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\li4426\ri0\sl-213\slmult0 \fs22\cf1\f0\charscalex100\b {Kata Pengantar }\b0 \pa
r\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\sl-373\slmult0 \f
s22\cf1\f1\charscalex100 {Segala puji bagi Allah SWT, Tuhan Yang Maha Pengas
ih dan Penyayang, sehingga }\par\pard\li733\ri0\sl-320\slmult0 \fs20\cf1\f1\c
harscalex100 {penyusunan buku}{ }\fs20\cf1\f1\charscalex100 {\uc1\u8220X}\fs20\c
f1\f1\charscalex100 {Mengenal Kasus-kasus Endokrin Anak}\fs20\cf1\f1\charscalex1
00 {\uc1\u8221X}\fs20\cf1\f1\charscalex100 { dapat diselesaikan. Buku ini disusu
n }\par\pard\li733\ri0\sl-253\slmult0 \fs22\cf1\f1\charscalex100 {sebagai salah
satu upaya memperkenalkan kasus-kasus di bidang endokrinologi anak. Upaya ini }\
par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {dilakukan karena s
elama ini kasus-kasus endokrin anak relatif belum dikenal luas termasuk di }\par
\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {kalangan medis baik d
okter spesialis, dokter umum, maupun tenaga medis lain. Di samping itu }\par\par
d\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {pengenalan kasus-kasus e
ndokrin anak ini juga untuk memberikan gambaran bahwa ilmu }\par\pard\li733
\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {endokrinologi itu tidak sulit
dipahami. Bahwa ada aspek-aspek genetik maupun biologi }\par\pard\li733\ri0\
sl-293\slmult0 \fs22\cf1\f1\charscalex100 {molekuler pada ilmu ini, juga tidak m
embuat ilmu ini otomatis sulit dimengerti karena memang }\par\pard\li733\ri0\sl293\slmult0 \fs22\cf1\f1\charscalex100 {perkembangan ilmu dan teknologi kedokter
an sekarang sangat pesat. }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\char
scalex100 {Akhirnya, semoga penyusunan buku ini bermanfaat bagi yang membaca da
n }\par\pard\li733\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {mempergunakann
ya dalam praktek sehari-hari. Kekurangan dan ketidaksempurnaan buku ini }\p
ar\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {sangat mungkin dit
emui. Untuk itu masukan, kritik dan saran akan kami terima untuk }\par\pard
\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {perbaikan lebih lanjut. }\
par\pard\li5373\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li5373\ri0\sl-373\slmult0
\fs20\cf1\f1\charscalex100 {Surakarta, 14 Agustus 2011 }\par\pard\li5373\ri0\sl213\slmult0 \fs18\cf0\par\pard\li5373\ri0\sl-373\slmult0 \fs22\cf1\f1\charscalex
100 {Penyusun }\par\pard\sect\sectd\sbkpage
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3\margtsxn666\margbsxn440\pard\li5320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li53
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\pard\li5320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li5320\ri0\sl-213\slmult0 \fs
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{BAB I }\b0 \par\pard\li2653\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2653\ri0\s
l-373\slmult0 \fs22\cf1\f0\charscalex100\b {MENGENAL DIABETES MELITUS TIPE 1 PAD
A ANAK }\b0 \par\pard\li4253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li4253\ri0\sl
-360\slmult0 \fs22\cf1\f1\charscalex100 {Annang Giri Moelyo, dr, SpA, MKes }\par
\pard\li3040\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Bagian/SMF Ilmu Kese
hatan Anak Fakultas Kedokteran UNS }\par\pard\li4773\ri0\sl-293\slmult0 \fs22\cf
1\f1\charscalex100 {annang.gm@fk.uns.ac.id }\par\pard\li1440\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1440\ri0\sl-373\slmult0 \fs22\cf1\f0\charscalex100\b {Penda
huluan }\b0 \par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Peny
akit diabetes pertama kali dideskripsikan pada masa Mesir kuno lebih dari }\par
\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {3500 tahun yang lalu
. Saat itu p}\fs22\cf1\f1\charscalex100 {enyakit ini digambarkan sebagai \uc1\u8
216Xsangat banyak buang }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charsc
alex100 {air kecil\uc1\u8217X. Sekitar 2000 tahun lalu,}{ }\fs20\cf1\f1\charscal
ex100 {terdapat laporan dari Turki yang juga menyebutkan }\par\pard\li1440\ri0\s
l-280\slmult0 \fs22\cf1\f1\charscalex100 {penyakit ini sebagai }{ }\fs22\cf1\f0
\charscalex100\i {kehausan yang sangat}\i0 \fs22\cf1\f1\charscalex100 { serta
}{ }\fs22\cf1\f0\charscalex100\i {kencing yang banyak}\i0 \fs22\cf1\f1\charsc
alex100 {. Pada tahun }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charsca
lex100 {1900, Stobolev di Rusia dan Opie di USA, pada waktu yang hampir be
rsamaan, }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {menyeb
utkan bahwa diabetes mellitus terjadi akibat destruksi dari pulau-pulau }\p
ar\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Langerhans kelenja
r pancreas (Brink SJ, dkk. 2010). }\par\pard\li2133\ri0\sl-293\slmult0 \*\tx580
0\fs22\cf1\f1\charscalex100 {Diabetes melitus secara definisi}\tab \fs22\cf1\
f1\charscalex100 {adalah keadaan hiperglikemia kronik. }\par\pard\li1440\ri0\
sl-293\slmult0 \fs20\cf1\f1\charscalex100 {Hiperglikemia ini dapat disebabkan
oleh beberapa keadaan, di antaranya adalah }\par\pard\li1440\ri0\sl-293\slmul
t0 \fs20\cf1\f1\charscalex100 {gangguan sekresi hormon insulin, gangguan ak
si/kerja dari hormon insulin atau }\par\pard\li1440\ri0\sl-293\slmult0 \fs22\c
f1\f1\charscalex100 {gangguan kedua-duanya (Weinzimer SA, Magge S. 2005). }\par\
pard\li2133\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {Pada makalah ini akan
dibahas gambaran umum tentang diabetes mellitus tipe 1, }\par\pard\li1440\ri0\s

l-293\slmult0 \fs22\cf1\f1\charscalex100 {karena insidennya lebih banyak pad

a anak. Sedangkan diabetes mellitus tipe yang }\par\pard\li1440\ri0\sl-293\sl
mult0 \fs22\cf1\f1\charscalex100 {lainnya (tipe 2, gestasional ataupun tipe lain
) tidak dibahas secara rinci. }\par\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1440\ri0\sl-373\slmult0 \fs22\cf1\f0\charscalex100\b {Epidemiologi }\b0
\par\pard\li2133\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {Angka kejadian
diabetes di USA adalah sekitar 1 dari setiap 1500 anak
(pada }\par\pa
rd\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {anak usia 5 tahun) d
an sekitar 1 dari setiap 350 anak (pada usia 18 tahun). Puncak }\par\pard
\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {kejadian diabetes adalah
pada usia 5-7 tahun serta pada masa awal pubertas seorang }\par\pard\li1440\
ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {anak. Kejadian pada laki dan pere
mpuan sama (Weinzimer SA, Magge S. 2005). }\par\pard\li2133\ri0\sl-293\slmult0 \
fs22\cf1\f1\charscalex100 {Insiden tertinggi diabetes mellitus tipe 1 terja
di di Finlandia, Denmark serta }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f
1\charscalex100 {Swedia yaitu sekitar 30 kasus baru setiap tahun dari setiap 100
.000 penduduk. Insiden }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charsca
lex100 {di Amerika Serikat adalah 12-15/100 ribu penduduk/tahun, di Afrika
5/100.000 }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {pendu
duk/tahun, di Asia Timur kurang dari 2/100 ribu penduduk/tahun (Weinzimer }
\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {SA, Magge S. 200
5). }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Insiden di
Indonesia sampai saat ini belum diketahui. Namun dari data registri }\par\p
ard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {nasional untuk penyaki
t DM pada anak dari UKK Endokrinologi Anak PP IDAI, terjadi }\par\pard\li1440\ri
0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {peningkatan dari jumlah sekitar
200-an anak dengan DM pada tahun 2008 menjadi}\par\pard\li1440\ri0\sl-293\s
lmult0 \fs20\cf1\f1\charscalex100 {sekitar 580-an pasien pada tahun 2011. San
gat dimungkinkan angkanya lebih tinggi }\par\pard\li1440\ri0\sl-293\slmult0
\fs20\cf1\f1\charscalex100 {apabila kita merujuk pada kemungkinan anak denga
n DM yang meninggal tanpa }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\c
harscalex100 {terdiagnosis sebagai ketoasidosis diabetikum ataupun belum semua
pasien DM tipe 1 }\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscale
x100 {yang dilaporkan. Data anak dengan DM di Subbagian endokrinologi anak
IKA FK}\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {UNS/RSUD
Dr. Moewardi Surakarta tahun 2008-2010 adalah sebanyak 11 penderita }\par\p
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pemeriksaan gula darah abnormal pada waktu yang berbeda (Rustama DS, }\par\pard
\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {dkk. 2010; ISPAD Clinical
Practice Consensus Guidelines 2009). }\par\pard\li2133\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li2133\ri0\sl-360\slmult0 \fs22\cf1\f1\charscalex100 {Kriteria has
il pemeriksaan gula darah abnormal adalah: }\par\pard\li2306\ri0\sl-293\slmult0
\*\tx2840\fs22\cf1\f1\charscalex100 {1.}\tab \fs22\cf1\f1\charscalex100 {Kadar g
ula darah sewaktu >200 mg/dl atau }\par\pard\li2306\ri0\sl-293\slmult0 \*\tx2840
\fs22\cf1\f1\charscalex100 {2.}\tab \fs22\cf1\f1\charscalex100 {Kadar gula darah
puasa >126 mg/dl atau }\par\pard\li2306\ri0\sl-293\slmult0 \*\tx2840\fs22\cf1\f
1\charscalex100 {3.}\tab \fs22\cf1\f1\charscalex100 {Kadar gula darah 2 jam post
prandial >200 mg/dl. }\par\pard\li2133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
2133\ri0\sl-373\slmult0 \fs22\cf1\f1\charscalex100 {Untuk menegakkan diagnosis
DM tipe 1, maka perlu dilakukan pemeriksaan }\par\pard\li1440\ri0\sl-293\slm
ult0 \fs20\cf1\f1\charscalex100 {penunjang, yaitu C-peptide <0,85 ng/ml. C-pep
tide ini merupakan salah satu penanda }\par\pard\li1440\ri0\sl-293\slmult0 \fs
22\cf1\f1\charscalex100 {banyaknya sel }{ }\fs22\cf1\f1\charscalex100 {\uc1\u94
6X}\fs22\cf1\f1\charscalex100 {-pankreas yang masih berfungsi. Pemeriksaan lai
n adalah adanya }\par\pard\li1440\ri0\sl-280\slmult0 \*\tx3493\*\tx6853\fs22\c
f1\f1\charscalex100 {autoantibodi, yaitu}\tab \fs22\cf1\f0\charscalex100\i {Isl
et cell autoantibodies}\i0 \fs22\cf1\f1\charscalex100 { (ICA),}\tab \fs22\cf1\f
0\charscalex100\i {Glutamic acid decarboxylase }\i0 \par\pard\li1440\ri0\sl-293
\slmult0 \*\tx4226\fs20\cf1\f0\charscalex100\i {autoantibodies}\i0 \fs20\cf1\f1\
charscalex100 { (65K GAD),}\tab \fs20\cf1\f0\charscalex100\i {IA2}\i0 \fs20\cf
1\f1\charscalex100 { ( dikenal sebagai ICA 512 atau tyrosine posphatase) }
\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f0\charscalex100\i {autoantibodies
}\i0 \fs22\cf1\f1\charscalex100 { dan }\fs22\cf1\f0\charscalex100\i {Insulin aut
oantibodies}\i0 \fs22\cf1\f1\charscalex100 { (IAA). Adanya autoantibodi mengkonf
irmasi }\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {DM tipe
1 karena proses autoimun. Sayangnya pemeriksaan autoantibodi ini relatif
}\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {mahal (Rustama
DS, dkk. 2010; ISPAD Clinical Practice Consensus Guidelines 2009) }\par\pard\li1
440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\sl-373\slmult0 \fs22\cf1\f0

\charscalex100\b {Perjalanan penyakit }\b0 \par\pard\li2133\ri0\sl-293\slmult0 \

fs22\cf1\f1\charscalex100 {Perjalanan penyakit ini melalui beberapa periode menu
rut ISPAD Clinical }\par\pard\li1440\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex1
00 {Practice Consensus Guidelines tahun 2009, yaitu: }\par\pard\sect\sectd\sbkno
ne\pgwsxn11893\pghsxn16826\marglsxn666\margrsxn133\cols2\colno1\colw2840\colsr-0
\colno2\colw8253\pard\li2133\ri0\sl-333\slmult0 \fs22\cf1\f3\charscalex100 {-}\p
ar\pard\li2133\ri0\sl-293\slmult0 \fs20\cf1\f3\charscalex100 {-}\par\pard\li2133
\ri0\sl-306\slmult0 \fs20\cf1\f3\charscalex100 {-}\par\pard\li2133\ri0\sl-293\sl
mult0 \fs20\cf1\f3\charscalex100 {-}\par\column\pard\li0\ri0\sl-306\slmult0 \fs2
2\cf1\f1\charscalex100 {Periode pra-diabetes }\par\pard\li0\ri0\sl-293\slmult0 \
fs22\cf1\f1\charscalex100 {Periode manifestasi klinis diabetes }\par\pard\li0\ri
0\sl-306\slmult0 \fs22\cf1\f1\charscalex100 {Periode}{ }\fs22\cf1\f0\charscalex1
00\i {honey-moon}\i0 \par\pard\li0\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100
{Periode ketergantungan insulin yang menetap }\par\pard\sect\sectd\sbknone\pgws
xn11893\pghsxn16826\marglsxn666\margrsxn133\pard\li1786\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li1786\ri0\sl-346\slmult0 \fs22\cf1\f1\charscalex100\ul {Periode p
ra-diabetes}\ul0 \fs22\cf1\f1\charscalex100\ul { }\ul0 \par\pard\li2133\ri0\sl-2
93\slmult0 \fs22\cf1\f1\charscalex100 {Pada periode ini gejala-gejala klinis d
iabetes belum nampak karena baru ada }\par\pard\li1786\ri0\sl-293\slmult0 \*\t
x4000\fs22\cf1\f1\charscalex100 {proses destruksi sel }\tab \fs22\cf1\f1\charsc
alex100 {\uc1\u946X}\fs22\cf1\f1\charscalex100 {-pankreas. Predisposisi geneti
k tertentu memungkinkan }\par\pard\li1786\ri0\sl-280\slmult0 \fs22\cf1\f1\char
scalex100 {terjadinya proses destruksi ini. Sekresi insulin mulai berkurang
ditandai dengan }\par\pard\li1786\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100
{mulai berkurangnya sel }\fs22\cf1\f1\charscalex100 {\uc1\u946X}\fs22\cf1\f1\cha
rscalex100 {-pankreas yang berfungsi. Kadar C-peptide mulai menurun. }\par\pard\
li1786\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Pada periode ini autoantib
odi mulai ditemukan apabila dilakukan pemeriksaan }\par\pard\li1786\ri0\sl-29
3\slmult0 \fs22\cf1\f1\charscalex100 {laboratorium. }\par\pard\li1786\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1786\ri0\sl-373\slmult0 \fs22\cf1\f1\charscalex100
\ul {Periode manifestasi klinis}\ul0 \fs22\cf1\f1\charscalex100\ul { }\ul0 \par\
pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Pada periode ini, gej
ala klinis DM mulai muncul. Pada periode ini sudah terjadi}\par\pard\li1786\ri0\
sl-293\slmult0 \fs20\cf1\f1\charscalex100 {sekitar 90% kerusakan sel }{ }\fs20
\cf1\f1\charscalex100 {\uc1\u946X}\fs18\cf1\f1\charscalex100 {-pankreas. Karena
sekresi insulin sangat kurang, maka }\par\pard\li1786\ri0\sl-293\slmult0 \f
s20\cf1\f1\charscalex100 {kadar gula darah akan tinggi/meningkat. Kadar gula dar
ah yang melebihi 180 mg/dl }\par\pard\li1786\ri0\sl-280\slmult0 \fs22\cf1\f1\cha
rscalex100 {akan menyebabkan diuresis osmotik. Keadaan ini menyebabkan terja
dinya }\par\pard\li1786\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {pengeluar
an cairan dan elektrolit melalui urin (poliuria, dehidrasi, polidipsi). Karena }
\par\pard\li1786\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {gula darah tida
k dapat di-}\fs20\cf1\f0\charscalex100\i {uptake}\i0 \fs20\cf1\f1\charscalex10
0 { ke dalam sel, penderita akan merasa lapar }\par\pard\li1786\ri0\sl-293\s
lmult0 \fs20\cf1\f1\charscalex100 {(polifagi), tetapi berat badan akan semaki
n kurus. Pada periode ini penderita }\par\pard\li1786\ri0\sl-293\slmult0 \fs2
2\cf1\f1\charscalex100 {memerlukan insulin dari luar agar gula darah di-}\fs22\c
f1\f0\charscalex100\i {uptake}\i0 \fs22\cf1\f1\charscalex100 { ke dalam sel. }\p
ar\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16826\marglsxn666\margrsxn133\cols2
\colno1\colw9226\colsr-0\colno2\colw1866\pard\li1440\ri0\sl-400\slmult0 \fs22\cf
1\f2\charscalex100 {Annang Giri Moelyo,dr, SpA, MKes }\fs22\cf1\f2\charscalex100
{\uc1\u8211X}\fs22\cf1\f2\charscalex100 { Fakultas Kedokteran UNS }\par\column\
pard\li0\ri0\sl-373\slmult0 \fs22\cf1\f2\charscalex100 {Page 3 }\par\pard\sect\s
ectd\sbknone\pgwsxn11893\pghsxn16826\marglsxn666\margrsxn133\pard\sect\sectd\sbk
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86\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1786\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1786\ri0\sl-213\slmult0 \fs
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1\f1\charscalex100\ul {Periode}\ul0 { }\fs22\cf1\f0\charscalex100\i \ul {honey-m
oon}\i0 \ul0 \par\pard\li2133\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {Per
iode ini disebut juga fase remisi parsial atau sementara. Pada periode ini sisa}\par\pard\li1786\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {sisa sel }{ }\f
s22\cf1\f1\charscalex100 {\uc1\u946X}\fs22\cf1\f1\charscalex100 {-pankreas akan
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\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {dalam tubuh sendiri. Pada saat ini k
ebutuhan insulin dari luar tubuh akan berkurang }\par\pard\li1786\ri0\sl-293\slm
ult0 \fs20\cf1\f1\charscalex100 {hingga kurang dari 0,5 U/kg berat badan/hari.
Namun periode ini hanya }\par\pard\li1786\ri0\sl-293\slmult0 \fs20\cf1\f1\char
scalex100 {berlangsung sementara, bisa dalam hitungan hari ataupun bulan, seh
ingga perlu }\par\pard\li1786\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {ad
anya edukasi pada orang tua bahwa periode ini bukanlah fase remisi yang }
\par\pard\li1786\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {menetap. }\par\p
ard\li1786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1786\ri0\sl-360\slmult0 \fs22
\cf1\f1\charscalex100\ul {Periode ketergantungan insulin yang menetap}\ul0 \fs22
\cf1\f1\charscalex100\ul { }\ul0 \par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f
1\charscalex100 {Periode ini merupakan periode terakhir dari penderita DM.
Pada periode ini }\par\pard\li1786\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100
{penderita akan membutuhkan insulin kembali dari luar tubuh seumur hidupnya. }\
par\pard\li1786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1786\ri0\sl-373\slmult0
\fs22\cf1\f0\charscalex100\b \i {Pitfall}\b0 \i0 \fs22\cf1\f0\charscalex100\b {
dalam diagnosis }\b0 \par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex
100 {Diagnosis diabetes seringkali salah, disebabkan gejala-gejala awalnya
tidak }\par\pard\li1786\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {terlalu k
has dan mirip dengan gejala penyakit lain. Di samping kemiripan gejala }\
par\pard\li1786\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {dengan penyakit
lain, terkadang tenaga medis juga tidak menyadari kemungkinan }\par\pard\li17
86\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {penyakit ini karena jarangny
a kejadian DM tipe 1 yang ditemui ataupun belum }\par\pard\li1786\ri0\sl-29
3\slmult0 \fs18\cf1\f1\charscalex100 {pernah menemui kasus DM tipe 1 pada a
nak. Beberapa gejala yang sering menjadi }\par\pard\li1786\ri0\sl-293\slmult0
\fs22\cf1\f0\charscalex100\i {pitfall}\i0 \fs22\cf1\f1\charscalex100 { dalam di
agnosis DM tipe 1 pada anak di antaranya adalah: }\par\pard\li2133\ri0\sl-293\sl
mult0 \*\tx2480\fs22\cf1\f1\charscalex100 {1.}\tab \fs22\cf1\f1\charscalex100 {S
ering kencing}\fs22\cf1\f1\charscalex100 {: kemungkinan diagnosisnya
adalah
infeksi saluran kemih }\par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1\f1\char
scalex100 {atau terlalu banyak minum (selain DM). Variasi dari keluhan ini

adalah }\par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {adanya

enuresis (mengompol) setelah sebelumnya anak tidak pernah }\par\pard\li2480
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arscalex100 {Berat badan turun atau tidak mau naik:}\fs22\cf1\f1\charscalex100
{ kemungkinan diagnosis adalah }\par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1
\f1\charscalex100 {asupan nutrisi yang kurang atau adanya penyebab organik la
in. Hal ini}\par\pard\li2480\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {dis
ebabkan karena masih tingginya kejadian malnutrisi di negara kita. Sering}\par\p
ard\li2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {pula dianggap sebagai
salah satu gejala tuberkulosis pada anak. }\par\pard\li2133\ri0\sl-293\slmult0 \
*\tx2480\fs22\cf1\f1\charscalex100 {3.}\tab \fs22\cf1\f1\charscalex100 {Sesak n
afas:}\fs22\cf1\f1\charscalex100 { kemungkinan diagnosisya adalah bronkopnem
onia. Apabila }\par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {d
isertai gejala lemas, kadang juga didiagnosis sebagai malaria. Padahal gejala }\
par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {sesak nafasnya
apabila diamati pola nafasnya adalah tipe Kusmaull (nafas }\par\pard\li24
80\ri0\sl-293\slmult0 \*\tx3213\*\tx5333\*\tx6173\*\tx9373\fs22\cf1\f1\charscale
x100 {cepat}\tab \fs22\cf1\f1\charscalex100 {dan dalam) yang}\tab \fs22\cf1\f1
\charscalex100 {sangat}\tab \fs22\cf1\f1\charscalex100 {berbeda dengan tipe n
afas}\tab \fs22\cf1\f1\charscalex100 {pada}\par\pard\li2480\ri0\sl-293\slmult0 \
fs22\cf1\f1\charscalex100 {bronkopnemonia. Nafas Kusmaull adalah tanda dari keto
asidosis. }\par\pard\li2133\ri0\sl-280\slmult0 \*\tx2480\fs22\cf1\f1\charscalex1
00 {4.}\tab \fs22\cf1\f1\charscalex100 {Nyeri perut:}\fs22\cf1\f1\charscalex100
{ seringkali dikira sebagai peritonitis atau apendisitis. Pada}\par\pard\li2
480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {penderita DM tipe 1, nyeri pe
rut ditemui pada keadaan ketoasidosis. }\par\pard\li2133\ri0\sl-293\slmult0 \*\t
x2480\fs22\cf1\f1\charscalex100 {5.}\tab \fs22\cf1\f1\charscalex100 {Tidak sada
r: keadaan ketoasidosis dapat dipikirkan pada kemungkinan }\par\pard\li2480\r
i0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {diagnosis seperti malaria sereb
ral, meningitis, ensefalitis, ataupun cedera }\par\pard\li2480\ri0\sl-293\slmul
t0 \fs22\cf1\f1\charscalex100 {kepala (Brink SJ, dkk. 2010) }\par\pard\sect\sect
d\sbknone\pgwsxn11893\pghsxn16826\marglsxn666\margrsxn133\cols2\colno1\colw9226\
colsr-0\colno2\colw1866\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1440\ri0\sl-373\slmult0 \fs22\cf1\f2\charscalex100 {Annang Giri Moelyo,dr,
SpA, MKes }\fs22\cf1\f2\charscalex100 {\uc1\u8211X}\fs22\cf1\f2\charscalex100 {
Fakultas Kedokteran UNS }\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li0\ri0\sl-346\slmult0 \fs22\cf1\f2\charscalex100 {Page 4 }\par\pard\se
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3\margtsxn666\margbsxn440\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li14
40\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1440\ri0\sl-213\slmult0 \fs22\cf1\f0\charscalex100\b
{Pilar-pilar Manajemen DM Tipe 1 }\b0 \par\pard\li2133\ri0\sl-293\slmult0 \fs20
\cf1\f1\charscalex100 {Tatalaksana pasien dengan DM tipe 1 tidak hanya me
liputi pengobatan berupa }\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\char
scalex100 {pemberian insulin. Ada hal-hal lain selain insulin yang perlu d
iperhatikan dalam }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex1
00 {tatalaksana agar penderita mendapatkan kualitas hidup yang optimal dala
m jangka }\par\pard\li1440\ri0\sl-280\slmult0 \fs20\cf1\f1\charscalex100 {pendek
maupun jangka panjang (Rustama DS, dkk. 2010; ISPAD Clinical Practice }\
par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Consensus Guideli
nes. 2009) }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Terd
apat 5 pilar manajemen DM tipe 1, yaitu: }\par\pard\li1866\ri0\sl-293\slmult0 \*
\tx2306\fs22\cf1\f1\charscalex100 {1.}\tab \fs22\cf1\f1\charscalex100 {Insulin }
\par\pard\li1866\ri0\sl-293\slmult0 \*\tx2306\fs22\cf1\f1\charscalex100 {2.}\tab
\fs22\cf1\f1\charscalex100 {Diet }\par\pard\li1866\ri0\sl-293\slmult0 \*\tx2306
\fs22\cf1\f1\charscalex100 {3.}\tab \fs22\cf1\f1\charscalex100 {Aktivitas fisik/
}\fs22\cf1\f0\charscalex100\i {exercise}\i0 \par\pard\li1866\ri0\sl-293\slmult0
\*\tx2306\fs22\cf1\f1\charscalex100 {4.}\tab \fs22\cf1\f1\charscalex100 {Edukasi
}\par\pard\li1866\ri0\sl-293\slmult0 \*\tx2306\fs22\cf1\f1\charscalex100 {5.}\t
ab \fs22\cf1\f1\charscalex100 {Monitoring kontrol glikemik }\par\pard\li1786\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li1786\ri0\sl-360\slmult0 \*\tx2133\fs22\cf1\
f0\charscalex100\b {1.}\b0 \tab \fs22\cf1\f0\charscalex100\b {Insulin }\b0 \par\
pard\li2840\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {Insulin merupakan t
erapi yang mutlak harus diberikan pada penderita }\par\pard\li2133\ri0\sl-293
\slmult0 \fs22\cf1\f1\charscalex100 {DM Tipe 1. Dalam pemberian insulin perl
u diperhatikan jenis insulin, dosis }\par\pard\li2133\ri0\sl-293\slmult0 \fs22
\cf1\f1\charscalex100 {insulin, regimen yang digunakan, cara menyuntik serta
penyesuaian dosis yang }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charsc
alex100 {diperlukan. }\par\pard\li2133\ri0\sl-293\slmult0 \*\tx2480\fs22\cf1\f1\
charscalex100 {a.}\tab \fs22\cf1\f1\charscalex100 {Jenis insulin: kita mengenal
beberapa jenis insulin, yaitu insulin kerja cepat, }\par\pard\li2480\ri0\sl-293\
slmult0 \fs22\cf1\f1\charscalex100 {kerja pendek, kerja menengah, kerja panjang,
maupun insulin campuran }\par\pard\li2480\ri0\sl-280\slmult0 \fs22\cf1\f1\cha
rscalex100 {(campuran kerja cepat/pendek dengan kerja menengah). Penggunaan

jenis }\par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {insulin i

ni tergantung regimen yang digunakan. }\par\pard\li2133\ri0\sl-293\slmult0 \*\tx
2480\fs22\cf1\f1\charscalex100 {b.}\tab \fs22\cf1\f1\charscalex100 {Dosis insuli
n: dosis total harian pada anak berkisar antara 0,5-1 unit/kg berat }\par\pard\l
i2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {badan pada awal diagnosis
ditegakkan. Dosis ini selanjutnya akan diatur }\par\pard\li2480\ri0\sl-293\
slmult0 \fs22\cf1\f1\charscalex100 {disesuaikan dengan faktor-faktor yang ad
a, baik pada penyakitnya maupun}\par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1\
f1\charscalex100 {penderitanya. }\par\pard\li2133\ri0\sl-293\slmult0 \*\tx2480
\fs22\cf1\f1\charscalex100 {c.}\tab \fs22\cf1\f1\charscalex100 {Regimen: kita m
engenal dua macam regimen, yaitu regimen konvensional }\par\pard\li2480\ri0\s
l-293\slmult0 \fs22\cf1\f1\charscalex100 {serta regimen intensif. Regimen ko
nvensional/}\fs22\cf1\f0\charscalex100\i {mix-split regimen}\i0 \fs22\cf1\f1\cha
rscalex100 { dapat}\par\pard\li2480\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex1
00 {berupa pemberian dua kali suntik/hari atau tiga kali suntik/hari. Sedangkan
}\par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {regimen intensi
f berupa pemberian regimen basal bolus. Pada regimen basal }\par\pard\li2480\ri0
\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {bolus dibedakan antara insulin yang
diberikan untuk memberikan dosis basal }\par\pard\li2480\ri0\sl-293\slmult0 \fs2
2\cf1\f1\charscalex100 {maupun dosis bolus. }\par\pard\li2133\ri0\sl-293\slmult
0 \*\tx2480\fs22\cf1\f1\charscalex100 {d.}\tab \fs22\cf1\f1\charscalex100 {Cara
menyuntik: terdapat beberapa tempat penyuntikan yang baik dalam hal }\par\pard\l
i2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {absorpsinya yaitu di daerah
abdomen (paling baik absorpsinya), lengan atas, }\par\pard\li2480\ri0\sl-293\sl
mult0 \fs22\cf1\f1\charscalex100 {lateral paha. Daerah bokong tidak dianjurka
n karena paling buruk}\par\pard\li2480\ri0\sl-293\slmult0 \fs22\cf1\f1\charsca
lex100 {absorpsinya. }\par\pard\li2133\ri0\sl-280\slmult0 \*\tx2480\fs22\cf1\f1\
charscalex100 {e.}\tab \fs22\cf1\f1\charscalex100 {Penyesuaian dosis: Kebutuhan
insulin akan berubah
tergantung dari }\par\pard\li2480\ri0\sl-293\slmult0
\fs22\cf1\f1\charscalex100 {beberapa hal, seperti hasil monitor gula darah
, diet, olahraga, maupun usia }\par\pard\li2480\ri0\sl-293\slmult0 \*\tx4773\*\t
x8080\*\tx9333\fs22\cf1\f1\charscalex100 {pubertas (terkadang}\tab \fs22\cf1\f1
\charscalex100 {kebutuhan meningkat hingga}\tab \fs22\cf1\f1\charscalex100 {2
unit/kg}\tab \fs22\cf1\f1\charscalex100 {berat }\par\pard\li2480\ri0\sl-293\slm
ult0 \fs22\cf1\f1\charscalex100 {badan/hari), kondisi stress maupun saat sakit.
}\par\pard\li1786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1786\ri0\sl-373\slmult
0 \*\tx2133\fs22\cf1\f0\charscalex100\b {2.}\b0 \tab \fs22\cf1\f0\charscalex100\
b {Diet }\b0 \par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16826\marglsxn666\ma
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0\sl-293\slmult0 \fs22\cf1\f2\charscalex100 {Annang Giri Moelyo,dr, SpA, MKes }\
fs22\cf1\f2\charscalex100 {\uc1\u8211X}\fs22\cf1\f2\charscalex100 { Fakultas Ked
okteran UNS }\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs22\cf1\f2\charscalex
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Secara umum diet pada anak DM tipe 1 tetap mengacu pada upaya untuk }\par\pard\l
i2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {mengoptimalkan proses pertu
mbuhan. Untuk itu pemberian diet terdiri dari 50-}\par\pard\li2133\ri0\sl-293\sl
mult0 \fs20\cf1\f1\charscalex100 {55% karbohidrat, 15-20% protein dan 30% le
mak. Pada anak DM tipe 1 asupan }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf
1\f1\charscalex100 {kalori perhari harus dipantau ketat karena terkait dengan
dosis insulin yang }\par\pard\li2133\ri0\sl-280\slmult0 \fs22\cf1\f1\charsca
lex100 {diberikan selain monitoring pertumbuhannya. Kebutuhan kalori perhari
}\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {sebagaimana ke
butuhan pada anak sehat/normal. Ada beberapa anjuran }\par\pard\li2133\ri0\sl
-293\slmult0 \fs22\cf1\f1\charscalex100 {pengaturan persentase diet yaitu 20% ma
kan pagi, 25% makan siang serta 25% }\par\pard\li2133\ri0\sl-293\slmult0 \fs
22\cf1\f1\charscalex100 {makan malam, diselingi dengan 3 kali snack masing-masin
g 10% total kebutuhan }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscal
ex100 {kalori perhari. Pemberian diet ini juga memperhatikan regimen yang diguna
kan.}\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Pada regime
n basal bolus, pasien harus mengetahui rasio insulin:karbohidrat }\par\pard
\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {untuk menentukan dosis pe
mberian insulin. }\par\pard\li1786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1786\
ri0\sl-360\slmult0 \*\tx2133\fs22\cf1\f0\charscalex100\b {3.}\b0 \tab \fs22\cf1\
f0\charscalex100\b {Aktivitas fisik/}\b0 \fs22\cf1\f0\charscalex100\b \i {exerci
se}\b0 \i0 \par\pard\li2840\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Anak
DM bukannya tidak boleh berolahraga. Justru dengan berolahraga }\par\pard\li2133
\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {akan membantu mempertahankan
berat badan ideal, menurunkan berat badan }\par\pard\li2133\ri0\sl-293\slmult
0 \fs22\cf1\f1\charscalex100 {apabila menjadi obes serta meningkatkan percaya di
ri. Olahraga akan membantu }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\cha
rscalex100 {menurunkan kadar gula darah serta meningkatkan sensitivitas tubu
h terhadap }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {ins

ulin. }\par\pard\li2840\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {Namun p

erlu diketahui pula bahwa olahraga dapat meningkatkan risiko }\par\pard\li2133
\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {hipoglikemia maupun hiperglikemi
a (bahkan ketoasidosis). Sehingga pada anak }\par\pard\li2133\ri0\sl-280\slmult0
\fs22\cf1\f1\charscalex100 {DM memiliki beberapa persyaratan yang harus dipen
uhi untuk menjalankan }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscal
ex100 {olahraga, di antaranya adalah target gula darah yang diperbolehkan
untuk }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {olahrag
a, penyesuaian diet, insulin serta monitoring gula darah yang aman. }\par\pard\
li2840\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {Apabila gula darah sebelum
olahraga di atas 250 mg/dl serta didapatkan }\par\pard\li2133\ri0\sl-293\slmult
0 \fs22\cf1\f1\charscalex100 {adanya ketonemia maka dilarang berolahraga. Ap
abila kadar gula darah di }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\c
harscalex100 {bawah 90 mg/dl, maka sebelum berolahraga perlu menambahkan die
t }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {karbohidrat u
ntuk mencegah hipoglikemia. }\par\pard\li1786\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1786\ri0\sl-360\slmult0 \*\tx2133\fs22\cf1\f0\charscalex100\b {4.}\b0 \tab
\fs22\cf1\f0\charscalex100\b {Edukasi }\b0 \par\pard\li2840\ri0\sl-293\slmult0
\fs20\cf1\f1\charscalex100 {Langkah yang tidak kalah penting adalah edukasi
baik untuk penderita }\par\pard\li2133\ri0\sl-293\slmult0 \*\tx3893\*\tx4800\*
\tx5866\*\tx8613\fs22\cf1\f1\charscalex100 {maupun orang}\tab \fs22\cf1\f1\chars
calex100 {tuanya.}\tab \fs22\cf1\f1\charscalex100 {Keluarga}\tab \fs22\cf1\f1\ch
arscalex100 {perlu diedukasi tentang}\tab \fs22\cf1\f1\charscalex100 {penyakitn
ya,}\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {patofisiolog
i, apa yang boleh dan tidak boleh pada penderita DM, insulin }\par\pard\
li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {(regimen, dosis, cara me
nyuntik, lokasi menyuntik serta efek samping }\par\pard\li2133\ri0\sl-293\sl
mult0 \fs22\cf1\f1\charscalex100 {penyuntikan), monitor gula darah dan juga
target gula darah ataupun HbA1c }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1
\f1\charscalex100 {yang diinginkan. }\par\pard\li1786\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li1786\ri0\sl-360\slmult0 \*\tx2133\fs22\cf1\f0\charscalex100\b {5.}
\b0 \tab \fs22\cf1\f0\charscalex100\b {Monitoring kontrol glikemik }\b0 \par\par
d\li2840\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {Monitoring ini menjadi e
valuasi apakah tatalaksana yang diberikan sudah }\par\pard\li2133\ri0\sl-293\slm
ult0 \fs22\cf1\f1\charscalex100 {baik atau belum. Kontrol glikemik yang baik a
kan memperbaiki kualitas hidup }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f
1\charscalex100 {pasien, termasuk mencegah komplikasi baik jangka pendek mau
pun jangka }\par\pard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {pan
jang. Pasien harus melakukan pemeriksaan gula darah berkala dalam sehari.}\par\p
ard\li2133\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Setiap 3 bulan memer
iksa HbA1c. Di samping itu, efek samping pemberian }\par\pard\sect\sectd\sbk
none\pgwsxn11893\pghsxn16826\marglsxn666\margrsxn133\cols2\colno1\colw9226\colsr
-0\colno2\colw1866\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f2\charsca
lex100 {Annang Giri Moelyo,dr, SpA, MKes }\fs22\cf1\f2\charscalex100 {\uc1\u8211
X}\fs22\cf1\f2\charscalex100 { Fakultas Kedokteran UNS }\par\column\pard\li0\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0
\ri0\sl-266\slmult0 \fs22\cf1\f2\charscalex100 {Page 6 }\par\pard\sect\sectd\sbk
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\pard\li1440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1440\ri0\sl-213\slmult0 \fs
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x100 {Brink SJ, Lee WRW, Pillay K, Kleinebreil (2010). Diabetes in children and
adolescents,}\par\pard\li1440\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {bas
ic training manual for healthcare professionals in developing countries, 1}\fs14
\cf1\f1\charscalex100 {st}\fs22\cf1\f1\charscalex100 { ed. }\par\pard\li1440\ri0
\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Argentina: ISPAD, h 20-21. }\par\par
d\li1440\ri0\sl-413\slmult0 \fs22\cf1\f1\charscalex100 {Weinzimer SA, Magge S (2
005). Type 1 diabetes mellitus in children. Dalam: Moshang T}\par\pard\li1440\ri
0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Jr. Pediatric endocrinology. Philad

elphia: Mosby Inc, h 3-18. }\par\pard\li1440\ri0\sl-400\slmult0 \fs22\cf1\f1\cha

rscalex100 {Rustama DS, Subardja D, Oentario MC, Yati NP, Satriono, Harjantien N
(2010).}\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Diabete
s Melitus. Dalam: Jose RL Batubara Bambang Tridjaja AAP Aman B. Pulungan,}\par\p
ard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {editor. Buku Ajar Endo
krinologi Anak, Jakarta: Sagung Seto 2010, h 124-161. }\par\pard\li1440\ri0\sl-4
13\slmult0 \fs22\cf1\f1\charscalex100 {ISPAD Clinical Practice Consensus Guideli
nes 2009.}{ }\fs22\cf1\f0\charscalex100\i {Pediatric Diabetes 2009: 10.}\i0 \par
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sl-373\slmult0 \fs22\cf1\f0\charscalex100\b {MENGENAL HIPOTIROID KONGENITAL }\b0
\par\pard\li3600\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li3600\ri0\sl-360\slmult
0 \fs22\cf1\f1\charscalex100 {Annang Giri Moelyo, dr, SpA, MKes }\par\pard\li238
6\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Bagian/SMF Ilmu Kesehatan Anak
Fakultas Kedokteran UNS }\par\pard\li4280\ri0\sl-293\slmult0 \fs22\cf1\f1\charsc
alex100 {annang.gm@fk.uns.ac.id }\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\pa
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lt0 \fs22\cf1\f0\charscalex100\b {Definisi dan Epidemiologi }\b0 \par\pard\li144
0\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Hipotiroid adalah keadaan yan
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3\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {kelainan pada hipotalamus (LaFr
anchi S. 2000). }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100
{Prevalensi di seluruh dunia sekitar 1:3000-4000. Pada penderita sindroma
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rscalex100 {Tidak ada perbedaan kasus ini }\par\pard\li733\ri0\sl-293\slmult0
\fs22\cf1\f1\charscalex100 {berdasarkan jenis kelamin, tetapi penelitian lain me
ngatakan perempuan lebih tinggi daripada }\par\pard\li733\ri0\sl-280\slmult0 \fs
22\cf1\f1\charscalex100 {laki-laki, yaitu 2:1. (LaFranchi S. 2000; Fort PF, Bro
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s22\cf1\f1\charscalex100 {Caplin N, Alter CA. 2005) }\par\pard\li733\ri0\sl-213\
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lex100\b {Patogenesis }\b0 \par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\char
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scalex100 {yaitu suatu pertumbuhan dari endoderm pada}\tab \fs20\cf1\f0\charsca
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pouches}\i0 \fs20\cf1\f1\charscalex100 { ke-4 dan mencapai posisi orang }\par\p
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\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {2005; Rossi WC, Capli
n N, Alter CA. 2005). }\par\pard\li1440\ri0\sl-293\slmult0 \fs20\cf1\f1\charscal
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fetal }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {secara f
ungsional sudah bebas dari pengaruh aksis pituitari-tiroid maternal. Produksi
T3 }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {(triiodotiro
nin) tergantung dari maturasi enzim deiodinase hepar, yaitu sekitar umur 30 ming
gu }\par\pard\li733\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {gestasi (Fort
PF, Brown RS. 1996; Rossi WC, Caplin N, Alter CA. 2005). }\par\pard\li1440\ri0\
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mult0 \fs22\cf1\f1\charscalex100 {iodida akan berikatan dengan molekul tirosi
n sehingga terbentuk Monoiodotirosin (MIT) dan }\par\pard\li733\ri0\sl-293\
slmult0 \*\tx5306\fs20\cf1\f1\charscalex100 {Diiodotirosin (DIT). Kemudian ter
jadi proses}\tab \fs20\cf1\f0\charscalex100\i {coupling}\i0 \fs20\cf1\f1\charsca
lex100 {. Dua molekul DIT akan membentuk }\par\pard\li733\ri0\sl-293\slmult0 \f
s22\cf1\f1\charscalex100 {tetraiodotironin=tiroksin (T4) dan satu molekul MI
T dengan satu molekul DIT akan }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsx
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\f2\charscalex100 {Annang Giri Moelyo,dr, SpA, MKes}{ }\fs24\cf1\f2\charscalex10

0 {\uc1\u8211X}\fs24\cf1\f2\charscalex100 { Fakultas Kedokteran UNS }\par\colum

n\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-320\slmult0 \fs24\cf
1\f2\charscalex100 {Page 1 }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16826
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{\sp{\sn fLayoutInCell}{\sv 1}}}}\pgwsxn11893\pghsxn16826\marglsxn666\margrsxn13
3\margtsxn666\margbsxn333\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs22\cf1\f1\charscalex100 {membentu
k triiodotironin (T3). Tiroglobulin dengan T3 dan T4 berikatan dan disimpan dala
m}\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {lumen folikel.}
\fs14\cf1\f1\charscalex100 {4}\fs22\cf1\f1\charscalex100 { TSH akan mengaktifkan
enzim-enzim yang dibutuhkan untuk melepaskan ikatan }\par\pard\li733\ri0\sl-293
\slmult0 \fs20\cf1\f1\charscalex100 {T3 dan T4 dari tiroglobulin. T4 merupakan h
ormon utama yang diproduksi dan dilepaskan oleh }\par\pard\li733\ri0\sl-293\slmu
lt0 \fs20\cf1\f1\charscalex100 {kelenjar tiroid dan hanya 10-40% dari T3 dalam s
irkulasi yang dilepaskan oleh kelenjar tiroid, }\par\pard\li733\ri0\sl-280\slmul
t0 \fs20\cf1\f1\charscalex100 {sedangkan sisanya dihasilkan dari proses monod
eiodonisasi dari T4 di kelenjar perifer. (Lane }\par\pard\li733\ri0\sl-293\slmu
lt0 \fs22\cf1\f1\charscalex100 {PA, Nuss R, Ambruso DR. 2001; Guyton AC. 1995).

}\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {T3 merupakan m

ediator utama yang mempunyai efek biologis dari kelenjar tiroid }\par\pard\li
733\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {dengan mengadakan interaksi
dengan }{ }\fs20\cf1\f0\charscalex100\i {reseptor nuclear specific}\i0 \fs20
\cf1\f1\charscalex100 {. Bila terjadi abnormalitas dari }\par\pard\li733\ri0\s
l-293\slmult0 \fs22\cf1\f1\charscalex100 {reseptor tersebut akan mengakibatkan
terjadinya hormon tiroid resisten. Pemeriksaan T3}\par\pard\li733\ri0\sl-29
3\slmult0 \fs22\cf1\f1\charscalex100 {dilakukan apabila dicurigai adanya resi
sten hormon tiroid yaitu ditemukan gejala klinis }\par\pard\li733\ri0\sl-2
93\slmult0 \fs22\cf1\f1\charscalex100 {hipotiroid namun kadar T4 dan TSH-nya nor
mal, serta dibuktikan tidak adanya kelainan kadar }\par\pard\li733\ri0\sl-293\sl
mult0 \fs22\cf1\f1\charscalex100 {T3 (Fadil R. 2005; Rossi WC, Caplin N, Alter C
A. 2005; Guyton AC. 1995). }\par\pard\li1440\ri0\sl-280\slmult0 \fs22\cf1\f1\ch
arscalex100 {Pengaruh kadar hormon tiroid ibu terhadap fetus sangat minimal
, tapi penyakit tiroid }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charsca
lex100 {ibu dapat mempengaruhi fungsi kelenjar tiroid fetus atau neonatus. Hormo
n T4 dapat melewati }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex1
00 {plasenta secara bebas, sedangkan hormon-hormon tiroid lain tidak (LaFr
anchi S. 2000). }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {
Autoantibodi IgG pada ibu penderita tiroiditis autoimun dapat melewati plase
nta dan akan }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {me
nghambat fungsi kelenjar tiroid fetus (Dussault JH, Fisher DA. 1999). Tiamin yan
g dipakai}\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {untuk t
erapi hipertiroid dapat memblok sintesis hormon tiroid fetal, tapi kebany
akan hal ini }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {b
ersifat transien. Iodium radioaktif yang dipakai ibu hamil akan merusak kelen
jar tiroid fetus }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100
{secara permanen (Fadil R. 2005; Lane PA, Nuss R, Ambruso DR. 2001). Obat
-obat lain yang}\par\pard\li733\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {
dapat mempengaruhi kelenjar tiroid adalah litium, estrogen, testosteron, sali
silat dan }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {antik
onvulsan
(karbamazepin, fenobarbital, difenilhidantoin, fenitoin) (Rossi W
C, Caplin N, }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Al
ter CA 2005; Lane PA, Nuss R, Ambruso DR. 2001). }\par\pard\li1440\ri0\sl-293\sl
mult0 \fs22\cf1\f1\charscalex100 {Hormon tiroid memberikan efek yang luas pad
a pertumbuhan, perkembangan dan }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f
1\charscalex100 {metabolisme, termasuk perubahan konsumsi oksigen, metabolisme
protein, karbohidrat, lipid }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\
charscalex100 {dan vitamin (Rossi WC, Caplin N, Alter CA. 2005; Guyton AC. 1995)
.}{ }\fs22\cf1\f1\charscalex100 {Hormon tiroid diperlukan }\par\pard\li733\ri0\s
l-293\slmult0 \fs22\cf1\f1\charscalex100 {untuk pertumbuhan otak dan proses miel
inisasi dari sistem konektivitas jaringan saraf. Periode}\par\pard\li733\ri0\sl293\slmult0 \fs22\cf1\f1\charscalex100 {kritis terbesar untuk perkembangan ota
k akan dipengaruhi hipotiroid, yaitu pada beberapa }\par\pard\li733\ri0\sl293\slmult0 \fs22\cf1\f1\charscalex100 {minggu atau bulan setelah lahir (Fadil R
. 2005). }\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-360
\slmult0 \fs22\cf1\f0\charscalex100\b {Etiologi}\b0 \par\pard\li1440\ri0\sl-293\
slmult0 \fs20\cf1\f1\charscalex100 {Etiologi dari hipotiroid kongenital tidak
selalu mudah diketahui. Beberapa etiologi }\par\pard\li733\ri0\sl-293\slmult0
\fs22\cf1\f1\charscalex100 {adalah sebagai berikut: }\par\pard\li733\ri0\sl-320
\slmult0 \*\tx906\fs22\cf1\f0\charscalex100 {-}\tab \fs22\cf1\f1\charscalex100 {
tiroid agenesis, tiroid disgenesis (aplasia, hipoplasia), tiroid ektopik sekitar
75-85%. }\par\pard\li733\ri0\sl-293\slmult0 \*\tx906\fs22\cf1\f0\charscalex100
{-}\tab \fs22\cf1\f1\charscalex100 { dishormogenesis (}\fs22\cf1\f0\charscalex10
0\i {TSH unresponsiveness}\i0 \fs22\cf1\f1\charscalex100 {, }{ }\fs22\cf1\f0\cha
rscalex100\i {iodine trapping defect}\i0 \fs22\cf1\f1\charscalex100 {, defek
organifikasi, defek }\par\pard\li906\ri0\sl-266\slmult0 \fs22\cf1\f1\charscalex
100 {tiroglobulin, defisiensi atau insensitif terhadap TRH) sekitar 10-18%.}\par
\pard\li733\ri0\sl-333\slmult0 \*\tx906\fs22\cf1\f0\charscalex100 {-}\tab \fs22\
cf1\f1\charscalex100 {disfungsi aksis hipotalamik-pituitari-tiroid sekitar 5%. }

\par\pard\li733\ri0\sl-293\slmult0 \*\tx906\fs22\cf1\f0\charscalex100 {-}\tab \f

s22\cf1\f1\charscalex100 {transplasental obat antitiroid dari ibu ke bayi (iodiu
m, obat-obatan atau antibodi ibu) sekitar }\par\pard\li906\ri0\sl-253\slmult0 \f
s22\cf1\f1\charscalex100 {10%. }\par\pard\li733\ri0\sl-333\slmult0 \*\tx906\fs22
\cf1\f0\charscalex100 {-}\tab \fs22\cf1\f1\charscalex100 {resistensi jaringan pe
rifer terhadap hormon tiroid. }\par\pard\li733\ri0\sl-293\slmult0 \*\tx906\fs22\
cf1\f0\charscalex100 {-}\tab \fs22\cf1\f1\charscalex100 {ibu yang mengkonsumsi m
akanan goitrogenik (Fadil R. 2005; Djemli A, dkk. 2004; Caron P, }\par\pard\li90
6\ri0\sl-253\slmult0 \fs22\cf1\f1\charscalex100 {dkk. 2003; Unachak K, Dejkhamro
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l-426\slmult0 \fs24\cf1\f2\charscalex100 {Annang Giri Moelyo,dr, SpA, MKes}{ }\f
s24\cf1\f2\charscalex100 {\uc1\u8211X}\fs24\cf1\f2\charscalex100 { Fakultas Kedo
kteran UNS }\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-386\slmult0 \fs24\cf1\f2\charscalex
100 {Page 2 }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16826\marglsxn666\ma
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rd\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf

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\fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs22\cf1\f0\charscalex100\b {Manife
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{Manifestasi klinik tergantung dari tingkat fungsi kelenjar tiroid. Gejala
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khas seringkali ringan atau tidak ada selama minggu-minggu pertama kehidupan
. Hanya 10-}\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {15%
bayi baru lahir dengan hipotiroid yang terlihat secara klinis (Fort PF, Brown RS
. 1996).}\par\pard\li1440\ri0\sl-280\slmult0 \fs20\cf1\f1\charscalex100 {Manifes
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san, }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {hipotonia o
tot, fontanel anterior dan posterior terbuka dan lebar, pucat, sianosis perifer,
suara }\par\pard\li733\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {tangis se
rak, konstipasi, hipotermi, dan }{ }\fs20\cf1\f0\charscalex100\i {prolonged phy
siologic jaundice }\i0 { }\fs20\cf1\f1\charscalex100 {(Kappy MS, Steelman }\par
\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {JW, Travers SH, Zeitl
er PS. 2001)}\fs22\cf1\f0\charscalex100\i {.}\i0 \par\pard\li1440\ri0\sl-293\slm
ult0 \fs22\cf1\f1\charscalex100 {Manifestasi klinis lanjut berupa depresi }{
}\fs22\cf1\f0\charscalex100\i {nasal bridge}\i0 \fs22\cf1\f1\charscalex100 {,
muka yang sempit (}\fs22\cf1\f0\charscalex100\i {narrow }\i0 \par\pard\li733\ri
0\sl-293\slmult0 \*\tx1826\fs22\cf1\f0\charscalex100\i {forehead),}\i0 \tab \fs2
2\cf1\f1\charscalex100 {kelopak mata bengkak, kulit kasar tebal dan kering,
rambut kasar, lidah besar, }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\
charscalex100 {distensi abdomen, hernia umbilikalis, refleks menurun, bradikar
dia, kardiomegali, efusi }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charsc
alex100 {perikardial asimtomatik, hipotensi, gangguan tekanan nadi, tuli ne
urosensoris, anemia tak }\par\pard\li733\ri0\sl-280\slmult0 \*\tx5053\fs20\cf1
\f1\charscalex100 {berespon terhadap besi, dapat terjadi}\tab \fs20\cf1\f0\cha
rscalex100\i {slipped capital femoral epiphysis}\i0 \fs20\cf1\f1\charscalex100 {
, gangguan }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {pertu
mbuhan dan perkembangan, retardasi mental, maturasi seksual terlambat, }\fs22\cf
1\f0\charscalex100\i {Kocher-Debre }\i0 \par\pard\li733\ri0\sl-293\slmult0 \fs20
\cf1\f0\charscalex100\i {semeliain syndrom}\i0 \fs20\cf1\f1\charscalex100 { ya
ng terdiri dari hipertropi seluruh otot sehingga anak seperti }{ }\fs20\cf1\f
0\charscalex100\i {Herculean }\i0 \par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f
0\charscalex100\i {appearance }\i0 \fs22\cf1\f1\charscalex100 {(Fadil R. 2005; K
appy MS, Steelman JW, Travers SH, Zeitler PS. 2001)}\fs22\cf1\f0\charscalex100\i
{.}\i0 \par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-373\s
lmult0 \fs22\cf1\f0\charscalex100\b {Pemeriksaan penunjang}\b0 \par\pard\li733\r
i0\sl-293\slmult0 \*\tx1080\fs22\cf1\f0\charscalex100\b {1.}\b0 \tab \fs22\cf1\f
0\charscalex100\b {Laboratorium}\b0 \par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf
1\f1\charscalex100 {Pemeriksaan laboratorium adalah pemeriksaan darah rutin/d
arah perifer lengkap dan }\par\pard\li1080\ri0\sl-280\slmult0 \fs22\cf1\f1\ch
arscalex100 {fungsi tiroid (TSH, T4, T3, TBG). Pemeriksaan fungsi tiroid yang di
periksa untuk hipotiroid }\par\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\chars
calex100 {adalah TSH, T4 total (TT4), atauT4 bebas (fT4). }\par\pard\li1440\ri0\
sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Kadar TSH normal di bawah 20-25 uU/ml
setelah 24 jam pertama kehidupan. Bila kadar}\par\pard\li1080\ri0\sl-293\slmult
0 \fs22\cf1\f1\charscalex100 {TSH antara 25-50 uU/ml maka perlu evaluasi leb
ih lanjut seperti kadar T4. Bila kadar }\par\pard\li1080\ri0\sl-293\slmult0
\fs22\cf1\f1\charscalex100 {TSH>50 uU/ml kemungkinan hipotiroid kongenital
sangat besar. Pada pasien ini kadar }\par\pard\li1080\ri0\sl-293\slmult0 \fs2
2\cf1\f1\charscalex100 {TSH 494,46 uIU/ml, sehingga didiagnosis hipotiroid kong
enital primer. Kadar TSH yang}\par\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f
1\charscalex100 {sangat tinggi dan kadar fT4 yang sangat rendah kebanyakan karen
a atireosis/aplasia tiroid,}\fs12\cf1\f1\charscalex100 {19 }\par\pard\li1080\ri0
\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {dan hasil dari USG pasien menyok
ong diagnosis adanya disgenesis kelenjar tiroid }\par\pard\li1080\ri0\sl-293\s
lmult0 \fs22\cf1\f1\charscalex100 {(hipoplasia). Hasil pemeriksaan kadar AMA d

an ATA yang negatif, menyingkirkan adanya }\par\pard\li1080\ri0\sl-280\slmul

t0 \fs22\cf1\f1\charscalex100 {hipotiroid yang didapat (Fadil R. 2005; Kappy M
S, Steelman JW, Travers SH, Zeitler PS. }\par\pard\li1080\ri0\sl-293\slmult0
\fs22\cf1\f1\charscalex100 {2001). }\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf
1\f1\charscalex100 {Anemia sering terjadi pada pasien hipotiroid. Biasanya anemi
a normositik normokrom, }\par\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\charsc
alex100 {terkadang mikrositik karena penurunan absorpsi besi, atau makrosit
ik karena defisiensi }\par\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\charsca
lex100 {folat dan kobalamin. Gambaran sumsum tulang tampak lemak lebih banyak da
n hiposeluler, }\par\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {
sedangkan eritropoesis biasanya normoblastik. Pada anemia makrositik dan sumsum
tulang }\par\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {megalobl
astik perlu dipikirkan adanya penyakit autoimun sehingga antibodi melawan se
l }\par\pard\li1080\ri0\sl-280\slmult0 \fs22\cf1\f1\charscalex100 {parietal seb
agaimana melawan kelenjar tiroid.Terapi hormon biasanya cukup efektif }\par
\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {memperbaiki anemia t
sb (Lane PA, Nuss R, Ambruso DR. 2001; Kappy MS, Steelman JW, }\par\pard\li1080\
ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {Travers SH, Zeitler PS. 2001; Lan
zkowsky P. 1995). }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16826\marglsxn
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lex100 {: }\par\pard\li1440\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Peme

riksaan radiologis merupakan pemeriksaan penunjang untuk mengetahui beberapa }\p
ar\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {gejala dari hipot
iroid, seperti adanya kardiomegali pada foto toraks, umur tulang yang }\pa
r\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {terlambat (}\fs22\c
f1\f0\charscalex100\i {delayed bone age}\i0 \fs22\cf1\f1\charscalex100 {) (Fadil
R. 2005). }\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-3
60\slmult0 \*\tx1080\fs22\cf1\f0\charscalex100\b {3.}\b0 \tab \fs22\cf1\f0\chars
calex100\b {Sidik tiroid}\b0 \fs22\cf1\f1\charscalex100 {: }\par\pard\li1440\ri
0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {Sintigrafi atau sidik tiroid menggu
nakan Tc99 atau I123 yang dapat membantu }\par\pard\li1080\ri0\sl-293\slmult0 \
fs22\cf1\f1\charscalex100 {menentukan etiologi hipotiroid kongenital. Tidak adan
ya }\fs22\cf1\f0\charscalex100\i {uptake radionuclide }\i0 \fs22\cf1\f1\charscal
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0 {kemungkinan }{ }\fs22\cf1\f0\charscalex100\i {sporadic athyroid hipotiroidism
}\i0 \fs22\cf1\f1\charscalex100 {, tiroid ektopik di lingual atau sublingual }\
par\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {(Fadil R. 2005).
}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-373\slmult0
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tiroid tapi pemeriksaan ini tidak }\par\pard\li1080\ri0\sl-293\slmult0 \fs22\cf1
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r\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-373\slmult0 \fs2
2\cf1\f0\charscalex100\b {Pengobatan }\b0 \par\pard\li1440\ri0\sl-293\slmult0 \f
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arscalex100 {
6-8 }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16826\margl
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2-3 }\par\pard\li1440\ri0\sl
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{overtreatment}\i0 \tab \fs22\cf1\f1\charscalex100 {yang harus dievaluasi selam

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f1\f0\charscalex100\b {Prognosis }\b0 \par\pard\li1440\ri0\sl-293\slmult0 \fs22\
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erikan hasil yang lebih }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charsca
lex100 {baik (Caron P, dkk. 2003; Narendra MB. 2002).Meskipun demikian, studi me
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edikit }\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {(Hanukogl
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rd\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-293\
slmult0 \fs22\cf1\f0\charscalex100\b {DAFTAR PUSTAKA}\b0 \par\pard\li733\ri0\sl213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733
\ri0\sl-266\slmult0 \fs22\cf1\f1\charscalex100 {LaFranchi S (2000). Disorders of
the thyroid gland. Dalam: Behrman RE, Kliegman RM, Jenson }\par\pard\li733\ri0\
sl-293\slmult0 \fs22\cf1\f1\charscalex100 {HB. Nelson textbook of pediatrics. Ed
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ult0 \fs20\cf1\f1\charscalex100 {Fort PF, Brown RS (1996). Thyroid disorders
in infancy. Dalam:Lifshitz F. Pediatric }\par\pard\li733\ri0\sl-293\slmult0 \
fs22\cf1\f1\charscalex100 {Endocrinology. Edisi ke-3. New York: Marcel Dekker In
c:369-381. }\par\pard\li733\ri0\sl-400\slmult0 \fs20\cf1\f1\charscalex100 {Fadil
R (2005). Hipotiroid kongenital. Dalam: Simposium peran endokrinologi ana
k dalam }\par\pard\li733\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex100 {proses
tumbuh kembang anak. Padang: Bagian IKA FK Unand bekerjasama dengan UKK }
\par\pard\li733\ri0\sl-293\slmult0 \fs22\cf1\f1\charscalex100 {Endokrinologi Ana
k IDAI. h. 8-17. }\par\pard\li733\ri0\sl-413\slmult0 \fs20\cf1\f1\charscalex100
{Djemli A, Fillion M, Belgoudi J, Lambert R, dkk (2004). Twenty years later:
a reevaluation of }\par\pard\li733\ri0\sl-293\slmult0 \fs20\cf1\f1\charscalex
100 {the contribution of plasma thyroglobulin to the diagnosis of thyroid dysgen
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73\slmult0 \fs20\cf1\f1\charscalex100 {Rossi WC, Caplin N, Alter CA (2005).
Thyroid disorders in children. Dalam:Moshang T, Jr. }\par\pard\li733\ri0\sl-2
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