Changes in growth pattern, body composition and biochemical markers of growth after adenotonsillectomy in prepubertal children

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Summary

Objective:

Adenotonsillar hypertrophy (ATH) is associated with growth interruption during childhood. The aim of this study was to determine the changes in growth, body composition and biochemical markers associated with growth following adenotonsillectomy (A&T) in prepubertal children.

Study design:

Twenty-eight children aged 3–10 years (mean age 73.90 ± 20.97 months) with ATH were followed up for 1 year after A&T. During the same period of time, 20 healthy children of similar ages (mean age 73.7 ± 18.2 months) were followed up too.

Methods:

Height, weight as well as insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) were measured during the preoperative period, 6 months and 1 year after surgery.

Results:

Height and weight of the patient group significantly increased during the first year after A&T (p < 0.01). Increase in height standard deviation score (SDS) during the first postoperative year reflected a true acceleration of growth (p = 0.04). Height and weight of patients were not significantly below those of their healthy peers at the preoperative measurement. Height velocity of the patients (p = 0.118), which was similar to that of their healthy peers in the first 6 months postoperatively, was significantly higher at the end of the second 6-month period after the operation (p = 0.048). IGF-1 levels of the patient group, which were significantly lower than those of the controls preoperatively (p < 0.001), increased to similar levels 1 year after the operation. IGFBP-3 levels of the patient group increased significantly after postoperative sixth month (p = 0.002).

Conclusion:

Although children with ATH do not have significant growth retardation, their growth rate is slower. Increase in weight and IGF-1 levels followed by the increase in height leads to an acceleration in growth rate after A&T. These results have led to the conclusion that either the levels or effect of growth hormone (GH) increase following A&T.

Introduction

Adenotonsillar hypertrophy (ATH) is the most common cause of chronic upper airway obstruction in children [1]. Not only failure to thrive is more commonly recognized but also complications, namely insufficient weight and height gain have been well documented in these children and “catch-up” growth after A&T has been demonstrated [2], [3], [4]. Although many different reasons such as poor appetite and difficulties in feeding resulting in lower total caloric intake, nocturnal hypoxemia, and nocturnal respiratory acidosis have been implicated, exact etiology of the growth retardation is unknown [2], [3], [5], [6]. Abnormal nocturnal growth hormone (GH) secretion and impaired GH action have also been suggested [4], [7], [8].

Anabolic and growth-promoting effects of growth hormone, the major regulator of postnatal body growth, are mainly mediated by stimulation of the expression of insulin-like growth factor-1 (IGF-1) in liver and the peripheral tissues [9], [10]. Measurement of serum IGF-1 is thus theoretically useful as a screening test for growth hormone deficiency; however, age, pubertal and nutritional status should be considered when evaluating the results [11]. Circulating concentrations of IGF-1 and IGF binding protein-3 (IGFB-3) which seem to correlate well with the physiological changes in GH secretion are strongly related to diurnal GH secretion, thus reflecting mean daily GH levels [12].

Previous studies have revealed a significant increase in body weight and IGF-1 levels following A&T despite the lack of a significant increase in IGFBP-3 levels; however, duration of patient follow-up was rather short in these studies and growth rate was not evaluated [4], [13], [14]. The aim of this study was to evaluate the influence of A&T on growth, body composition and serum IGF-1 and IGFBP-3 levels of children with ATH as well as the height velocity and weight gain and compare these with those of healthy peers.

Section snippets

Patients and methods

Prepubertal children (16 males and 12 females) aged 3–10 years (mean age 73.90 ± 20.97 months) who had chronic recurrent hypertrophic adenotonsillitis accompanied by obstructive symptoms such as night-time snoring, apneas, or difficult breathing were recruited for this study and referred to the Department of Otolaryngology, Head and Neck Surgery at Celal Bayar University, Faculty of Medicine. Those with known upper airway abnormalities, underlying disease predisposing to upper airway obstruction,

Results

In the study group, both the anthropometric measurements and biochemical parameters during a 1-year period were evaluated in two periods of 6 months. Although, height increased significantly during both the first and second 6-month periods postoperatively (p = 0.04), increase in height SDS was found significant only between the preoperative period and postoperative first year (p = 0.04) (Table 1). Body weight increased significantly during both periods of 6 months after the operation (p = 0.0001 and p

Discussion

ATH is associated with interruption of growth in childhood [4], [6], [16], [17]. In this study, prominent growth retardations were not detected in the prepubertal children with ATH. However, heights of these children were shorter than those of their healthy peers at the preoperative period although statistically insignificant. Nevertheless, their heights reached those of their peers at the end of 1 year postoperatively.

One further way to express height (and any other oxological data) is to

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