Evaluation of the effects of adenotonsillar hypertrophy and adenotonsillectomy on growth in children

Abstract

Aim: Several factors including genetic factors nutrition and environment play a critical role in the growth of children Adenotonsillar hypertrophy ATH can cause growth retardation by obstructing the upper airway Surgical treatment of ATH has been considered to have a positive effect on growth The aim of this study was to evaluate the role of chronic ATH on growth by measuring weight height body mass index BMI bone age serum insulin like growth factor 1 IGF 1 and insulin like growth factor binding protein 3 IGFBP 3 values before and after adenotonsillectomy Material and Method: The study was approved by the Ethics Committee 4 5 2004; 04 170 and written informed consents were obtained from parents of the participants A total of 40 prepubertal children who were diagnosed as chronic ATH were enrolled Obstructive symptoms were questioned in the medical history before surgery Weight height BMI and bone age values were measured and compared with reference values Preoperative serum IGF 1 and IGFBP 3 values were compared with the control group which consisted of healthy children Rates of obstructive symptoms weight height BMI bone age serum IGF 1 and IGFBP 3 values of the patients were determined seven months after adenotonsillectomy and were compared with preoperative values Results: Obstructive symptoms in children with ATH decreased remarkably after surgery Preoperative mean value of bone age of the patients was statistically lower than reference values p lt;0 05 and mean value of serum IGF 1 was lower than than the control group p lt;0 05 IGF 1 and IGFBP 3 values did not increase significantly after surgery p gt;0 05 However growth retardation was detected in three out of 40 patients based on the anthropometric measurements Conclusions: In this study antropometric findings showed that chronic ATH did not cause significant growth retardation in prepubertal children In addition we could not prove that surgical treatment of ATH improved the growth in the postoperative follow up period of seven months This result may be related with our study population with a limited number of patients who had baseline growth retardation and short postoperative follow up period Further studies with large number of patients and longer postoperative follow up periods are required to determine the exact role of chronic ATH in growth retardation Turk Arch Ped 2012; 47: 260 6

Keywords

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Çocuklarda kronik adenotonsiller hipertrofinin büyüme üzerine etkilerinin adenotonsillektomi öncesi ve sonrası dönemde değerlendirilmesi

Öz

Amaç: Büyüme genetik beslenme ve çevresel etmenlerin rol oynadığı çok yönlü bir süreçtir Büyüme geriliğine neden olabilecek etmenler arasında üst hava yolu tıkanıklığı yapan adenotonsiller hipertrofi de yer almaktadır Adenotonsiller hipertrofinin cerrahi tedavisinin büyüme üzerine olumlu etkisi olduğu düşünülmektedir Bu çalışmada adenotonsillektomi öncesi ve sonrası dönemde ölçülen ağırlık boy beden kitle indeksi kemik yaşı serum insülin benzeri büyüme faktörü 1 IGF 1 ve insülin benzeri büyüme faktörü bağlama protein 3 IGFBP 3 değerleriyle kronik adenotonsiller hipertrofinin büyüme üzerine etkilerinin gösterilmesi amaçlanmıştır. 

Gereç ve Yöntem: Çalışma için etik kurul onayı 04 05 2004; no: 04 170 ve çocukların velilerinden bilgilendirilmiş gönüllü olur formu alındı Kronik adenotonsiller hipertrofi tanısı konan 40 ergenlik öncesi çocuk çalışmaya dahil edildi Ameliyat öncesi tıkayıcı belirtiler sorgulandı Hastaların ağırlık boy beden kitle indeksi ve kemik yaşı değerleri kaynak değerlerle karşılaştırıldı Ameliyat öncesi ölçülen serum IGF 1 ve IGFBP 3 değerleri 27 sağlıklı çocuktan oluşan kontrol grubununkilerle karşılaştırıldı Adenotonsillektomiden yedi ay sonra bulguların görülme oranı ve ağırlık boy beden kitle indeksi kemik yaşı serum IGF 1 ve IGFBP 3 değerleri saptanarak ameliyat öncesi değerlerle karşılaştırıldı. 

Bulgular: Tıkayıcı belirtilerin ameliyattan sonra belirgin şekilde azaldığı saptandı Hastaların kemik yaşı ortalamaları sağlıklı kaynak değerlere göre düşük bulundu p lt;0 05 Serum IGF 1 değerleri ameliyat öncesi dönemde kontrol grubuna göre istatistiksel olarak anlamlı düşük bulundu p lt;0 05 Ameliyattan sonra IGF 1 ve IGFBP 3 değerlerinde ameliyat öncesi döneme göre anlamlı artış gözlenmedi p gt;0 05 Bununla birlikte antropometrik ölçümlere göre 40 hastanın yalnız üçünde büyüme geriliği saptandı. 

Çıkarımlar: Bu çalışmada antropometrik bulgular kronik adenotonsiller hipertrofinin ergenlik öncesi çocuklarda önemli ölçüde büyüme geriliği yapmadığını göstermiştir Ayrıca adenotonsiller hipertrofinin cerrahi tedavisinin ameliyat sonrası yedi aylık dönemde büyümeyi hızlandırdığına ilişkin yeterli kanıt bulunamamıştır Bu sonuç hasta grubunda ameliyat öncesi büyüme geriliği olan az sayıda hasta olması ve ameliyat sonrası kısa izlem süresine bağlı olabilir Kronik adenotonsiller hipertrofinin ve cerrahi tedavisinin büyüme üzerine etkisinin anlaşılması için daha uzun postoperatif izlem süreli ve geniş çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Adenoid hipertrofi
• adenotonsillektomi
• antropometri
• büyüme
• IGF-1
• IGFBP-3
• kemik yaşı ölçümü
• tonsil hipertrofisi
• tonsillektomi

References

1. Rothschild MA, Catalano P, Biller HF. Ambulatory pediatric tonsillectomy
2. and the identification of high-risk subgroups. Otolaryngology Head Neck Surg 1994; 110(2): 203.
3. Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, Loughlin GM.
4. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr 1994; 125(4): 556-62.
5. Selimoglu E, Selimoglu M, Orbak Z. Does adenotonsillectomy improve
6. growth in children with obstructive adenotonsillar hypertrophy? J Int Med Res 2003;31(2): 84-7.
7. Finkelstein JW, Roffwarg HP, Boyar RM, Kream J, Hellman L. Age
8. related change in the twenty-four hour spontaneous secretion of growth hormone. J Clin Endocrinol Metab 1972; 35(5): 665-70.

9. Guilhaume A, Benoit O, Gourmelen M, Richardet J. Relationship
10. between sleep stage IV deficit and reversible HGH deficiency in psychosocial dwarfism. Pediatr Res 1982; 16(4): 299-303.
11. Leach J, Olson J, Hermann J, Manning S. Polysomnographic and
12. clinical findings in children with obstructive sleep apnea. Arch Otolaryngology Head and Neck Surg 1992; 118(7): 741-4.
13. Basut O. Pediatric obstructive sleep apnea syndrome. Turkiye Klinikleri
14. J ENT 2007; 3(23): 124.
15. Banerjee I, Clayton P. Clinical utility of insulin-like growth factor-I (IGF-I)
16. and IGF binding protein-3 measurements in paediatric practice. Pediatr Endocrinol Rev 2006; 3(4): 393-402.
17. Blum WF, Schweizer R. Insulin-like growth factors and their binding
18. proteins. Diagnostics of endocrine function in children and adolescents Karger, Basel; 2003: 166-99.
19. Clayton P, Hall C. Insulin-like growth factor I levels in healthy children. Horm Res 2004; 62(1): 2-7.
20. Karachaliou F, Stamoyannou L, Maravelias K, Bartsocas C, Koutselinis A. Serum levels of IGFBP-3: usefulness in diagnosis of GH deficiency and relationship to measurements of GH secretion in children. J Pediatr Endocrinol Metab 1996; 9(2): 169-74.
21. Kawai N, Kanzaki S, Takano-Watou S, et al. Serum free insulin-like growth factor I (IGF-I), total IGF-I, and IGF-binding protein-3 concentrations in normal children and children with growth hormone deficiency. J Clin Endocrinol Metab 1999; 84(1): 82-9.
22. Yüksel B, Özbek MN, Mungan NÖ, et al. Serum IGF-1 and IGFBP-3 Levels in healthy children between 0 and 6 years of age. J Clin Res Pediatr Endocrinol 2011; 3(2): 84-8.
23. Wormald P, Prescott C. Adenoids: comparison of radiological assessment methods with clinical and endoscopic findings. J Laryngol Otol 1992; 106(4): 342-4.
24. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sag ve Hast Derg 2008; 51(1): 1-14.
25. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2thed Stanford California. Stanford University Pres, 1959: 160-228.
26. Richardson MA. Sore throat, tonsillitis, and adenoiditis. Med Clin of North Am 1999; 83(1): 75-83.
27. Farber JM. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002; 110(6): 1255-7.
28. Aji DY, Sarıoğlu A, Sever L, Arısoy N. Pulmonary hypertension due to chronic upper airway obstruction: a clinical review and report of four cases. Turk J Pediatr 1991; 33(1): 35-41.
29. Hoşal N, Kaya S, Güney E. Çocuklarda tonsil ve adenoid hiperplazilerinin kardiyopulmoner sistem üzerine olan etkileri. Çocuk Sağlığı ve Hastalıkları Dergisi 1976; 19: 45-56.
30. Wilkinson A, McCormick M, Freeland A, Pickering D. Electrocardiographic signs of pulmonary hypertension in children who snore. Br Med (Clinical research ed) 1981; 282(6276): 1579- 81.
31. Goldstein SJ, Wu RHK, Thorpy MJ, Shprintzen RJ, Marion RE, Saenger P. Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea. Acta Endocrinologica 1987; 116(1): 95.
32. Aydogan M, Toprak D, Hatun S, Yüksel A, Gokalp AS. The effect of recurrent tonsillitis and adenotonsillectomy on growth in childhood. Int J Pediatr Otorhinolaryngol 2007; 71(11): 1737-42.
33. Brouillette RT, Morielli A, Leimanis A, Waters KA, Luciano R, Ducharme FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics 2000; 105(2): 405.
34. Bland R, Bulgarelli S, Ventham J, Jackson D, Reilly J, Paton J. Total energy expenditure in children with obstructive sleep apnoea syndrome. Eur Respir J 2001; 18(1): 164-9.
35. Cooper BG, White J, Ashworth LA, Alberti K, Gibson GJ. Hormonal and metabolic profiles in subjects with obstructive sleep apnea syndrome and the acute effects of nasal continuous positive airway pressure (CPAP) treatment. Sleep 1995; 18(3): 172.
36. Ersoy B, Yücetürk AV, Taneli F, Ürk V, Uyanik BS. Changes in growth pattern, body composition and biochemical markers of growth after adenotonsillectomy in prepubertal children. Int J Pediatr Otorhinolaryngol 2005; 69(9): 1175-81.
37. Saini J, Krieger J, Brandenberger G, Wittersheim G, Simon C, Follenius M. Continuous positive airway pressure treatment. Horm Metab Res 1993; 25(7): 375-81.
38. Stradling J, Thomas G, Warley A, Williams P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. The Lancet 1990; 335(8684): 249-53.
39. Chan J, Edman JC, Koltai PJ. Obstructive sleep apnea in children. Am Fam Physician 2004; 69(5):1147-54.
40. Chiba S, Ashikawa T, Moriwaki H, Tokunaga M, Miyazaki H, Moriyama H. The influence of sleep breathing disorder on growth hormone secretion in children with tonsil hypertrophy]. Nippon Jibiinkoka Gakkai Kaiho 1998;101(7): 873.
41. Wiatrak B, Woolley A. Pharyngitis and adenotonsillar disease. Pediatr Otolaryngol Head Neck Surg 1998; 3: 188-215.
42. Ahlqvist-Rastad J, Hultcrantz E, Melander H, Svanholm H. Body growth in relation to tonsillar enlargement and tonsillectomy. Int J Pediatr Otorhinolaryngol 1992; 24(1): 55-61.
43. Vontetsianos HS, Davris SE, Christopoulos GD, Dacou-Voutetakis C. Improved somatic growth following adenoidectomy and tonsillectomy in young children. Possible pathogenetic mechanisms. Hormones (Athens) 2005; 4(1): 49-54.
44. Williams EF 3rd, Woo P, Miller R, Kellman R. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg 1991; 104(4): 509-16.
45. Nieminen P, Löppönen T, Tolonen U, Lanning P, Knip M, Löppönen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002; 109(4): e55.
46. Yılmaz MD, Hoşal AS, Oğuz H, Yordam N, Kaya S. The effects of tonsillectomy and adenoidectomy on serum IGF1 and IGFBP3 levels in children. Laryngoscope 2002; 112(5): 922-5.
47. Bar A, Tarasiuk A, Segev Y, Phillip M, Tal A. The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome. J Pediatr 1999; 135(1): 76-80.
48. Juul A, Bang P, Hertel N, et al. Serum insulin-like growth factor-I in 1030 healthy children, adolescents, and adults: relation to age, sex, stage of puberty, testicular size, and body mass index. J Clin Endocrinol Metab 1994; 78(3): 744-52.
49. Gümüşsoy M, Atmaca S, Bilgici B, Ünal R. Changes in IGF-I, IGFBP-3 and ghrelin levels after adenotonsillectomy in children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2009; 73(12): 1653-6.