Changes in serum IGF-1 and IGFBP-3 levels and growth in children following adenoidectomy, tonsillectomy or adenotonsillectomy

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 ± 112.13 ng/ml to 159.82 ± 122.91 ng/ml (p < 0.001) and IGFBP-3 levels increased by 7%, from 3.34 ± 1.17 μg/l to 3.57 ± 1.16 μg/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 −0.06 ± 0.98 to 0.118 ± 1.18, p < 0.001) and heights (mean Z score from 0.30 ± 0.98 to 0.42 ± 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.