The Effects of Tonsillectomy and Adenoidectomy on Serum IGF‐I and IGFBP3 Levels in Children

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Abstract
Objective Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. Interruption of growth hormone‐insulin‐like growth factor I axis resulting from abnormal nocturnal growth hormone secretion is among the postulated causes. Growth hormone (GH) mediates its anabolic effects on tissues through insulin‐like growth factor I (IGF‐I). Most of the circulating IGF‐I is bound to insulin‐like growth factor binding protein 3 (IGFBP3). The objective of this study is to determine blood serum levels of IGF‐I and IGFBP3 in patients with adenoid and tonsillar hypertrophy. Furthermore, we want to investigate the effect of tonsillectomy and adenoidectomy (T&A) on these levels. Study Design The blood serum levels of IGF‐I and its binding protein IGFBP3 were examined in 41 randomly selected children with a diagnosis of upper airway obstruction resulting from hypertrophic tonsils and adenoids. Methods Blood samples were taken preoperatively and repeated at 3 to 6 months (mean, 4.3 mo) following T&A operation. Coated‐tube immunoradiometric assay (IRMA) method was used to analyze IGF‐I and IGFBP3 levels. Results Thirty‐two of 41 children were eligible for the analysis. When the preoperative and postoperative results were compared, it was found that there was a statistically significant increase in serum IGF‐I and IGFBP3 levels in these 32 children (P <.001). In 7 of the 32 patients, the preoperative serum IGF‐I levels were below normal. Postoperatively these levels increased within normal range. This was also statistically significant (P = .016). Conclusion These findings revealed that obstructive adenoid and tonsillar hypertrophy may cause decreased serum IGF‐I levels by affecting the GH‐IGF‐I axis, and T&A is an effective therapeutic measure in these patients.