Hypertriglyceridaemia in adolescents may have serious complications.

Acute pancreatitis is an often-overlooked cause of acute abdominal pain in children and adolescents. Severe hypertriglyceridaemia is an important cause of recurrent acute pancreatitis. Monogenic causes of hypertriglyceridaemia, such as familial chylomicronaemia caused by lipoprotein lipase deficiency, are more frequently encountered in children and adolescents, but remain rare. Polygenic hypertriglyceridaemia is more common, but may require a precipitant before manifesting. With the global increase in obesity and type 2 diabetes, secondary causes of hypertriglyceridaemia in children and adolescents are increasing. We report two cases of severe hypertriglyceridaemia and pancreatitis in adolescent females. Hypertriglyceridaemia improved markedly with restriction of dietary fat. An inhibitor to lipoprotein lipase was found to be the cause in one patient, while in the other limited genetic investigation excluded chylomicronaemia owing to deficiency of lipoprotein lipase, its activators and processing proteins.

Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression.

A recently published approach to paediatric asthma management neither recommended screening for nor suggested any management of hypothalamic-pituitary-adrenal axis suppression in asthmatic children treated with corticosteroids. The existing literature on this topic was therefore reviewed and the quality of the evidence assessed. Recommendations for diagnosis, screening and management are made utilising the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Is adrenal suppression in asthmatic children reversible? A case series.

BACKGROUND: Six hypocortisolaemic asthmatic children on steroids given at physiological doses were identified during a previous study. OBJECTIVES: To establish whether hypothalamic-pituitary-adrenal axis suppression (HPAS) could be reversed in hypocortisolaemic asthmatic children treated with steroids without sacrificing asthma control. METHODS: In this case series, treatment of six hypocortisolaemic patients was modified by introducing steroid-sparing asthma medications. Serum cortisol and repeat overnight metyrapone tests (ONMTPTs) were done until HPAS was reversed in all patients. A retrospective folder review was performed and the following data were extracted: body mass index standard deviation score (BMI SDS), adherence, daily steroid type and dose, treatment modification, serum cortisol, final ONMTPT result and time taken to achieve normalisation. RESULTS: The median serum cortisol level recovered to 311 nmol/L after 0.9 years (median). The ONMTPT normalised within 3.3 years (median). Steroid load decreased from 9.2 to 5.0 hydrocortisone equivalent mg/m2/d (medians), while asthma score improved from 1.42 to 0.85 (medians). Poor adherence was noted in two children before and four after treatment modification. BMI SDS decreased from -0.08 to -0.16 (medians). CONCLUSIONS: Hypocortisolaemia and HPAS could be reversed in asthmatic children treated with physiological doses of steroids by reducing steroid load by 40% and supplementing therapy with steroid-sparing medication. Poor adherence may have either contributed to or retarded HPA recovery. Simultaneously, asthma control improved. Confirmation by a prospective study would be ideal, but may not be feasible.

Abnormal thyroid function tests in children on ethionamide treatment.

Ethionamide (ETH) treatment may cause hypothyroidism. Clinical data, serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels were retrospectively assessed in 137 children receiving anti-tuberculosis treatment including ETH. Abnormal thyroid function tests (TFTs) were recorded in 79 (58%) children: elevated serum TSH and suppressed fT4 (n = 30), isolated elevated serum TSH (n = 20), isolated low serum fT4 (n = 28) and isolated low TSH (n = 1). The risk for biochemical hypothyroidism was higher for children on regimens including para-aminosalicylic acid and in human immunodeficiency virus infected children. TFT abnormalities are frequent in children on ETH and are mainly due to primary hypothyroidism or euthyroid sick syndrome.

Protein energy malnutrition and its recognition in outpatient departments in Venda hospitals.

Between April and June 1988 the number of children under 5 years old attending outpatient departments of Venda hospitals who had protein energy malnutrition (PEM) was determined, the proportions at 3 Venda hospitals were compared, and what percentage of these children was detected by attendant health workers was determined. Approximately 6% had severe PEM; this finding was consistent for all 3 hospitals. The rates for mild PEM were 22% for Tshilidzini and Donald Fraser Hospitals and 33% for Siloam Hospital. This statistically significant difference has not been explained. Health workers failed to recognise about 25% of children with severe PEM and 50% of children with mild PEM. It is suggested that certain interventions and activities are essential if PEM is to be adequately managed: these are efficient monitoring; pre-employment and in-service education for health workers; a breast-feeding and weaning survey; and an investigation of the variation of malnutrition among Venda hospitals.

Congenital lymphoedema in a child--an unusual diagnosis of ankle oedema seen at a peripheral hospital. A case report.

A patient with congenital lymphoedema--the clinical picture being that of Milroy's disease--is presented. The diagnosis, differential diagnosis and treatment are discussed and the modified autosomal dominant mode of inheritance with sex influence and variable expressivity is described.