x 100 mg/hari
-1

tidak tahan panas skor : wayne > 20, new castle > 40 fx : menghambat konversi t4 - t3
diare aman bumil trimester 1
struma I px es : bayi hipotiroid kongenital
Goiter Propanolol 30 - 40 mg/hari
Benjolandi
trod UJCIMTUAGBERKBAR
① Th
-1151-1 tftq
normal

Hamil G) Hamill)
② -13
Trimester 1 1st Meti
.

ptu
2nd ptu
Trimester 2,3 Metlnnazdp
 gejala hipertiroid
tremor
berderbar
/ bb

:
nafsu makan /
tidak tahan panas
diare
struma

/ flings
(-) lab -11rad (+) lab : tztat exoftalmus /r kesadaran
① ig tsi (+) hipertermi
TSH t
hipotensi
autoimun
3b
tirotoksikosis hipertiroid grave disease krisis tiroid Baddy / TIROID

STORM
Th
Stabilkan hemodinamik :
Info 5
tdnjutkdh.

Ptu dosis tinggi 600-1000 mg, 200 mg/4 jam

Antipirerik 10-15 mg/bb/x beri
Propanolol 30-60 mg
⑧
0

④ 0
0 0

dx :
grave

⑧
o

dy =

grave → ① hamil 1st Meti

:

Ma 2010
 hipotiroid

etio dx Penunjang Th
1st
autoimun / bb
^
Fungsi tiroid : tsh /,
-1
ft4, ft3 ,/
,
Levotiroksin 50-100 mcg
obat ptu/metimazol dalam jangka panjang nafsu makan / 1- Fnab : infiltrasi limfosit Liotronin 50 mcg
tidak tahan dingin hurtle cell rots in

konstipasi anti tpo 2/910-11Tromp

IU -

struma Skor : indeks bilewictz

c)
Banjo Ian
'
 1134 HAMIL :
HIPERTIROID

gejala hipotiroid
/ bb PTU/Me-11mA 201
^

nafsu makan ,
/
tidak tahan dingin
Bayi HI POTI Rad tongenital
:

konstipasi
struma ITRETI NISMO

PEMDEK
IQ tt
infiltrasi limfosit / kesadaran
}
"

hurtle cell fnaBIB.io psi hipotermi

anti tpo → Strdogi bradipnea
edema anasarka
autoimun

tiroiditis hashimoto koma miksidema

th tdnjuttan
.

Levotiksoin dosis tinggi 200-500 mcg, 100-200 mcg

⑧
②

b④
to
1-

turtle cell
get Hlpotiroin t
 ftp.OIDH15
-111011015
Hashimoto

HIPOTIROD
1-
TIMIDITY
CIKUT hurt@ cell
ftp.qppyr
TIMIDITY antltpo
sypuratlf
Dequervain Post-partum
Benjolan
HIPERTIROID
Nyeri + postpartum
-1
DENOM
DENNY
 diagnose anatomic

901-1012/511711770 G)

98010 TIROID BentUtlB@njol.ap

8. TOHSIH 5. tlontotslt 5.
Dlfllsa 5. Modular
"
"
MENYEBAR
② ①
④ gejala -09901A Bilateral .

Unilateral

# per
HI Bata 's -08105 BATCH ④ jelas
Benway
⑧ ✓
.
u
v0

o o

struma
t
9901A Kiper : Tokat
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merata :
Dlfusd
① set as
 HI # RTIROID HIPOTIROID

settundeRSUBHlnlszpnnslpSEARC.IM PRIMER
PRIMER EHLINGER SUBHAS
Esta N

-13T¢ T tztat testa N tztat tztat t > tan

Tstt TSHT TSH t TSH t TSH t TSH t

fhpotirolb

primer sekunder Albums

tztat tztat tartan

tstit tsh t tsh t

⑧

↳ Tat
ftp.er-nroid Prinsep.

TSH primer

⑤
O -
O -

↳ Rendah \ normal
↳
fllpertirold USNBKIM "
 hormon kortisol
Kombat t
acth
hiperkortisol hipokortisol ace ti t
-

negative
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torts 01
Kortisol T
insufisiensi adrenal akut insufisiensi adrenal kronik
acth I
krisis adrenal addison disease
 hiperkortisol -Cushing-
3b

Kid DX penuiijang Tty

013881-195 RUJUIT
Cushing Cushing moonfase Cushing Cushing
syndrome disease BUFFALO hump syndrome disease
HIRSUTISM
.

STRIAE KOITISOIT KOITISOIT

Iv
OBAT
STEROID
TUMOR ACTH plasma ACTH plasma T
HIPOFISISCMTEMOR

Detsainetasot suppression test (BST)

170815 Rendall 120815 Tinggi

015mg / 6AM 2mg/ 6AM
torso / 7
2mg/HARI .

8mg / hari

① tersuptesi Tersllptesi ① tersuptesi

Tersllptesi4×01715011
yaorllsoli

normal Cushing Cushing ectopic ACTH

syndrome disease Uttar : .ca
pan
 ftp.rkortlsol

Cushing
syndrome disease
① OBAT STEROID
ETIO TUMOR ftp.OFKH

②
ITORTISOIT tortlsolt
Harmony acth t acth T

③
DST Dosistendah Doslstlnggi
e) Tetsupresi ④ 1- Ersupresy
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insufisiensi adrenal akut insufisiensi adrenal kronik

krisis adrenal
3b addison disease
1
e -110 DX ETIO DX PX
stop steroid lxtescldatatl Leman KOTTISOH,
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+ glutosd ITD
POST -10$
op TUMOR
MUCH
MUMMY auto /
mug gangnyoopsigap-HIPERPIG.MN
stop OBCIT STEROID

TH Th
Retlldtasi NaCl 0,9% 11ham Rlljut
lnj 1-110101-101--11809 130145111100mg HIDROITOTTISOM
Bolus dextrose
to
-25mg/ Hari
 ITOFHSOI STEROID
ftp.okotasol
-_

adrenal
lnsufiensi

IPEP.pk/MentasilTtkls-
adrenal addison disease

CIKUT Kronk
e) Sadar ④ Sadar
④ DEMON @ DEMON
④ O
O O
-o
↳ tendon
zg
① NBAT STEROID

HIT } ② rendah TIDAK

tersvpres
U

upresi

⑧
3g

0
0
-
=

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① DST
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para

⑧
0
syndrome
DX =

Cushing y
kortlsolt
Acth 1 .
 2
gang GnRH
gonadotropin =
PUBERTAS .

etlo the Ttl

ldlopa -111-1
17741-951801701-11-1 Rlljllt
Hlpersettesi Hlposettesi
GARHI gnrtlt
eho
Delayed
PUB02tasarisetllnc.HR
PUBERTCIS ptetots
CIRI SCHUMER
cepattnuncul KIMBCHINUNCUL
gepypql perlfer
Organ
HIPOFISIS
reproduksi
F- ath 0%91-4 f > 12th Osyth

01g 12/19
⑧ 0
②
- -

dx :
pub eras prekoks
u
j GnRH
 2 diabetes insipidus

eto DX tho PX Th

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