The role of lepti̇n and ghrelin in development of obesity after adenoi̇dectomy or adenotonsillectomy

Obesity is one of the most important health issues of this era; it is becoming more frequent. Frequency of weight gain and obesity is reported to be increased after adenoidectomy/adenotonsillectomy. IGF-1, IGFBP-3, insulin resistance, leptin and ghrelin are acknowledged as factors that might be contributing in the pathogenesis of weight gain following the surgeries. Here, their tissue levels and effect on weight gain were studied. Aged between 2–10 years, 38 patients who were operated in Ear Nose Throat Department of our institution from February 2010 to August 2010 due to adenoid/adenotonsiller hypertrophy, were enrolled in the study. Patients having signs of obstruction and adenotonsiller hypertrophy of 3rd–4th degree endoscopically were eligible for the study. We measured height and weight of each case and took blood samples to check their glucose, insulin, IGF-1, IGFBP-3, leptin and ghrelin levels prior to surgeries. We called them back at postoperative 1 year to repeat the same procedures. These parameters were compared with a control group of 28 healthy children of the same age. There was no significant difference between study and control groups before surgery with respect to height, weight and BMI score. Insulin resistance was found in neither of the groups. In study group, SDS of height (p=0,001) and SDS of weight (p=0,004) were found to be increased while there was no change in SDS of BMI at postoperative 1 year. Levels of IGF-1 (p=0,01) and IGFBP-3 (p=0,001) were increased while ghrelin level (p<0,001) was decreased at postoperative 1 year. Preoperative leptin level was higher in the study group compared to control group (p=0,002). Leptin was found to be increased gradually at postoperative year 1 (p=0,036). In conclusion, height and weight development was found to be normal in children with adenoid or adenotonsiller hypertrophy. Postoperatively, IGF-1 and IGFBP-3 were increased while ghrelin was decreased. This may be an outcome of regularized growth hormone release by virtue of a beneficial sleep activity. Preoperative leptin levels were significantly higher in cases compared to healthy controls. Several studies have revealed leptin level returning to normal values among patients with OSAS, when obstruction was relieved. However in this study, leptin levels stayed high even though the cases showed no signs of obstruction at postoperative year 1. Leptin levels should be checked in these patients in long term periods in order to suggest leptin resistance. There was no difference in SDS of BMI pre and postoperatively among our patients. Persistent high levels of leptin might be attributed to its resistance among obese patients in the long term. Hence, we need more studies including more participants with longer follow-ups.