International Journal of Pediatric Otorhinolaryngology
Changes in growth pattern, body composition and biochemical markers of growth after adenotonsillectomy in prepubertal children
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.
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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
References (26)
- et al.
Obstructive sleep apnea syndrome due to adenotonsillar hypertrophy in infants
Int. J. Pediatr. Otorhinolaryngol.
(2003) - et al.
The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome
J. Pediatr.
(1999) - et al.
Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children
Lancet
(1990) - et al.
Complications of pediatric obstructive sleep apnea
Otolaryngol. Clin. North Am.
(1990) - et al.
A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy
Int. J. Pediatr. Otorhinolaryngol.
(1987) - et al.
Leptin levels and IGF-binding proteins in malnourished children: effect of weight gain
Nutrition
(2002) - et al.
The effects of adenotonsillectomy on growth in young children
Otolaryngol. Head Neck Surg.
(1991) - et al.
Short stature caused by obstructive apnoea during sleep
Arch. Dis. Child.
(1984) - et al.
Determinants of growth in children with the obstructive sleep apnea syndrome
J. Pediatr.
(1994) - et al.
Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea
Acta Endocrinol. (Copenhagen)
(1987)