title: The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: a blind, prospective clinical study.
abstract: OBJECTIVE
  Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. An adenoid-nasopharynx (A/N) ratio determined by means of lateral cephalometric radiographs has long been used as a diagnostic tool in the assessment of adenoid size. This study was designed to investigate the effect of adenotonsillectomy on insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels and correlation between A/N ratio and IGF-I and IGFBP-3 levels.
  
  
  METHODS
  Patients (n=48) that had been operated on our clinic with a diagnosis of adenotonsillar hypertrophy between July 2009 and January 2010 were included in the study. The routine ear-nose and throat examination was done in all patients. Blood samples were taken, and lateral cephalometric radiographs were obtained preoperatively and repeated at 6-9 months (mean 7.2 ± 1.0 mo) following tonsillectomy and adenoidectomy. The chemiluminescent enzyme-linked immunosorbent method was used to IGF-I and IGFBP-3 levels. Each cephalometric radiograph was evaluated by a blinded radiologist. The A/N ratio was calculated using the Fujioka method.
  
  
  RESULTS
  When the preoperative and postoperative results were compared, a statistically significant increase in serum IGF-I and IGFBP-3 and a decreased A/N ratio were found. However, although correlation between the Δ(preoperative-postoperative difference) IGFBP-3 and ΔA/N ratio was 40%, it was not statistically significant. Additionally, no statistically significant correlation between the ΔIGF-I and ΔA/N ratio was found.
  
  
  CONCLUSIONS
  The results of the present study indicate that adenotonsillectomy could result in the relief of nasopharyngeal obstruction and have a positive effect on growth in children by decreasing the A/N ratio and increasing IGF-I and IGFBP-3. There was no correlation between the ΔA/N ratio and ΔIGF-I and ΔIGFBP-3 levels.
authors.affiliation: Haydarpasa Numune Research and Training Hospital, 1st ENT Clinic, Uskudar, Istanbul, Turkey. arzutatli@yahoo.com
authors.forename: Arzu
authors.initials: A
authors.lastname: Tatlıpınar
authors.forename: Sacide
authors.initials: S
authors.lastname: Atalay
authors.forename: Erkan
authors.initials: E
authors.lastname: Esen
authors.forename: Gökalp
authors.initials: G
authors.lastname: Yılmaz
authors.forename: Sema
authors.initials: S
authors.lastname: Köksal
authors.forename: Tanju
authors.initials: T
authors.lastname: Gökçeer
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology; D001827:Body Height; D002508:Cephalometry / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000517:prevention & control; D006801:Humans; D066298:In Vitro Techniques; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D009305:Nasopharynx / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D011859:Radiography; D016037:Single-Blind Method; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D018972:Insulin-Like Growth Factor Binding Protein 3; D007334:Insulin-Like Growth Factor I