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Scudder C, Church D. Feline Comorbidities: Hypersomatotropism-induced diabetes in cats. J Feline Med Surg 2024; 26:1098612X241226690. [PMID: 38323402 PMCID: PMC10911310 DOI: 10.1177/1098612x241226690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PRACTICAL RELEVANCE Diabetes mellitus is the second-most common feline endocrinopathy, affecting an estimated 1/200 cats. While the underlying causes vary, around 15-25% of cats with diabetes mellitus develop the condition secondarily to progressive growth hormone (GH)-induced insulin resistance. This typically results in a form of diabetes that is challenging to manage, whereby the response to insulin is very variable or high doses are required to achieve even minimal diabetic control. CLINICAL CHALLENGES Although uncontrolled chronic excessive GH may result in phenotypic changes that raise suspicion for acromegaly, many cats with hypersomatotropism (HST) do not have these changes. In these situations, a clinician's index of suspicion may be increased by the presence of less dramatic changes such as marked polyphagia, stertor or uncontrolled diabetes mellitus. The current diagnostic test of choice is demonstration of a markedly increased serum insulin-like growth factor 1 (IGF1) concentration, but some affected cats will have only a marginal increase; additionally, chronic insulin administration in cats results in an increase in serum IGF1, making the diagnosis less clear cut and requiring additional confirmatory tests. EVIDENCE BASE Over the past two decades, HST has increasingly been recognised as an underlying cause of diabetes mellitus in cats. This review, which focuses on diagnosis and treatment, utilises data from observational studies, clinical trials and case series, as well as drawing on the experience of the authors in managing this condition.
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Affiliation(s)
- Christopher Scudder
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hertfordshire, UK
| | - David Church
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hertfordshire, UK
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Niessen SJM. Hypersomatotropism and Other Causes of Insulin Resistance in Cats. Vet Clin North Am Small Anim Pract 2023; 53:691-710. [PMID: 36906467 DOI: 10.1016/j.cvsm.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
True insulin resistance should be differentiated from management-related difficulties (eg, short insulin duration, inappropriate insulin injection, inappropriate storage). Hypersomatotropism (HST) is the number one cause of insulin resistance in cats, with hypercortisolism (HC) occupying a more distant second place. Serum insulinlike growth factor-1 is adequate for screening for HST, and screening at the time of diagnosis, regardless of presence of insulin resistance, is advocated. Treatment of either disease centers on removal of the overactive endocrine gland (hypophysectomy, adrenalectomy) or inhibition of the pituitary or adrenal glands by using drugs such as trilostane (HC), pasireotide (HST, HC) or cabergoline (HST, HC).
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Affiliation(s)
- Stijn J M Niessen
- Royal Veterinary College London, UK; Veterinary Specialist Consultations and VIN Europe, Loosdrechtseweg 56, Hilversum 1215 JX, the Netherlands.
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Corsini A, Niessen SJM, Miceli DD, Caney S, Zeugswetter FK, Sieber-Ruckstuhl NS, Arenas C, Fleeman LM, Leal RO, Battellino M, Fracassi F. Quality of life and response to treatment in cats with hypersomatotropism: the owners' point of view. J Feline Med Surg 2022; 24:e175-e182. [PMID: 35616046 PMCID: PMC10812257 DOI: 10.1177/1098612x221098718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to collect clinical information from owners of cats with hypersomatotropism (HS) distributed worldwide, assessing the impact of HS and its treatments on cats' quality of life (QoL) and survival time. METHODS A survey focused on clinical presentation, diagnostic procedures, treatments, cats' QoL and disease progression was distributed worldwide to owners of cats with HS. The owner's perception of the cats' QoL before and after or during treatment was defined using a score ranging from 1 (poor) to 5 (excellent). Improvement following treatment (IFT) was quantified using a score ranging from 1 (absent) to 5 (obvious). Different treatment groups, including at least five cases, were compared. RESULTS A total of 127 cats were included from at least 11 different countries. Among these, 120 (95%) were diabetic and 7 (5%) were not. Out of 120 diabetic cats, 55 (46%) were treated with insulin as a single treatment (INS). Other treatments were not mentioned to owners in 35/120 (29%) cases. The median QoL score at diagnosis was 2 (range 1-5) and improved after treatment in all groups. Cabergoline (4; range 1-5), radiotherapy (4; range 2-5) and hypophysectomy (5; range 4-5) showed better median IFT scores compared with INS (3; range 1-5) (P = 0.046, P <0.002 and P <0.0001, respectively). Hypophysectomy IFT proved superior to cabergoline (P = 0.047) and was equal to radiotherapy IFT (P = 0.32). No difference was found between cabergoline and radiotherapy IFT (P = 0.99). The median survival time (MST) was 24 months (range 0-75 months). Cats treated with INS showed shorter MST (22 months; range 0-69 months) compared with cats treated with causal treatments combined (36 months; range 3-75 months) (P = 0.04). CONCLUSIONS AND RELEVANCE Not all cats with HS will have diabetes mellitus. Causal treatments seem associated with the greatest improvements in perceived cats' QoL and survival; such treatments should therefore be discussed with owners. Cabergoline could be an effective alternative management option.
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Affiliation(s)
- Andrea Corsini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Italy
- Department of Veterinary Medical Sciences, University of Parma, Parma, Italy
| | - Stijn JM Niessen
- Royal Veterinary College, London, UK
- Veterinary Specialist Consultations, Hilversum, Netherlands
| | - Diego D Miceli
- Faculty of Veterinary Sciences, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Sarah Caney
- Vet Professionals, Midlothian Innovation Centre, Roslin, UK
| | - Florian K Zeugswetter
- Clinical Department for Small Animals and Horses, Veterinarmedizinische Universitat Wien, Vienna, Austria
| | - Nadja S Sieber-Ruckstuhl
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | | | - Rodolfo O Leal
- CIISA – Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
| | - Martina Battellino
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Italy
| | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Italy
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Watson-Skaggs ML, Gieger TL, Yoshikawa H, Nolan MW. Endocrine response and outcome in 14 cats with insulin resistance and acromegaly treated with stereotactic radiosurgery (17 Gy). Am J Vet Res 2022; 83:64-71. [PMID: 34773702 DOI: 10.2460/ajvr.21.08.0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe clinical outcomes in cats with insulin resistance and acromegaly treated with stereotactic radiosurgery (SRS). ANIMALS 14 client-owned cats. PROCEDURES Medical records of cats with insulin resistance and acromegaly treated with SRS (17 Gy) between August 2013 and November 2019 at a single institution were reviewed. Kaplan-Meier analysis was used to evaluate overall survival time. RESULTS Acute adverse effects of SRS included somnolence (n = 2) and alopecia (1). Delayed adverse effects of SRS included unspecified neurologic complications (n = 1; 481 days), seizures (1; 1,541 days), and hypothyroidism (1; 64 days). Exogenous insulin requirements decreased in 10 of the 14 cats, with a median time to lowest insulin dose of 399 days (range, 42 to 879 days). Complete diabetic remission was achieved in 3 cats. The median overall survival time was 741 days (95% CI, 353 to 1,129 days). Six cats were still alive at the end of the study period, with a median follow-up time of 725 days. In 7 of the 8 cats that had died, death was presumptively attributed to acromegaly owing to continued insulin resistance, organ failure, or altered neurologic status. CLINICAL RELEVANCE The SRS protocol was well tolerated and associated with survival times similar to those reported previously. Most cats had decreased exogenous insulin requirements after SRS. Latency to an endocrine response was highly variable, emphasizing the need for careful ongoing diabetic monitoring of acromegalic cats after pituitary gland irradiation.
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Affiliation(s)
- Maegan L Watson-Skaggs
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Tracy L Gieger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Hiroto Yoshikawa
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Michael W Nolan
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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Chiara Perego M, Bellitto N, Maylem ERS, Caloni F, Spicer LJ. Effects of selected hormones and their combination on progesterone and estradiol production and proliferation of feline granulosa cells cultured in vitro. Theriogenology 2021; 168:1-12. [PMID: 33826978 DOI: 10.1016/j.theriogenology.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/27/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
Little is known about the hormonal regulation of feline ovarian granulosa cell proliferation and steroidogenesis. The present study aimed to develop a hormone responsive granulosa cell culture system to measure steroidogenic and cell proliferation responses to help identify factors that might regulate ovarian function in queens. Five experiments were conducted each with 75 or more ovaries, three in spring and two in fall seasons. Granulosa cells were isolated and treated in vitro with various hormones in serum-free medium for 48 h after an initial 48 h plating in 10% fetal calf serum. In granulosa cells isolated from spring and fall collected feline ovaries, IGF1 alone and combined with FSH stimulated (P < 0.05) cell proliferation, whereas FSH alone had no effect (P > 0.10) on cell proliferation. Also, in granulosa cells collected in spring and fall, IGF1 alone and FSH alone increased (P < 0.05) estradiol production by severalfold, and a combination of FSH and IGF1 increased (P < 0.05) estradiol production above either FSH or IGF1 treatment alone. The FSH plus IGF1 treatment increased (P < 0.05) CYP19A1 mRNA abundance by 27-fold. In contrast, EGF decreased (P < 0.05) FSH plus IGF1-induced estradiol production by over 80% in granulosa cells of both spring and fall collected ovaries. In granulosa cells isolated from spring and fall collected ovaries, IGF1 plus FSH inhibited (P < 0.05) progesterone production. Melatonin increased (P < 0.05) FSH plus IGF1-induced cell proliferation and amplified (P < 0.05) the FSH plus IGF1-induced inhibition of progesterone production. However, melatonin and GH had no effect (P > 0.10) on estradiol production either alone or in combination with FSH plus IGF1 in both spring and fall. Prolactin, FGF9 and activin had no effect (P > 0.10) on cell proliferation or steroidogenesis. FGF2 decreased (P < 0.05) estradiol production without affecting progesterone production or cell numbers. Growth differentiation factor 9 (GDF9) increased (P < 0.05) progesterone production but had no effect (P > 0.10) on granulosa cell proliferation or estradiol production. In conclusion, the in vitro system described herewithin may be useful to assess and evaluate ovarian function in feline species and has identified EGF, FSH and IGF1 as major regulators of feline ovarian follicular function.
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Affiliation(s)
- M Chiara Perego
- Department of of Animal and Food Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Nicholas Bellitto
- Department of Environmental Science and Policy, Università Degli Studi di Milano, Via Celoria 10, 20133, Milan, Italy
| | - Excel Rio S Maylem
- Department of of Animal and Food Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Francesca Caloni
- Department of Environmental Science and Policy, Università Degli Studi di Milano, Via Celoria 10, 20133, Milan, Italy
| | - Leon J Spicer
- Department of of Animal and Food Sciences, Oklahoma State University, Stillwater, OK, 74078, USA.
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Gouvêa FN, Pennacchi CS, Assaf ND, Branco LDO, Costa PB, Dos Reis PA, Borin-Crivellenti S. Acromegaly in dogs and cats. ANNALES D'ENDOCRINOLOGIE 2021; 82:107-111. [PMID: 33727117 DOI: 10.1016/j.ando.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/19/2022]
Abstract
Acromegaly is an endocrine disease that leads to elevated production and secretion of growth hormone (GH). It can occur in adult and aged cats and is usually associated with neoplasms, such as functional pituitary macroadenoma of somatotropic cells. In dogs it is usually related to an increase in serum progesterone that induces production of GH by the mammary glands. The main clinical signs are related to insulin resistance and the anabolic effect induced by GH: polyuria, polydipsia, polyphagia, increased tissue growth, weight gain, prognathism, and other changes. The condition can be diagnosed from clinical signals and imaging associated to measurement of serum concentrations of GH and insulin-like growth factor 1 (IGF-1, also known as somatomedin C). The main therapeutic modalities are radiotherapy, hypophysectomy, and several drugs such as somatostatin analogs, dopaminergic agonists and GH receptor antagonists. The present review aims to provide a relevant animal model of acromegaly with an update on the therapeutic approach that may help clinicians to consider the GH axis-IGF-1 system, its pathogenesis and the clinical signs induced by this hormonal disorder.
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Affiliation(s)
- Fernanda Nastri Gouvêa
- Graduate student of Graduate Program in Veterinary Science (PPGCVET), Universidade Federal de Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil.
| | - Caio Santos Pennacchi
- Graduate student of Graduate Program in Veterinary Science (PPGCVET), Universidade Federal de Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | | | - Luana de Oliveira Branco
- Graduate student of Graduate Program in Veterinary Science (PPGCVET), Universidade Federal de Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Paula Barbosa Costa
- Graduate student of Graduate Program in Veterinary Science (PPGCVET), Universidade Federal de Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | | | - Sofia Borin-Crivellenti
- Professor at College of Veterinary Medicine (FAMEV) and Graduate Program in Veterinary Science (PPGCVET), Universidade Federal de Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil.
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7
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van Bokhorst KL, Galac S, Kooistra HS, Valtolina C, Fracassi F, Rosenberg D, Meij BP. Evaluation of hypophysectomy for treatment of hypersomatotropism in 25 cats. J Vet Intern Med 2021; 35:834-842. [PMID: 33621385 PMCID: PMC7995432 DOI: 10.1111/jvim.16047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Successful treatment of cats with hypersomatotropism by transsphenoidal hypophysectomy is described in small numbers of cats. OBJECTIVES To describe the endocrine profile, survival, and remission rates of hypersomatotropism and diabetes mellitus in a cohort of cats with hypersomatotropism that underwent hypophysectomy between 2008 and 2020. ANIMALS Twenty-five client-owned cats with spontaneous hypersomatotropism. METHODS Retrospective study. Diagnosis of hypersomatotropism was based on clinical signs, plasma insulin-like growth factor-1 (IGF-1) concentration, and imaging of the pituitary gland. Growth hormone (GH) and IGF-1 concentrations were measured repeatedly after surgery. Survival times were calculated based on follow-up information from owners and referring veterinarians. RESULTS Median postoperative hospital stay was 7 days (range, 3-18 days). One cat died within 4 weeks of surgery. Median plasma GH concentration decreased significantly from 51.0 ng/mL (range, 5.0-101.0 ng/mL) before surgery to 3.8 ng/mL (range, 0.6-13.0 ng/mL) at 5 hours after surgery. Remission of hypersomatotropism, defined as normalization of plasma IGF-1 concentration, occurred in 23/24 cats (median, 34 ng/mL; range, 14-240 ng/mL) and 22/24 cats entered diabetic remission. Median survival time was 1347 days (95% confidence interval, 900-1794 days; range, 11-3180 days) and the overall 1-, 2-, and 3-year all-cause survival rates were 76%, 76%, and 52%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE This study shows the beneficial outcome of hypophysectomy in cats with hypersomatotropism, marked by low death rate and a high percentage of diabetic remission and definitive cure.
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Affiliation(s)
- Kirsten L. van Bokhorst
- Department of Clinical SciencesFaculty of Veterinary Medicine, Utrecht UniversityUtrechtThe Netherlands
- IVC EvidensiaVleutenThe Netherlands
| | - Sara Galac
- Department of Clinical SciencesFaculty of Veterinary Medicine, Utrecht UniversityUtrechtThe Netherlands
| | - Hans S. Kooistra
- Department of Clinical SciencesFaculty of Veterinary Medicine, Utrecht UniversityUtrechtThe Netherlands
| | - Chiara Valtolina
- Department of Clinical SciencesFaculty of Veterinary Medicine, Utrecht UniversityUtrechtThe Netherlands
| | - Federico Fracassi
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | | | - Björn P. Meij
- Department of Clinical SciencesFaculty of Veterinary Medicine, Utrecht UniversityUtrechtThe Netherlands
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8
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Steele MM, Borgeat K, Payne JR, Coss P, Navarro-Cubas X, Church DB, Niessen SJ, Connolly DJ. Increased insulin-like growth factor 1 concentrations in a retrospective population of non-diabetic cats diagnosed with hypertrophic cardiomyopathy. J Feline Med Surg 2021; 23:952-958. [PMID: 33541239 DOI: 10.1177/1098612x20987995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of the study was to document whether a proportion of non-diabetic cats with left ventricular hypertrophy (LVH) previously diagnosed with hypertrophic cardiomyopathy (HCM) have elevated circulating insulin-like growth factor 1 (IGF-1) concentrations. METHODS A retrospective analysis of residual blood samples obtained at the time of echocardiographic diagnosis of HCM from a population of 60 non-diabetic cats were analysed for circulating IGF-1 concentrations using a validated radioimmunoassay and compared with a control group of 16 apparently healthy cats without LVH. Clinical and echocardiographic data for cats with an IGF-1 level >1000 ng/ml were compared with those with an IGF-1 level <800 ng/ml. RESULTS In total, 6.7% (95% confidence interval 1.8-16.2%) of cats with HCM had an IGF-1 level >1000 ng/ml. The prevalence of an IGF-1 level >1000 ng/ml in the control group was zero. CONCLUSIONS AND RELEVANCE A small proportion of non-diabetic cats previously diagnosed with HCM had an IGF-1 concentration at a level that has been associated with feline hypersomatotropism (fHS) in the diabetic cat population. Further prospective research is required to confirm or refute the presence of fHS in non-diabetic cats with LVH and increased IGF-1.
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Affiliation(s)
- Matthew Me Steele
- Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | | | | | - Peter Coss
- Langford Vets, University of Bristol, Bristol, UK
| | | | - David B Church
- Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | | | - David J Connolly
- Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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9
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Wormhoudt TL, Boss MK, Lunn K, Griffin L, Leary D, Dowers K, Rao S, LaRue SM. Stereotactic radiation therapy for the treatment of functional pituitary adenomas associated with feline acromegaly. J Vet Intern Med 2018; 32:1383-1391. [PMID: 29782043 PMCID: PMC6060317 DOI: 10.1111/jvim.15212] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/21/2018] [Accepted: 04/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Conventional fractionated radiotherapy has been shown to be partially effective for management of pituitary tumors in cats that cause acromegaly and diabetes mellitus (DM), but, the efficacy and safety of stereotactic radiation therapy (SRT) as a treatment for acromegalic cats has not been described. Hypothesis Stereotactic radiation therapy is an effective and safe treatment for controlling acromegaly associated with pituitary adenomas in cats. Additionally, SRT‐treated acromegalic cats with DM will experience a decrease in insulin requirements after radiation therapy. Animals Fifty‐three client‐owned cats referred to Colorado State University for SRT to treat pituitary tumors causing poorly controlled DM secondary to acromegaly. Methods Retrospective study of cats treated for acromegaly with SRT between 2008 and 2016 at Colorado State University. Diagnosis of acromegaly was based on history, physical examination, laboratory results, and cross‐sectional imaging of the pituitary. Signalment, radiation protocol, insulin requirements over time, adverse effects, and survival were recorded. Results Median survival time was 1072 days. Of the 41 cats for which insulin dosage information was available, 95% (39/41) experienced a decrease in required insulin dose, with 32% (13/41) achieving diabetic remission. Remission was permanent in 62% (8/13) and temporary in 38% (5/13) cats. Median duration to lowest insulin dose was 9.5 months. Of the treated cats, 14% developed hypothyroidism and required supplementation after SRT. Conclusions Stereotactic radiation therapy is safe and effective for treating cats with acromegaly. Cats treated with SRT have improved survival time and control of their DM when compared to previously reported patients treated with non‐SRT.
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Affiliation(s)
- Tiffany L Wormhoudt
- Flint Animal Cancer Center, Colorado State University, Fort Collins, Colorado
| | - Mary-Keara Boss
- Flint Animal Cancer Center, Colorado State University, Fort Collins, Colorado
| | - Katharine Lunn
- Department of Clinical Sciences, North Carolina State University Veterinary Hospital, Raleigh, North Carolina
| | - Lynn Griffin
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Del Leary
- Flint Animal Cancer Center, Colorado State University, Fort Collins, Colorado
| | - Kristy Dowers
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Susan M LaRue
- Flint Animal Cancer Center, Colorado State University, Fort Collins, Colorado
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10
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Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats*. J Am Anim Hosp Assoc 2018; 54:1-21. [DOI: 10.5326/jaaha-ms-6822] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Diabetes mellitus (DM) is a common disease encountered in canine and feline medicine. The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats revise and update earlier guidelines published in 2010. The 2018 guidelines retain much of the information in the earlier guidelines that continues to be applicable in clinical practice, along with new information that represents current expert opinion on controlling DM. An essential aspect of successful DM management is to ensure that the owner of a diabetic dog or cat is capable of administering insulin, recognizing the clinical signs of inadequately managed DM, and monitoring blood glucose levels at home, although this is ideal but not mandatory; all topics that are reviewed in the guidelines. Insulin therapy is the mainstay of treatment for clinical DM. The guidelines provide recommendations for using each insulin formulation currently available for use in dogs and cats, the choice of which is generally based on efficacy and duration of effect in the respective species. Also discussed are non-insulin therapeutic medications and dietary management. These treatment modalities, along with insulin therapy, give the practitioner an assortment of options for decreasing the clinical signs of DM while avoiding hypoglycemia, the two conditions that represent the definition of a controlled diabetic. The guidelines review identifying and monitoring patients at risk for developing DM, which are important for avoiding unnecessary insulin therapy in patients with transient hyperglycemia or mildly elevated blood glucose.
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Affiliation(s)
- Ellen Behrend
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama (E.B.); Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee (A.H.); Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (P.L.); Mid Atlantic Cat Hospital, Queen
| | - Amy Holford
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama (E.B.); Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee (A.H.); Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (P.L.); Mid Atlantic Cat Hospital, Queen
| | - Patty Lathan
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama (E.B.); Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee (A.H.); Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (P.L.); Mid Atlantic Cat Hospital, Queen
| | - Renee Rucinsky
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama (E.B.); Department of Small Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee (A.H.); Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (P.L.); Mid Atlantic Cat Hospital, Queen
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11
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Campora C, Freeman KP, Baral R. Clinical application of biological variation data to facilitate interpretation of canine and feline laboratory results. J Small Anim Pract 2017; 59:3-9. [PMID: 29135020 DOI: 10.1111/jsap.12781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 11/30/2022]
Abstract
Interpretation of laboratory results is based on comparison of the patient's own results against established decision thresholds or reference intervals in the context of the clinical presentation and history. Blood measurand analysis has pre-analytical, analytical and physiological sources of variation, which may complicate interpretation of results. Biological variation describes the physiological random fluctuation of blood measurands around a homeostatic set point, which varies within and between individuals. This article reviews the practical applications of biological variation in the everyday clinical setting. Examples are offered to highlight how biological variation can be used to: (1) assess the usefulness of subject-based reference intervals, (2) determine measurand homeostatic set points, (3) interpret single or serial results for diagnosis of disease and (4) evaluate changes in serial results during monitoring.
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Affiliation(s)
- C Campora
- IDEXX Laboratories, Ltd, Wetherby, West Yorkshire, LS227DN, UK
| | - K P Freeman
- IDEXX Laboratories, Ltd, Wetherby, West Yorkshire, LS227DN, UK
| | - R Baral
- Paddington Cat Hospital, Paddington, New South Wales, 2021, Australia
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12
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Wofford JA, Zollers B, Rhodes L, Bell M, Heinen E. Evaluation of the safety of daily administration of capromorelin in cats. J Vet Pharmacol Ther 2017; 41:324-333. [DOI: 10.1111/jvp.12459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/03/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - B. Zollers
- Aratana Therapeutics, Inc.; Leawood KS USA
| | - L. Rhodes
- Aratana Therapeutics, Inc.; Leawood KS USA
| | - M. Bell
- ClinData Services, Inc.; Fort Collins CO USA
| | - E. Heinen
- Aratana Therapeutics, Inc.; Leawood KS USA
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Fracassi F, Salsi M, Sammartano F, Bo S, Kooistra HS. Acromegaly in a non-diabetic cat. JFMS Open Rep 2017; 2:2055116916646585. [PMID: 28491423 PMCID: PMC5362850 DOI: 10.1177/2055116916646585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/16/2022] Open
Abstract
Case summary A 14-year-old, neutered male European shorthair cat was evaluated for a routine health check. The owner did not report any clinical signs except for respiratory stridor. On physical examination the main findings were broad facial features and increased interdental spaces. On haematology, a mild, non-regenerative anaemia was detected, whereas the serum biochemistry profile and urinalysis were unremarkable. The serum glucose concentration was within the reference interval. Serum insulin-like growth factor-1 concentration was markedly elevated (>1600 ng/ml). The basal serum growth hormone concentration was elevated and decreased only mildly after somatostatin administration. Basal serum insulin concentration was high, and the insulin concentration increased considerably after glucose loading, consistent with insulin resistance. CT scanning of the skull showed an enlarged pituitary gland and increased skull bone thickness. The final diagnosis was acromegaly. Relevance and novel information These findings demonstrate that acromegaly should be pursued and suspected in cats other than those with diabetes mellitus.
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Affiliation(s)
- Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | | | | | | | - Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Abstract
Practical relevance Clinicians who deal with diabetic cats can have mixed experiences. Some patients are ‘textbook cases’, responding very well to insulin administration; others prove to be more challenging. Recent studies have shown a significant proportion of problem diabetic cats to have underlying acromegaly (hypersomatotropism). Recognising this syndrome in these cats will be key to successfully managing the concurrent diabetes. Patient group Just like the ‘normal’ (non-acromegalic) diabetic cat, the acromegalic diabetic cat tends to be a middle-aged to older male neutered domestic short hair. However, with increasing case experience, this signalment may change. Most patients are insulin resistant, although this may not be the initial presenting sign. No breed predispositions have been recognised to date. Clinical challenges There is no single diagnostic test for feline acromegaly — a confident diagnosis relies on a combination of clinical signs, feline growth hormone and insulin-like growth factor 1 levels, and intracranial imaging. Additionally, the ideal treatment protocol has yet to be established. Currently, radiotherapy is considered by many to be the best treatment; however, costs, the need for multiple anaesthetics, and the often delayed and unpredictable treatment response represent serious limitations of this modality. Previously, medical treatment has proven unsuccessful. Recent studies provide some evidence in favour of, and some against, the use of newer long-acting somatostatin analogue preparations in a proportion of acromegalic cats. Evidence base Two recent studies have revealed a relatively high prevalence of acromegaly among diabetic cats. One also specifically assessed the value of hormonal tests, computed tomography and magnetic resonance imaging during the diagnostic process.
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Affiliation(s)
- Stijn J M Niessen
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, UK; Diabetes Research Group, Newcastle University Medical School, Newcastle-upon-Tyne, Tyne and Wear, UK
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Gostelow R, Scudder C, Keyte S, Forcada Y, Fowkes RC, Schmid HA, Church DB, Niessen SJM. Pasireotide Long-Acting Release Treatment for Diabetic Cats with Underlying Hypersomatotropism. J Vet Intern Med 2017; 31:355-364. [PMID: 28145031 PMCID: PMC5354018 DOI: 10.1111/jvim.14662] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/16/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Long-term medical management of hypersomatotropism (HS) in cats has proved unrewarding. Pasireotide, a novel somatostatin analogue, decreases serum insulin-like growth factor 1 (IGF-1) and improves insulin sensitivity in cats with HS when administered as a short-acting preparation. OBJECTIVES Assess once-monthly administration of long-acting pasireotide (pasireotide LAR) for treatment of cats with HS. ANIMALS Fourteen cats with HS, diagnosed based on diabetes mellitus, pituitary enlargement, and serum IGF-1 > 1000 ng/mL. METHODS Uncontrolled, prospective cohort study. Cats received pasireotide LAR (6-8 mg/kg SC) once monthly for 6 months. Fructosamine and IGF-1 concentrations, and 12-hour blood glucose curves (BGCs) were assessed at baseline and then monthly. Product of fructosamine concentration and insulin dose was calculated as an indicator of insulin resistance (Insulin Resistance Index). Linear mixed-effects modeling assessed for significant change in fructosamine, IGF-1, mean blood glucose (MBG) of BGCs, insulin dose (U/kg) and Insulin Resistance Index. RESULTS Eight cats completed the trial. Three cats entered diabetic remission. Median IGF-1 (baseline: 1962 ng/mL [range 1051-2000 ng/mL]; month 6: 1253 ng/mL [524-1987 ng/mL]; P < .001) and median Insulin Resistance Index (baseline: 812 μmolU/L kg [173-3565 μmolU/L kg]; month 6: 135 μmolU/L kg [0-443 μmolU/L kg]; P = .001) decreased significantly. No significant change was found in mean fructosamine (baseline: 494 ± 127 μmol/L; month 6: 319 ± 113.3 μmol/L; P = .07) or MBG (baseline: 347.7 ± 111.0 mg/dL; month 6: 319.5 ± 113.3 mg/dL; P = .11), despite a significant decrease in median insulin dose (baseline: 1.5 [0.4-5.2] U/kg; 6 months: 0.3 [0.0-1.4] U/kg; P < .001). Adverse events included diarrhea (n = 11), hypoglycemia (n = 5), and worsening polyphagia (n = 2). CONCLUSIONS AND CLINICAL IMPORTANCE Pasireotide LAR is the first drug to show potential as a long-term management option for cats with HS.
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Affiliation(s)
- R Gostelow
- Diabetic Remission Clinic, Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK
| | - C Scudder
- Diabetic Remission Clinic, Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK
| | - S Keyte
- Diabetic Remission Clinic, Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK
| | - Y Forcada
- Diabetic Remission Clinic, Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK
| | - R C Fowkes
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - H A Schmid
- Novartis Institutes for Biomedical Research, Oncology Research, Novartis Pharma AG, Basel, Switzerland
| | - D B Church
- Diabetic Remission Clinic, Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK
| | - S J M Niessen
- Diabetic Remission Clinic, Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK.,Newcastle Medical School, Newcastle upon Tyne, UK
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16
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Keyte SV, Kenny PJ, Forcada Y, Church DB, Niessen SJM. Serum N-Terminal Type III Procollagen Propeptide: An Indicator of Growth Hormone Excess and Response to Treatment in Feline Hypersomatotropism. J Vet Intern Med 2016; 30:973-82. [PMID: 27425382 PMCID: PMC5108467 DOI: 10.1111/jvim.14373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/25/2016] [Accepted: 06/11/2016] [Indexed: 01/03/2023] Open
Abstract
Background N‐terminal type III procollagen propeptide (PIIINP) is a biomarker of soft tissue proliferation. Hypersomatotropism (HS) is associated with soft tissue proliferation. Hypothesis Serum PIIINP is increased in cats with HS and decreases with effective treatment, and may be an additional tool in the diagnosis and treatment of feline HS. Animals Cats with uncomplicated diabetes mellitus (DM; n = 30) and with HS‐induced DM (HSDM; n = 30). Pre‐ and posttreatment samples were available from 5 cats undergoing radiotherapy (RT) and 16 cats undergoing hypophysectomy (HPX). Methods Retrospective and prospective cross‐sectional study. Analytical performance of a serum PIIINP ELISA was assessed and validated for use in cats. PIIINP and insulin‐like growth factor 1 (IGF‐1) radioimmunoassays (RIA) were performed pre‐ and post‐treatment in cats with DM and HSDM. PIIINP and IGF‐1 were compared between cats treated by RT and HPX. Results Serum PIIINP concentrations were significantly higher (P < .001) in HSDM cats (median, 19.6 ng/mL; range, 1.7–27.9) compared to DM cats (median, 5.0 ng/mL; range, 2.1–10.4). A cut‐off of 10.5 ng/mL allowed differentiation between DM and HSDM cats with 87% sensitivity and 100% specificity (area under the curve [AUC], 0.91; 95% confidence interval [CI], 0.82‐1). After RT, PIIINP increased significantly (P = .043) with no significant change in IGF‐1 concentrations. After HPX, serum PIIINP (P = .034) and IGF‐1 concentrations (P < .001) decreased significantly. Conclusion and clinical importance PIIINP concentrations are increased in cats with untreated HSDM compared to those with DM, demonstrating the effect of excess GH on soft tissue. PIIINP concentrations decreased after HPX in most HSDM cats.
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Affiliation(s)
- S V Keyte
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - P J Kenny
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Y Forcada
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - D B Church
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - S J M Niessen
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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Fletcher JM, Scudder CJ, Kiupel M, Pipe-Martin HN, Kenny PJ, Mantis P, Fenn J, Smith K, Blair RV, Granger LA, Niessen SJM. Hypersomatotropism in 3 Cats without Concurrent Diabetes Mellitus. J Vet Intern Med 2016; 30:1216-21. [PMID: 27255700 PMCID: PMC5089606 DOI: 10.1111/jvim.14360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- J M Fletcher
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70810
| | - C J Scudder
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, AL9 7TA, Herts, UK
| | - M Kiupel
- Department of Pathobiology and Diagnostic Investigation, Diagnostic Center for Population and Animal Health, Michigan State University, Lansing, MI, 48910
| | - H N Pipe-Martin
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70810
| | - P J Kenny
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, AL9 7TA, Herts, UK
| | - P Mantis
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, AL9 7TA, Herts, UK
| | - J Fenn
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, AL9 7TA, Herts, UK
| | - K Smith
- Department of Pathology and Pathogen Biology, The Royal Veterinary College, University of London, North Mymms, AL9 7TA, Herts, UK
| | - R V Blair
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70810
| | - L A Granger
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70810
| | - S J M Niessen
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, AL9 7TA, Herts, UK
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Jensen KB, Forcada Y, Church DB, Niessen SJM. Evaluation and diagnostic potential of serum ghrelin in feline hypersomatotropism and diabetes mellitus. J Vet Intern Med 2015; 29:14-20. [PMID: 25619512 PMCID: PMC4858111 DOI: 10.1111/jvim.12536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 10/28/2014] [Accepted: 12/02/2014] [Indexed: 01/06/2023] Open
Abstract
Background Ghrelin is a growth hormone secretagogue. It is a potent regulator of energy homeostasis. Ghrelin concentration is down‐regulated in humans with hypersomatotropism (HS) and increases after successful treatment. Additionally, ghrelin secretion seems impaired in human diabetes mellitus (DM). Hypothesis Serum ghrelin concentration is down‐regulated in cats with HS‐induced DM (HSDM) compared to healthy control cats or cats with DM unrelated to HS and increases after radiotherapy. Animals Cats with DM (n = 20) and with HSDM (n = 32), 13 of which underwent radiotherapy (RT‐group); age‐matched controls (n = 20). Methods Retrospective cross‐sectional study. Analytical performance of a serum total ghrelin ELISA was assessed and validated for use in cats. Differences in serum ghrelin, fructosamine, IGF‐1 and insulin were evaluated. Results Ghrelin was significantly higher (P < .001) in control cats (mean ± SD: 12.9 ± 6.8 ng/mL) compared to HSDM‐ (7.9 ± 3.3 ng/mL) and DM‐cats (6.7 ± 2.3 ng/mL), although not different between the HSDM‐ and DM‐cats. After RT ghrelin increased significantly (P = .003) in HSDM‐cats undergoing RT (from 6.6 ± 1.9 ng/mL to 9.0 ± 2.2 ng/mL) and the after RT ghrelin concentrations of HSDM cats were no longer significantly different from the serum ghrelin concentration of control cats. Serum IGF‐1 did not significantly change in HSDM‐cats after RT, despite significant decreases in fructosamine and insulin dose. Conclusion and Clinical Importance Ghrelin appears suppressed in cats with DM and HSDM, although increases after RT in HSDM, suggesting possible presence of a direct or indirect negative feedback system between growth hormone and ghrelin. Serum ghrelin might therefore represent a marker of treatment effect.
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Affiliation(s)
- K B Jensen
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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19
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Strage EM, Theodorsson E, Ström Holst B, Lilliehöök I, Lewitt MS. Insulin-like growth factor I in cats: validation of an enzyme-linked immunosorbent assay and determination of biologic variation. Vet Clin Pathol 2015; 44:542-51. [PMID: 26418310 DOI: 10.1111/vcp.12289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Insulin-like growth factor I (IGF-I) measurements are used in veterinary medicine for diagnosing growth hormone disorders. IGF-I assays are subject to interference by IGF-binding proteins (IGFBP) which may not be efficiently removed by standard extraction methods. Adding excess IGF-II during analysis may improve accuracy. OBJECTIVES The purpose of the study was to validate a commercial human IGF-I ELISA which uses excess IGF-II for feline samples and to evaluate biologic variation. METHODS Precision was determined by calculating the coefficient of variation (CV). Accuracy was determined by recovery after removal of IGFBP, addition of IGF-I, and linear dilution after the addition of IGFBP. Biologic variation was determined by repeated sampling in 7 cats. RESULTS There was interference by IGFBP in the high measuring range, resulting in falsely low IGF-I concentrations. This was overcome by the addition of high concentrations of IGF-II. Untreated serum had a measured/expected ratio of 98-115% compared to serum where IGFBP had been removed. Recovery after the addition of IGF-I was 83-112%. Inter- and intra-assay CVs ranged from 2.4% to 5.0% which is within the minimum acceptance criteria based on biologic variation. The reference interval of IGF-I was wide (90-1207 ng/mL) and there was a significant association between body weight and ln IGF-I (P < .000001). CONCLUSIONS This human ELISA is suitable for feline samples, but interfering IGFBP can cause falsely low concentrations. It is recommended to dilute samples such that IGF-I is < 28 ng/mL on the standard curve to grant for sufficient IGF-II for binding of interferent IGFBP.
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Affiliation(s)
- Emma M Strage
- Department of Clinical Sciences, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden.,Department of Clinical Pathology Laboratory, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Elvar Theodorsson
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bodil Ström Holst
- Department of Clinical Sciences, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Inger Lilliehöök
- Department of Clinical Pathology Laboratory, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Moira S Lewitt
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
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20
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Park WK, Kim SG, Park HM. Suspected pituitary gland double adenoma in a cat with insulin-resistant diabetes mellitus. J Biomed Res 2014. [DOI: 10.12729/jbr.2014.15.4.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lourenço BN, Randall E, Seiler G, Lunn KF. Abdominal ultrasonographic findings in acromegalic cats. J Feline Med Surg 2014; 17:698-703. [DOI: 10.1177/1098612x14556847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Acromegaly is increasingly recognized as a cause of insulin resistance in cats with diabetes mellitus (DM). The objective of this study was to determine if ultrasonographic changes in selected abdominal organs of acromegalic cats could be used to raise the index of suspicion for this condition. Methods In this retrospective case-control study, medical records of cats presenting to North Carolina State University or Colorado State University from January 2002 to October 2012 were reviewed. Cats were included in the acromegaly group if they had insulin-resistant DM with increased serum insulin-like growth factor (IGF-1) concentrations and had an abdominal ultrasound examination performed with report available. A control group included age-matched cats that had abdominal ultrasound examination performed for investigation of disease unlikely to involve the kidneys, adrenal glands, pancreas or liver. Results Twenty-four cats were included in each group. IGF-1 concentrations in the acromegaly group ranged from >148 to 638 nmol/l. When compared with age-matched controls, cats with acromegaly demonstrated significantly increased median left and right kidney length, significantly increased median left and right adrenal gland thickness, and significantly increased median pancreatic thickness. Hepatomegaly and bilateral adrenomegaly were reported in 63% and 53% of acromegalic cats, respectively, and in none of the controls. Pancreatic abnormalities were described in 88% of the acromegalic cats and 8% of the controls. Conclusions and relevance These findings indicate that compared with non-acromegalic cats, age-matched acromegalic patients have measurably larger kidneys, adrenal glands and pancreas. Diagnostic testing for acromegaly should be considered in poorly regulated diabetic cats exhibiting organomegaly on abdominal ultrasound examination.
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Affiliation(s)
- Bianca N Lourenço
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Elissa Randall
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Gabriela Seiler
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Katharine F Lunn
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Myers JA, Lunn KF, Bright JM. Echocardiographic findings in 11 cats with acromegaly. J Vet Intern Med 2014; 28:1235-8. [PMID: 24962737 PMCID: PMC4857958 DOI: 10.1111/jvim.12386] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 03/18/2014] [Accepted: 04/29/2014] [Indexed: 12/01/2022] Open
Abstract
Background Information regarding cardiac changes in domestic cats with acromegaly is limited. Hypothesis/Objectives The objective of this study was to describe the echocardiographic findings in cats with acromegaly. Animals Eighteen cats diagnosed with acromegaly at Colorado State University between 2008 and 2012. Of these 18 cats, 11 had echocardiography performed. Methods A retrospective review of medical records was made to identify cats with acromegaly that also had echocardiography performed. Results Of the 11 cats identified, 7 had left ventricular concentric hypertrophy, 6 had left atrial enlargement, and 7 had evidence of abnormal diastolic function. All 11 cats had evidence of structural or functional cardiac disease. Conclusions and Clinical Importance Cardiovascular abnormalities frequently are present in cats with acromegaly, and a complete cardiac evaluation should be considered in these patients.
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Affiliation(s)
- J A Myers
- Triangle Veterinary Referral Hospital, Raleigh, NC
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Hoenig M. Carbohydrate Metabolism and Pathogenesis of Diabetes Mellitus in Dogs and Cats. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2014; 121:377-412. [DOI: 10.1016/b978-0-12-800101-1.00012-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lamb CR, Ciasca TC, Mantis P, Forcada Y, Potter M, Church DB, Niessen SJ. Computed tomographic signs of acromegaly in 68 diabetic cats with hypersomatotropism. J Feline Med Surg 2013; 16:99-108. [DOI: 10.1177/1098612x13497212] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In order to describe the signs of acromegaly in cats, a case-control study was done based on computed tomography (CT) scans of the heads of 68 cats with hypersomatotropism and 36 control cats. All cats with a diagnosis of hypersomatotropism had diabetes mellitus, serum insulin-like growth factor-1 >1000 ng/ml and a pituitary mass. Measurements of bones and soft tissues were done by two independent observers without knowledge of the diagnosis. Pituitary masses were identified in CT images of 64 (94%) cats with hypersomatotropism. Analysis of variance found a moderate effect of gender on the size of bones and a large effect of hypersomatotropism on the size of bones and thickness of soft tissues. In cats with hypersomatotropism the frontal and parietal bones were, on average, 0.8 mm thicker ( P <0.001); the distance between the zygomatic arches was, on average, 5.4 mm greater ( P <0.001); and the mandibular rami were, on average, 1.1 mm thicker ( P <0.001) than in control cats. The skin and subcutis dorsal to the frontal bone were, on average, 0.4 mm thicker ( P = 0.001); lateral to the zygomatic arch were, on average, 0.7 mm thicker ( P <0.001); and ventral to the mandibular rami were, on average, 1.1 mm thicker ( P = 0.002) in cats with hypersomatotropism than in control cats. The cross-sectional area of the nasopharynx was, on average, 11.1 mm2 smaller in cats with hypersomatotropism than in control cats ( P = 0.02). Prognathia inferior and signs of temporomandibular joint malformation were both observed more frequently in cats with hypersomatotropism than in control cats ( P = 0.03). Overall, differences between affected and unaffected cats were small. Recognising feline acromegaly on the basis of facial features is difficult.
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Affiliation(s)
- Christopher R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
| | - Taízha C Ciasca
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
| | - Panagiotis Mantis
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
| | - Yaiza Forcada
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
| | - Maegan Potter
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
| | - David B Church
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
| | - Stijn J Niessen
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
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Rosca M, Forcada Y, Solcan G, Church DB, Niessen SJM. Screening diabetic cats for hypersomatotropism: performance of an enzyme-linked immunosorbent assay for insulin-like growth factor 1. J Feline Med Surg 2013; 16:82-8. [PMID: 23828811 DOI: 10.1177/1098612x13496246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Screening diabetic cats for feline hypersomatotropism (HS) is currently dependent on using a radioimmunoassay (RIA) for measurement of growth hormone or insulin-like growth factor 1 (IGF-1), both of which require radioactivity, are costly and have limited availability. Performance of an enzyme-linked immunosorbent assay (ELISA) using anti-human IGF-1 antibodies was assessed. Total IGF-1 was determined in diabetic cat samples across a wide range of IGF-concentrations using a previously validated RIA (serum: 92 cats; plasma: 31 cats). Repeat IGF-1 measurement was then performed using the ELISA-system. Mean IGF-1 recovery after serial dilution proved satisfactory with a correlation coefficient of 0.96 (serum) and 0.97 (plasma). Appropriate precision was established [intra-assay coefficient of variation (CV) 9.5 ± 2% (serum) and 13.6 ± 7% (plasma); inter-assay CV 11.4 ± 4% (serum) and 7.6 ± 6% (plasma)] and significant effect of hyperlipidaemia, haemoglobinaemia, bilirubinaemia and storage was excluded, with the exception of an increase in serum IGF-1 when left at room temperature for more than 24 h. ELISA concentrations correlated significantly with RIA concentrations (serum Pearson r(2): 0.75; plasma: 0.83, P <0.001). Receiver operating characteristics analysis showed an area under the curve of 0.99 (serum) and 0.96 (plasma), and indicated high diagnostic accuracy for categorising a diabetic cat correctly as suspicious for HS at a serum IGF-1 cut-off of 997 ng/ml (sensitivity, 100%; specificity, 88.1%). The current study is the first to validate an easy-to-use and economical IGF-1 ELISA for the screening for HS among diabetic cats, which is important given the suspected significant prevalence of HS-induced diabetes mellitus.
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Affiliation(s)
- Madalina Rosca
- 1Department of Veterinary Clinical Sciences, 'Ion Ionescu de la Brad' University of Agricultural Sciences and Veterinary Medicine Iasi, Romania
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Tschuor F, Zini E, Schellenberg S, Wenger M, Boretti FS, Reusch CE. Evaluation of four methods used to measure plasma insulin-like growth factor 1 concentrations in healthy cats and cats with diabetes mellitus or other diseases. Am J Vet Res 2013; 73:1925-31. [PMID: 23176419 DOI: 10.2460/ajvr.73.12.1925] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate 4 methods used to measure plasma insulin-like growth factor (IGF) 1 concentrations in healthy cats and cats with diabetes mellitus or other diseases. ANIMALS 39 healthy cats, 7 cats with diabetes mellitus, and 33 cats with other diseases. PROCEDURES 4 assays preceded by different sample preparation methods were evaluated, including acid chromatography followed by radioimmunoassay (AC-RIA), acid-ethanol extraction followed by immunoradiometry assay (AEE-IRMA), acidification followed by immunochemiluminescence assay (A-ICMA), and IGF-2 excess followed by RIA (IE-RIA). Validation of the methods included determination of precision, accuracy, and recovery. The concentration of IGF-1 was measured with all methods, and results were compared among cat groups. RESULTS The intra-assay coefficient of variation was < 10% for AC-RIA, A-ICMA, and AEE-IRMA and 14% to 22% for IE-RIA. The linearity of dilution was close to 1 for each method. Recovery rates ranged from 69% to 119%. Five healthy cats had IGF-1 concentrations > 1,000 ng/mL with the AEE-IRMA, but < 1,000 ng/mL with the other methods. Compared with healthy cats, hyperthyroid cats had significantly higher concentrations of IGF-1 with the A-ICMA method, but lower concentrations with the IE-RIA method. Cats with lymphoma had lower IGF-1 concentrations than did healthy cats regardless of the method used. CONCLUSIONS AND CLINICAL RELEVANCE Differences in the methodologies of assays for IGF-1 may explain, at least in part, the conflicting results previously reported in diabetic cats. Disorders such as hyperthyroidism and lymphoma affected IGF-1 concentrations, making interpretation of results more difficult if these conditions are present in cats with diabetes mellitus.
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Affiliation(s)
- Flurin Tschuor
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
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Hypersomatotropism, Acromegaly, and Hyperadrenocorticism and Feline Diabetes Mellitus. Vet Clin North Am Small Anim Pract 2013; 43:319-50. [DOI: 10.1016/j.cvsm.2012.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fischetti AJ, Gisselman K, Peterson ME. CT and MRI evaluation of skull bones and soft tissues in six cats with presumed acromegaly versus 12 unaffected cats. Vet Radiol Ultrasound 2012; 53:535-9. [PMID: 22703122 DOI: 10.1111/j.1740-8261.2012.01957.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/03/2012] [Indexed: 11/27/2022] Open
Abstract
Feline acromegaly is predominantly caused by an adenoma of the pituitary gland, resulting in excessive growth hormone and insulin-like growth factor (IGF-1) secretion. In advanced cases, cats will display prominent facial features and upper airway congestion secondary to bony and soft tissue proliferation. The purpose of this study was to describe CT and MRI characteristics of soft tissues and skull bones in six cats with presumed acromegaly and to compare findings with those observed in 12 unaffected cats. In the five acromegalic cats with CT or MRI evidence of a pituitary tumor, frontal bone thickness was greater than age-matched controls with and without a history of upper airway disease. These five cats also had evidence of soft tissue accumulation in the nasal cavity, sinuses, and pharynx. One cat with insulin-resistant diabetes mellitus, elevated IGF-1, and a normal pituitary size did not have evidence of frontal bone thickening or upper airway congestion.
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Benchekroun G, Fornel-Thibaud P, Dubord M, Dossin O, Fracassi F, Rannou B, Garnier F, Maurey-Guenec C, Daminet S, Rosenberg D. Plasma ACTH Precursors in Cats with Pituitary-Dependent Hyperadrenocorticism. J Vet Intern Med 2012; 26:575-81. [DOI: 10.1111/j.1939-1676.2012.00924.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 02/07/2012] [Accepted: 03/02/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- G. Benchekroun
- Internal Medicine Unit; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort; France
| | | | - M. Dubord
- Biochemistry Unit; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort; France
| | - O. Dossin
- Department of Clinical Sciences and Clinical Research Unit; Ecole Nationale Vétérinaire de Toulouse; Toulouse; France
| | - F. Fracassi
- Department of Veterinary Medical Sciences; Università di Bologna; Ozzano dell'Emilia; Italia
| | - B. Rannou
- Biochemistry Unit; Vetagro Sup; Campus Vétérinaire de Lyon; Marcy l'Etoile; France
| | - F. Garnier
- Biochemistry Unit; Vetagro Sup; Campus Vétérinaire de Lyon; Marcy l'Etoile; France
| | - C. Maurey-Guenec
- Internal Medicine Unit; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort; France
| | - S. Daminet
- Department of Small Animal Medicine; Ghent University; Merelbeke; Belgium
| | - D. Rosenberg
- Internal Medicine Unit; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort; France
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Ciftci G, Yarim GF. Evaluation of IGF-I levels and serum protein profiles of diabetic cats and dogs. J Vet Sci 2011; 12:325-31. [PMID: 22122898 PMCID: PMC3232391 DOI: 10.4142/jvs.2011.12.4.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In this study, we measured the insulin-like growth factor (IGF)-I levels and evaluated the serum protein profiles of diabetic, insulin-treated, and healthy cats and dogs. The total IGF-I concentrations were 33.74 ± 3.4 ng/mL for normal, 25.8 ± 4.5 ng/mL for diabetic, and 180.4 ± 31.4 ng/mL for insulin-treated cats. IGF-I concentrations were 46.4 ± 6.6 ng/mL for normal, 25.1 ± 4.1 ng/mL for diabetic, and 303.0 ± 61.3 ng/mL for insulin-treated dogs. Total serum protein profiles were analyzed by SDS-PAGE. Fourteen bands ranging from 25 to 240 kDa in size were observed for cats, and 17 bands ranging from 25 to 289 kDa were observed for dogs. The densities of the bands differed among control, diabetic, and insulin-treated animals. In conclusion, we found that serum protein profiles and IGF-I concentrations were altered in both diabetic and insulin-treated animals. When judiciously interpreted in the light of other clinical and laboratory data, the techniques used in our study provide a valuable modality for measuring the severity of diabetes mellitus in dogs and cats.
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Affiliation(s)
- Gulay Ciftci
- Department of Biochemistry, Faculty of Veterinary Medicine, University of Ondokuz Mayis, 55139 Samsun, Turkey.
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POSCH BARBARA, DOBSON JANE, HERRTAGE MIKE. MAGNETIC RESONANCE IMAGING FINDINGS IN 15 ACROMEGALIC CATS. Vet Radiol Ultrasound 2011; 52:422-7. [DOI: 10.1111/j.1740-8261.2011.01821.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Meij BP, Auriemma E, Grinwis G, Buijtels JJCWM, Kooistra HS. Successful Treatment of Acromegaly in a Diabetic Cat with Transsphenoidal Hypophysectomy. J Feline Med Surg 2010; 12:406-10. [DOI: 10.1016/j.jfms.2010.03.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2010] [Indexed: 11/16/2022]
Abstract
Patient and surgical treatment An 11-year-old, castrated male cat was referred for insulin-resistant diabetes mellitus. It had a ravenous appetite, increased body weight, polyuria/polydipsia and a dull hair coat. The cat was receiving 25 IU insulin four times daily but blood glucose concentrations remained elevated. Plasma concentrations of growth hormone (GH) (51 μug/l, reference range 0.8–7.2 μg/l) and insulin-like growth factor 1 (IGF-1) (3871 μg/l, reference range 39–590 μg/l) were highly elevated, whereas those of alpha-melanocyte-stimulating hormone, adrenocorticotropic hormone and Cortisol were normal. Computed tomography revealed a thick palatum molle and an enlarged pituitary gland, indicating a pituitary neoplasm. Microsurgical transsphenoidal hypophysectomy was performed and microscopic examination of the surgical specimen revealed an acidophilic, infiltrative pituitary adenoma that showed positive immunostaining for GH. Outcome The clinical signs resolved and 3 weeks after surgery the cat no longer required insulin administration. One year after hypophysectomy the plasma concentrations of GH and IGF-1 were 2.4 μg/l and 113 μg/l, respectively. Practical relevance This is the first report detailing transsphenoidal hypophysectomy as a feasible and effective treatment for feline acromegaly due to a pituitary somatotroph adenoma. Moreover, in this patient, concurrent insulin-resistant diabetes mellitus resolved completely. The surgery is discussed in the context of human and other feline therapies for acromegaly.
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Affiliation(s)
- Björn P Meij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht, The Netherlands
| | - Edoardo Auriemma
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht, The Netherlands
| | - Guy Grinwis
- Department of Pathology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, Utrecht, The Netherlands
| | - Jenny J C W M Buijtels
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht, The Netherlands
| | - Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht, The Netherlands
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Dunning MD, Lowrie CS, Bexfield NH, Dobson JM, Herrtage ME. Exogenous insulin treatment after hypofractionated radiotherapy in cats with diabetes mellitus and acromegaly. J Vet Intern Med 2009; 23:243-9. [PMID: 19192146 DOI: 10.1111/j.1939-1676.2008.0242.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The optimal treatment for feline acromegaly has yet to be established. Surgical and medical therapies are minimally effective although radiotherapy might have greater efficacy. The purpose of this study was to review the response and outcome of cats with acromegaly and insulin-resistant diabetes mellitus (DM) to radiotherapy. HYPOTHESES That radiotherapy improves glycemic control in cats with acromegaly and that improved glycemic control is due to remission of clinical acromegaly; demonstrated by a fall in serum insulin-like growth factor-1 (IGF-1) concentrations. ANIMALS Fourteen cats with naturally occurring acromegaly. METHODS Retrospective case review; records of all cats treated for acromegaly with radiotherapy were reviewed from 1997 to 2008. Cats were selected on the basis of compatible clinical signs, laboratory features, and diagnostic imaging findings. Fourteen cats received radiotherapy, delivered in 10 fractions, 3 times a week to a total dose of 3,700 cGy. RESULTS Thirteen of 14 cats had improved diabetic control after radiotherapy. These improvements were sustained for up to 60 months. DM progressed in 2 cats and 1 did not respond. Seven cats responded before the final treatment. Ten cats were euthanized, 1 as a consequence of radiotherapy. In 8 cats in which IGF-1 was measured after treatment, changes in its concentration did not reflect the clinical improvement in glycemic control. CONCLUSIONS AND CLINICAL IMPORTANCE Radiotherapy represents an effective treatment for cats with insulin-resistant DM resulting from acromegaly. IGF-1 concentration after treatment does not provide a suitable method by which remission from either acromegaly or insulin-resistant DM may be assessed.
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Affiliation(s)
- M D Dunning
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
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Blois SL, Holmberg DL. Cryohypophysectomy used in the treatment of a case of feline acromegaly. J Small Anim Pract 2008; 49:596-600. [PMID: 18684148 DOI: 10.1111/j.1748-5827.2008.00590.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 10-year-old female spayed cat was diagnosed with acromegaly secondary to a pituitary tumour. At the time of diagnosis, the cat had insulin-resistant diabetes mellitus and its insulin-like growth factor-I levels were elevated. Clinical signs included polyuria, polydipsia and weight gain. Persistent hyperglycaemia and glucosuria were identified, and fructosamine levels remained elevated. Magnetic resonance imaging of the brain showed a pituitary tumour. Transsphenoidal cryohypophysectomy was used to treat the pituitary tumour. Postoperatively, the serum insulin-like growth factor-I levels decreased and the diabetes mellitus was controlled with routine levels of insulin. To the authors' knowledge, this is the second reported case of acromegaly treated with cryohypophysectomy, and the first that reports a favourable long-term outcome. Cryohypophysectomy may be a safe and effective treatment for cats with a pituitary mass resulting in acromegaly.
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Affiliation(s)
- S L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, N1G 2W1 Canada
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