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Insulin-like growth factor alpha changes after tonsillectomy for obstructive and nonobstructive causes




To assess the effect of tonsillectomy, weather performed for obstructive or nonobstructive causes, on the serum levels of insulin-like growth factor alpha (IGF-1).

Patients and methods

This prospective study was carried out on 60 children who underwent tonsillectomy or adenotonsillectomy at Zagazig University Hospitals. The children were divided into two groups: the first group included 30 children who underwent tonsillectomy because of obstructive symptoms and the second group included 30 children who underwent tonsillectomy because of recurrent tonsillitis with no manifestations of upper-airway obstruction. Preoperative and 3 months’ postoperative blood levels of IGF-1 were estimated and the data were statistically analyzed.


Six children from the first group (24 children) and four children from the second group (26 children) did not follow-up after surgery and were excluded from the study. Both study groups were matched for age and sex. In the first (obstructive) group, there was a statistically significant increase in the mean level of IGF-1 from 119.08109 ± 27.81797 preoperatively to 222.395 ± 6.62559 postoperatively and the difference was significant (P < 0.0001). However, in the second (infection) group, the mean IGF-1 values increased from 155.0715 ± 89.83015 preoperatively to 191.4075 ± 57.38667 postoperatively, and the difference was not significant (P = 0.0883).


Insufficient weight and height gain in children who had obstructive adenotonsillar hypertrophy could be attributed to low IGF-1, and this can be corrected after surgery. This is not the case in patients with chronic tonsillitis without upper-airway obstruction, and other factors may explain the retarded growth in these patients. Study design A prospective study.


  1. Van den Akker EH, Schilder AG, Kemps YJ, van Balen FA, Hordijk GJ, Hoes AW. Current indications for (adeno)tonsillectomy in children: a survey in The Netherlands. Int J Pediatr Otorhinolaryngol 2003; 67:603–607.

    Article  Google Scholar 

  2. Richards W, Ferdman RM. Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children. Clin Pediatr (Phila) 2002; 39: 103–108.

    Article  Google Scholar 

  3. Ungkanont K, Areyasathidom S. Factors affecting quality of life of pediatric outpatients with symptoms suggestive of sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2006; 70: 945–948.

    Article  Google Scholar 

  4. Liu X, Ma Y, Wang Y, Jiang Q, Rao X, Lu X, et al. Brief report: an epidemiologic survey of the prevalence of sleep disorders among children 2 to 12 years old in Beijing, China. Pediatrics 2005; 11:266–268.

    Article  Google Scholar 

  5. 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: 76–80.

    Article  CAS  Google Scholar 

  6. Williams EFIII, Woo P, Miller R, Kellman RM. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg 1991; 104: 509–516.

    Article  Google Scholar 

  7. Kiris M, Muderris T, Celebi S, Cankaya H, Bercin S. Changes in serum IGF-1 and IGFBP-3 levels and growth in children following adenoidectomy, tonsillectomy or adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2010; 74: 528–531.

    Article  Google Scholar 

  8. Grunstein RR, Handelsman DJ, Lawrence SJ, Blackwell C, Caterson ID, Sullivan CE. Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy. J Clin Endocrinol Metab 1989; 68: 352–358.

    Article  CAS  Google Scholar 

  9. Goldstein SJ, Wu RH, 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 Endocrinol (Copenh) 1987; 116: 95–101.

    Article  CAS  Google Scholar 

  10. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics 1998; 1023: 616–620.

    Article  Google Scholar 

  11. Tran KD, Nguyen CD, Weedon J, Goldstein NA. Child behavior and quality of life in pediatric obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 2005; 1311: 52–57.

    Article  Google Scholar 

  12. Furlanetto RW. Insulin like growth factor measurements in the evaluation of growth hormone secretion. Horm Res 1990; 33: 25–30.

    Article  CAS  Google Scholar 

  13. Aydogan M, Toprak D, Hatun S, Yüksel A, Goklap AS. The effect of recurrent tonsillitis and adenotonsillectomy on growth in childhood. Int J Pediatr Otorhinolaryngol 2007; 71: 1737–1742.

    Article  Google Scholar 

  14. 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: 1–6.

    Article  Google Scholar 

  15. Vontetsianos HS, Davris SE, Cristopoulos GD, Dacou-Voutetakis C. Improved somatic growth following adenoidectomy and tonsillectomy in young children. Possible pathogenetic mechanisms. Hormones 2005; 4: 49–54.

    Article  Google Scholar 

  16. Yilmaz MD, Hosal S, Oðuz H, Yordam N, Kaya S. The effects of tonsillectomy and adenoidectomy on serum IGF-I and IGFBP3 levels in children. Laryngoscope 2002; 112: 922–925.

    Article  CAS  Google Scholar 

  17. Blum WF, Albertsson-Wikland K, Rosberg S, Ranke MB. Serum levels of insulin-like growth factor I (IGF-I) and IGF binding protein 3 reflect spontaneous growth hormone secretion. J Clin Endocrinol Metab 1993; 76: 1610–1616.

    PubMed  CAS  Google Scholar 

  18. Li AM, Wong E, Kew J, Hui S, Fok TF. Use of tonsil size in the evaluation of obstructive sleep apnea. Arch Dis Child 2002; 87: 156–159.

    Article  CAS  Google Scholar 

  19. Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, Loughlin GM. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr 1994; 125: 556–562.

    Article  CAS  Google Scholar 

  20. Gümüssoy M, Atmaca S, Bilgici B, Unal R. Changes in IGF-I, IGFBP-3 and ghrelin levels after adenotonsillectomy in children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2009; 73: 1653–1656.

    Article  Google Scholar 

  21. Ahlqvist RJ, Hulterantz E, Melander H, Svanholm H. Body growth in relation to tonsillar enlargement and tonsillectomy. Int J Pediatr Otorhinolaryngol 1992; 24:55–61.

    Article  Google Scholar 

  22. Barr GS, Osborne J. Weight gain in children following tonsillectomy. J Laryngol Otol 1988; 102: 595–597.

    Article  CAS  Google Scholar 

  23. Camilleri AE, Mackenzie K, Gatehouse S. The effect of recurrent tonsillitis and tonsillectomy on growth in childhood. Clin Otolaryngol 1995; 20: 153–155.

    Article  CAS  Google Scholar 

  24. Topal K, Kara CO, Bozkurt AI, Saatci E. The risk of overweight and obesity in children after tonsillectomy: a cross-sectional study. Eur Arch Otorhinolaryngol 2013; 270: 689–694.

    Article  Google Scholar 

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Correspondence to Mohammad W. El-Anwar MD.

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Elnashar, I., El-Anwar, M.W., Raafat, A. et al. Insulin-like growth factor alpha changes after tonsillectomy for obstructive and nonobstructive causes. Egypt J Otolaryngol 30, 343–346 (2014).

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