Changes in IGF-I, IGFBP-3 and ghrelin levels after adenotonsillectomy in children with sleep disordered breathing

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Abstract

Objective

The aim of this study was to determine the changes in insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein-3 (IGFBP-3) and ghrelin levels following adenotonsillectomy (T&A) in children with sleep disordered breathing (SDB).

Methods

Forty children (mean age 4.85 ± 2.15 years) clinically diagnosed with adenotonsillar hypertrophy (ATH) related SDB were enrolled. All children underwent T&A. Serum levels of IGF-I, IGFBP-3 and ghrelin were measured before and 6 months after T&A.

Results

Serum levels of IGF-I and IGFBP-3 were significantly higher after T&A (p < 0.001). Serum ghrelin levels showed a significant decrease after T&A (p < 0.001).

Conclusion

Children with ATH related SDB who underwent T&A showed significant increases in IGF-I and IGFBP-3 levels indicating an increase in diurnal growth hormone secretion as well as a significant decrese in ghrelin levels indicating an increased oral food intake in the postoperative period.

Introduction

Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction and sleep disordered breathing (SDB) in children [1], [2], [3], [4], [5]. Failure to thrive and catch-up growth after tonsillectomy and adenoidectomy (T&A) have been well documented in these children [1], [2], [3], [4], [5], [6], [7], [8]. Although the exact mechanism is unclear, poor growth can be attributed to low caloric intake due to poor appetite and dysphagia, abnormal nocturnal growth hormone (GH) secretion, high energy expenditure as a consequence of increased work of breathing during sleep, nocturnal hypoxemia, nocturnal acidosis and increased motor activity during the day [1], [2], [3], [4], [7], [8], [9], [10]. Insulin-like growth factor-I (IGF-I) and its carrier insulin-like growth factor binding protein-3 (IGFBP-3) are highly correlated with diurnal GH secretion and reflect mean daily GH levels [1], [2], [3], [4], [6], [7], [8], [11], [12], [13]. Ghrelin, secreted from the stomach, is a potent stimulator of GH release that has been implicated in weight gain induction by stimulating food intake and reducing fat use [14], [15], [16], [17], [18], [19], [20], [21]. Plasma ghrelin levels are increased in anorexia nervosa (AN), low caloric intake and cancer associated cachexia whereas they are decreased in obesity and after feeding [14], [19]. The aim of this prospective study was to evaluate the influence of T&A on serum IGF-I, IGFBP-3 and ghrelin levels in children with ATH related SDB.

Section snippets

Study cohort

Forty prepubertal children (22 girls and 18 boys) aged 2–10 years (mean: 4.85 ± 2.15 years) were enrolled in the study. The study cohort was randomly selected from the patients who underwent T&A for ATH related SDB between March 2008 and August 2008. Since IGF-I, IGFBP-3 and ghrelin levels do not fluctuate significantly in 6 months in a growing child, a control group was not established. Exclusion criteria were congenital airway anomalies, asthma, chronic diseases, allergic rhinitis and other

Results

Every single patient had increased levels of IGF-I and IGFBP-3 and reduced levels of ghrelin at postoperative 6th month compared with preoperative measurements (Table 1, Table 2, Table 3). The mean serum levels of IGF-I were increased by 63.6% from 94.3 ± 52.9 ng/ml (before T&A) to 154.3 ± 79.9 ng/ml (6 months after T&A). The mean serum levels of IGFBP-3 were increased by 20.5% from 3.4 ± 1.1 μg/ml to 4.1 ± 1.2 μg/ml (Table 4). The mean serum levels of ghrelin were reduced by 22% from 2186 ± 314.9 pg/ml to

Discussion

ATH, the most common cause of SDB in children, is associated with failure to thrive and reduced nocturnal GH secretion [1], [2], [3], [4], [6]. GH secretion is phasic during a 24-h cycle and closely associated with sleep-wake cycle [1], [3], [6], [11]. GH stimulates IGF-I synthesis in liver and other target tissues [6]. IGF-I reflects daily mean GH levels and correlates well with the physiologic changes in GH secretion [6], [11], [12], [13]. IGF-I is considered as the main mediator of growth

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  • Cited by (22)

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