Changes in serum IGF-1 and IGFBP-3 levels and growth in children following adenoidectomy, tonsillectomy or adenotonsillectomy Muzaffer Kırıs a , Togay Muderris a, *, Sezgin Celebi b , Hakan Cankaya b , Sami Bercin a a ENT Department, Ankara Ataturk Research and Education Hospital, Ankara, Turkey b ENT Department, Yuzuncu Yıl University Faculty of Medicine, Van, Turkey 1. Introduction Adenotonsillar hypertrophy may cause recurrent tonsillitis and upper airway obstruction in children. A reduced dietary intake and failure to gain weight are frequently reported by the parents of children with a history of recurrent acute tonsillitis [1,2]. Also, it has been shown that sleep disordered breathing (SDB), which is characterized by snoring, mouth breathing and obstructive sleep apnea is a risk factor for growth failure [3,4]. Chronic upper airway obstruction attributable to adenotonsillar hypertrophy is the most common cause of SDB in children [5]. SDB affects an estimated 4–20% of children, while 1–3% experience obstructive sleep apnea [6]. Insufficient weight and height gain have been well documented in children with recurrent tonsillitis and SDB, and ‘‘catch-up’’ growth after adenotonsillectomy (A&T) has been reported [7,8]. Although the exact cause of the poor growth is unknown, many reasons such as low caloric intake caused by poor appetite and dysphagia, high energy consumption due to difficult night breathing, nocturnal hypoxemia and nocturnal acidosis have been implicated [8–10]. Abnormal nocturnal growth hormone (GH) secretion and impaired GH action have also been suggested [11,12]. Nocturnal GH secretion is frequently reduced in clinical conditions involving sleep disorders (e.g. in children with OSAS), and surgical correction of OSAS may restore normal GH secretion [12]. Anabolic and growth promoting effects of GH are mainly mediated by stimulation of the expression of insulin-like growth factor-1 (IGF-1) in liver and the peripheral tissues [11]. Most of the circulating IGF-1 is bound to a carrier protein called insulin-like growth factor binding protein-3 (IGFBP-3). The synthesis of IGFBP- 3 is also controlled by GH. Circulating concentrations of IGF-1 and International Journal of Pediatric Otorhinolaryngology 74 (2010) 528–531 ARTICLE INFO Article history: Received 30 October 2009 Received in revised form 10 February 2010 Accepted 15 February 2010 Keywords: Growth retardation Adenotonsillectomy IGF-1 IGFBP-3 ABSTRACT Objective: The aim of this study is to determine the effect of adenoidectomy, tonsillectomy or adenotonsillectomy on growth. For this purpose, we prospectively reviewed the postoperative changes in serum levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3), weight and height in children that underwent adenoidectomy, tonsillectomy or adenotonsillectomy. Methods: Ninety-six children with symptoms of sleep disordered breathing (SDB) or recurrent adenotonsillitis were enrolled to study. Blood samples were taken preoperatively and repeated at 6 months following operation to determine the changes in serum IGF-1 and IGFBP-3 levels, pre- and postoperative values of weight and height were recorded for each operation. Results: Thirty-six patients underwent adenoidectomy, 52 patients underwent adenotonsillectomy and 8 patients underwent tonsillectomy. Seventy of the operations were performed for SDB and 26 were performed for recurrent adenotonsillitis. The mean serum levels of IGF-1 increased by 26%, from 126.74 Æ 112.13 ng/ml to 159.82 Æ 122.91 ng/ml (p < 0.001) and IGFBP-3 levels increased by 7%, from 3.34 Æ 1.17 mg/l to 3.57 Æ 1.16 mg/l (p < 0.05) 6 months after operation. The increase was independent from the preoperative diagnosis. There was a significant increase both in patients with SDB and in children with recurrent infections (p < 0.001 for IGF-1, p < 0.05 for IGFBP-3). Their Z scores (standard deviation scores) for body weights (mean Z score from À0.06 Æ 0.98 to 0.118 Æ 1.18, p < 0.001) and heights (mean Z score from 0.30 Æ 0.98 to 0.42 Æ 0.88, p < 0.001) were significantly higher 6 months after the operation compared to preoperative period. Conclusions: We found a significant increase in weight, height, and IGF-1 and IGFBP-3 levels of children with SDB or recurrent infections postoperatively. These results suggest that upper airway obstruction may not be the only mechanism that causes retardation on growth in children. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Ankara Ataturk Eg ˘itim Arastırma Hastanesi 2, KBB Klinig ˘i, Bilkent, Ankara, Turkey. Tel.: +90 5055025141; fax: +90 3123105058. E-mail address: togaymuderris@yahoo.com (T. Muderris). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2010.02.014