Introduction: The commonest cause of paediatric hyperthyroidism is Graves' disease. Previous studies in the Malaysian context haven’t captured data from Negeri Sembilan. This study aims to describe the demographic and clinical features of children with hyperthyroidism from Hospital Tuanku Jaafar. Methodology: A retrospective cohort study collating socio-demographic and clinical data from electronic medical records was conducted. Statistical analysis was conducted using Microsoft Excel (v2602). Results: Fourteen children between 2015 and 2025 were identified. Females comprised 93% (n = 13). The mean age at diagnosis was 9.76 ± 3.4 years, with 64% (n = 9) aged >10 years. Malay ethnicity comprised 64% (n = 9). Family history was positive in 43% (n = 6). Three (21%) children were detected on routine screening. At presentation, 50% (n = 7) were prepubertal and 36% (n = 5) were underweight, with mean BMI SDS −1.4 ± 1.2. All had high fT4 78.43 ± 72 pmol/L and suppressed TSH TRAb positivity was 86% (n = 12). AntiTPO or anti-thyroglobulin antibodies positivity was 79% (n = 11). In one child, all three antibodies were negative. Thyroiditis was the commonest ultrasound finding. Carbimazole starting dose was 0.6 mg/kg/day and average treatment duration was 3.5 ± 2.4 years, which achieved biochemical euthyroidism in 49 days. Relapse rate on carbimazole was 57% (n = 8). No adverse effects occurred, and none had definitive therapy. Currently, 71% (n = 10) are euthyroid on a mean carbimazole dose of 0.2 mg/kg/ day; one is off carbimazole. Current height is −1.1 ± 1.31 SD and BMI SDS −0.42 ± 1.7 SD respectively. Conclusion Graves’ disease is the commonest form of paediatric hyperthyroidism in Negeri Sembilan, affecting prepubertal Malay females who commonly present with thyrotoxicosis. Carbimazole effectively achieves biochemical euthyroidism with minimal side effects. However, linear growth is affected. Future studies should evaluate the factors associated with these findings.
Child ; Retrospective Studies ; Hyperthyroidism

Introduction: Hyperinsulinemic hypoglycemia of infancy may be congenital or acquired, and rarely due to factitious hypoglycemia imposed by another. A thorough medical and social history, critical sampling, and screening for inborn errors of metabolism are crucial. Case: A 5-month-old, ex-29 weeker, twin female infant, born to a non-consanguineous couple was admitted at 4 months with severe refractory hypoglycemia and seizures requiring a glucose infusion rate (GIR) of 16 mg/kg/min. Critical sampling suggested hypoglycemia due to exogenous insulin: glucose 1.1 mmol/L, ketones 0.2 mmol/L, insulin 1,208 pmol/L (17.8–173), and C-peptide 18.2 pmol/L (366– 1,466). Free fatty acids were not raised; growth hormones were 2.223 µg/L (0.14–6.27) and cortisol >1,000 nmol/L (145.4–619.4). Metabolic and genetic testing excluded glycogen storage disorder. Two months prior, she was admitted with a severe human metapneumovirus and parainfluenza infection, hypoglycemia, lactic acidosis and left ventricular hypertrophy. Her twin had died of sudden infant death syndrome. Examination revealed a small puncture mark on the abdomen, but otherwise it was unremarkable. The GIR dropped dramatically over 3 days and the intravenous dextrose was discontinued. Normoglycemia was maintained on 3-hourly feeds and she tolerated an age-appropriate fast before discharge. No hypoglycemic episodes were reported. Of note, the mother suffered from bipolar disorder and had access to insulin for gestational diabetes mellitus. The infant is currently in foster care, is scheduled to have neuroimaging and continues to have growth and developmental follow-up. Conclusion Factitious hypoglycemia should be suspected when there are red flags in the clinical history and critical sampling demonstrates high insulin levels, suppressed C-peptide in the face of hypoglycem ia with low ketones and low free fatty acids. A multidisciplinary approach involving paediatrics, psychiatry, and child protective services is mandatory
Infant ; Hypoglycemia

Introduction: Intralesional triamcinolone acetonide (TAC) is an accepted management option for paediatric keloid. TAC is a corticosteroid with five times the potency of hydrocortisone and acts by inhibiting fibroblast growth and thus keloid size. Dermatological adverse effects of TAC are common, but repeated high-dose intralesional TAC can cause the rare complication of Cushing syndrome and suppression of the hypothalamic–pituitary–adrenal (HPA) axis. Case: We report the case of an 11-year-old female referred for worsening lower limb striae and low serum cortisol. Prior to referral, intralesional TAC was administered by a general practitioner to a left lower limb keloid which had developed following an orthopedic intervention. A total of five injections were administered over 4 months: a cumulative dose of 150 mg (equivalent to 700 mg hydrocortisone). The last dose was administered 6 months prior to referral. The morning serum cortisol was low (<13.8 nmol/L) with a concomitantly low adrenocorticotropic hormone (ACTH 0.41 pmol/L) level, consistent with suppression of the HPA axis secondary to exogenous steroids. Renin (84.80 mU/L), aldosterone (280.40 pmol/L), testosterone (0.31 nmol/L), estradiol (85.9 pmol/L) and thyroid function were normal. Physiological oral hydrocortisone replacement was promptly commenced, with education on adrenal crisis and sick days while awaiting recovery of the HPA axis. Conclusion This case illustrates the serious complication of Cushing syndrome with secondary HPA axis suppression due to repeated intralesional TAC therapy for paediatric keloid scars. Factors such as appropriate paediatric doses, size of the keloid, site of injection (dermal, not subcutaneous), and frequency of injections should all be given due consideration before using TAC. Clinicians prescribing steroids to children should be aware that suppression of the HPA axis is a very real and life-threatening complication and that steroids should be prescribed judiciously.
Child ; Keloid ; Triamcinolone

Introduction: Evidence showed considerable variability of health risk factors within different socioeconomic groups. This study aimed to characterise dietary intakes by total household income among a sample of Malaysian pre-adolescents in urban Kuala Lumpur. Methods: Baseline data of 243 healthy, pre-adolescent children between 9 and 11 years old including socio-demographic background (gender, ethnicity, and total household monthly income), anthropometry (body weight and height), and 7-day diet histories were collected. Secondary analysis was performed on dietary intakes to quantify food groups based on the Malaysian Dietary Guidelines and NOVA classification systems besides nutrients. Differences and associations between total monthly household income categories with anthropometry and dietary intakes were tested using independent t-test/Mann-Whitney U (depending on normality) and chi-square tests, respectively. Results: Most children in this study population had dietary intakes below the recommended serving sizes for five food groups, except meat/poultry (195.2±107.2%) and fish (110.1±106.3%) and consumed about 32% of energy from ultra-processed foods (NOVA food group 4). While there was no difference in dietary intake between the bottom 40% with the middle 40% and high 20% household income groups, the percentage of energy contributed by NOVA food group 4 (processed fats/oils, condiments, and sauces) was higher in the bottom 40% households (p=0.024). Conclusion: Most pre-adolescent children in this study, regardless of household income, did not meet dietary recommendations and ate diets comprised of less nutritious foods. Comprehensive approaches that aim to improve dietary patterns and reduce the risk of diet-related chronic diseases are warranted.

Stunting is a common phenomenon in Malaysian children. Optimising outcomes for children with growth disorders rests on early recognition and prompt referral. In this context, a framework for the clinical approach can help to guide appropriate growth assessment and referral. This review article aims to provide family medicine specialists with such a framework whilst raising awareness about the shortcomings of the existing growth monitoring system in Malaysia. It also invites readers to consider additional measures that could further optimise this system.