title: Adenotonsillectomy Normalizes Hormones and Urinary Electrolytes in Children With Nocturnal Enuresis and Sleep-Disordered Breathing.
abstract: OBJECTIVE
  To assess (1) plasma levels of antidiuretic hormone (ADH) and brain natriuretic peptide (BNP) and urinary levels of electrolytes in children with sleep disordered breathing (SDB), with or without nocturnal enuresis (NE), and (2) the effect of adenotonsillectomy (T&A) on urinary electrolytes and the secretion of ADH and BNP in children with NE and SDB. We previously reported post-T&A improvements in plasma levels of BNP and ADH in children with SDB and NE. However, the differences in plasma concentration of these hormones in SDB children with and without NE, and their relationships with urinary electrolytes, have not yet been addressed.
  
  
  METHODS
  This prospective study compared concentrations of urinary electrolytes and plasma ADH and BNP in (1) children with SDB and NE (study group) and an age- and sex-matched control group of children with SDB without NE, and (2) the study group before and 1-month after T&A.
  
  
  RESULTS
  Compared with the control group (n = 31), the study group (n = 37) exhibited significantly lower ADH (P = .04) and higher BNP (P = .009) plasma levels. The differences in urinary electrolytes were not significant. Post-T&A, the study group showed significantly decreased BNP (P = .018), urinary sodium-to-creatinine ratio (P = .02), and urinary calcium-to-creatinine ratio (P = .007) compared with the pre-T&A values. Post-T&A changes in urinary calcium were significantly correlated with changes in sodium excretion (P = .002) and in plasma levels of BNP (P <.001).
  
  
  CONCLUSIONS
  The presence of NE is associated with altered ADH and BNP levels in children with SDB. T&A led to normalization of ADH and BNP, probably through a calcium- and sodium-dependent mechanism.
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI. Electronic address: lkovacev@dmc.org.
authors.forename: Larisa
authors.initials: L
authors.lastname: Kovacevic
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Hong
authors.initials: H
authors.lastname: Lu
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Cortney
authors.initials: C
authors.lastname: Wolfe-Christensen
authors.affiliation: Division of Pulmonology and Sleep Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abdulhamid
authors.affiliation: Department of Otolaryngology, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Prasad J
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Mark
authors.initials: M
authors.lastname: Lulgjuraj
authors.affiliation: Department of Otolaryngology, Children's Hospital of Michigan, Detroit, MI.
authors.forename: David N
authors.initials: DN
authors.lastname: Madgy
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Yegappan
authors.initials: Y
authors.lastname: Lakshmanan
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004573:Electrolytes / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000097:blood*; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000150:complications / Q000378:metabolism*; D011184:Postoperative Period; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000378:metabolism*; D014068:Tonsillectomy
chemical_list: D004573:Electrolytes; D006728:Hormones