International Journal of Pediatric Otorhinolaryngology
Changes in IGF-I, IGFBP-3 and ghrelin levels after adenotonsillectomy in children with sleep disordered breathing
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.
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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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Association between adenotonsillar hypertrophy and leptin, ghrelin and IGF-1 levels in children
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2018, Journal of DentistryCitation Excerpt :Further research, however, is still required to confirm the validity of audio recordings of snoring to use as an accurate screening tool for OSA [57]. Improvement in growth hormone levels has been shown to be associated with an AHI reduction in children after adenotonsillectomy [58]. In the current study the pattern toward increased levels of IGF-1 in blood was detected when using the Twin-Block and this warrants further investigation to confirm its significance.
The influence of pediatric tracheostomy on the body weight percentile of children
2016, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :After adenotosillectomy serum levels of insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) are reported to increase and this stimulates a growth spurt [8]. Children who have chronic upper airway obstruction often present with growth impairment due to decrease level of growth hormone release and increase metabolic requirement for respiration [8]. Thus, resolution of airway obstruction by pediatric tracheostomy would be expected to have favorable effects on a patient's growth.
Does adenotonsillectomy alter IGF-1 and ghrelin serum levels in children with adenotonsillar hypertrophy and failure to thrive? A prospective study
2013, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Ghrelin potentially stimulates GH release which in turns affects weight gain by stimulating food intake and reducing fat use [6,7]. Ghrelin levels tend to increase in anorexia nervosas, low caloric intake and cancer-associated cachexia; while they are declined in obesity and after feeding [6]. IGF-1 has two major functions (i.e. GH-like and insulin-like actions) which are dose dependent and could be altered by the duration of use and route of administration.
Response to the letter to the editor regarding "The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: A blind, prospective clinical study"
2012, International Journal of Pediatric OtorhinolaryngologyThe effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: A blind, prospective clinical study
2012, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :In this study, postoperative IGF-I and IGFBP-3 levels at 6–9 months were significantly higher than preoperative levels. These findings are consistent with studies by Nieminen et al., Yılmaz et al., and Gümüşsoy et al. [2,5,10]. We did not evaluate the height and weight changes because the minimum interval to assess the height and weight for evaluation of growth is 9–12 months.