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Meij BP, van Stee LL. Transsphenoidal Surgery for Pituitary Tumors. Vet Clin North Am Small Anim Pract 2024:S0195-5616(24)00063-9. [PMID: 39227253 DOI: 10.1016/j.cvsm.2024.07.009] [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: 09/05/2024]
Abstract
Transsphenoidal surgery for the treatment of pituitary masses in cats and dogs has become a more established treatment over the last 2 decades. Although expert centers and surgeons that provide this service remain limited, the patient population presented for pituitary surgery increases with wider availability of advanced imaging, together with more challenging cases. In this review, the current state of hypophysectomy is described with future challenges and opportunities.
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Affiliation(s)
- Björn P Meij
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3584CM, The Netherlands
| | - Lucinda L van Stee
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3584CM, The Netherlands.
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Lopes-Pinto M, Marques PL, Lacerda-Nobre E, Miceli D, Leal RO, Marques P. Acromegaly in humans and cats: Pathophysiological, clinical and management resemblances and differences. Growth Horm IGF Res 2024; 76:101595. [PMID: 38810595 DOI: 10.1016/j.ghir.2024.101595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/28/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Acromegaly is a disorder associated with excessive levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). In general, GH/IGF-1 excess leads to morphologic craniofacial and acral changes as well as cardiometabolic complications, but the phenotypic changes and clinical presentation of acromegaly differ across species. Here, we review the pathophysiology, clinical presentation and management of acromegaly in humans and cats, and we provide a systematic comparison between this disease across these different species. DESIGN A comprehensive literature review of pathophysiology, clinical features, diagnosis and management of acromegaly in humans and in cats was performed. RESULTS Acromegaly is associated with prominent craniofacial changes in both species: frontal bossing, enlarged nose, ears and lips, and protuberant cheekbones are typically encountered in humans, whereas increased width of the head and skull enlargement are commonly found in cats. Malocclusion, prognathism, dental diastema and upper airway obstruction by soft tissue enlargement are reported in both species, as well as continuous growth and widening of extremities resulting in osteoarticular compromise. Increase of articular joint cartilage thickness, vertebral fractures and spine malalignment is more evident in humans, while arthropathy and spondylosis deformans may also occur in cats. Generalized organomegaly is equally observed in both species. Other similarities between humans and cats with acromegaly include heart failure, ventricular hypertrophy, diabetes mellitus, and an overall increased cardiometabolic risk. In GH-secreting pituitary tumours, local compressive effects and behavioral changes are mostly observed in humans, but also present in cats. Cutis verticis gyrata and skin tags are exclusively found in humans, while palmigrade/plantigrade stance may occur in some acromegalic cats. Serum IGF-1 is used for acromegaly diagnosis in both species, but an oral glucose tolerance test with GH measurement is only useful in humans, as glucose load does not inhibit GH secretion in cats. Imaging studies are regularly performed in both species after biochemical diagnosis of acromegaly. Hypophysectomy is the first line treatment for humans and cats, although not always available in veterinary medicine. CONCLUSION Acromegaly in humans and cats has substantial similarities, as a result of common pathophysiological mechanisms, however species-specific features may be found.
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Affiliation(s)
| | - Patrícia Lunet Marques
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Portugal; Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Portugal
| | - Ema Lacerda-Nobre
- Endocrinology Department, Unidade Local de Saúde de Santa Maria, Portugal
| | - Diego Miceli
- IBYME - Institute of Experimental Biology and Medicine (CONICET), Buenos Aires, Argentina
| | - Rodolfo Oliveira Leal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Portugal; Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Portugal
| | - Pedro Marques
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, Lisbon, Portugal; Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal.
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Steele MME, Lawson JS, Scudder C, Watson AH, Ho NTZ, Yaffy D, Batchelor D, Fenn J. Transsphenoidal hypophysectomy for the treatment of hypersomatotropism secondary to a pituitary somatotroph adenoma in a dog. J Vet Intern Med 2024; 38:351-357. [PMID: 37916616 PMCID: PMC10800194 DOI: 10.1111/jvim.16929] [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] [Received: 07/03/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
Pituitary-dependent hypersomatotropism is rarely diagnosed in dogs and surgical treatment is not reported. A 6-year-10-month male neutered Patterdale Terrier presented with polyuria, polydipsia, progressive pharyngeal stertor, excessive hair growth and widened facial features and paws. Serum insulin-like growth factor-1 concentration via radioimmunoassay was consistent with hypersomatotropism (1783 ng/mL). A pituitary mass was identified on magnetic resonance and computed tomography imaging. Six weeks later, glucosuria, starved hyperglycemia and serum fructosamine above the reference range (467.6 μmol/L, RI 177-314) were documented, consistent with diabetes mellitus. Transsphenoidal hypophysectomy was performed under general anesthesia without complications. Pituitary histopathology identified an acidophil neoplasm, with positive immunostaining for growth hormone. Postoperatively, there was rapid resolution of clinical, biochemical and morphologic changes of hypersomatotropism with persistence of diabetes mellitus. This case demonstrates successful resolution of hypersomatotropism with ongoing diabetes mellitus in a dog after surgical treatment by transsphenoidal hypophysectomy.
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Affiliation(s)
| | - Jack S. Lawson
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Christopher Scudder
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Alice H. Watson
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Nicola T. Z. Ho
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Dylan Yaffy
- Department of Pathobiology and Population SciencesRoyal Veterinary CollegeHatfieldUK
| | - Daniel Batchelor
- Department of Small Animal Clinical SciencesUniversity of LiverpoolNestonUK
| | - Joe Fenn
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
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O'Sullivan LE, Kent M, Glass EN, Song RB, Warren JD, de Lahunta A, Miller A. Pathology in Practice. J Am Vet Med Assoc 2021; 258:857-860. [PMID: 33825532 DOI: 10.2460/javma.258.8.857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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: 14] [Impact Index Per Article: 4.7] [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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Miller MA, Piotrowski SL, Donovan TA, Scott-Moncrieff JC, Owen TJ, McCue JP, DuSold DM, Ramos-Vara JA, Weng HY, Chen AV, Martin LG, Bruyette DS. Feline Pituitary Adenomas: Correlation of Histologic and Immunohistochemical Characteristics With Clinical Findings and Case Outcome. Vet Pathol 2021; 58:266-275. [PMID: 33280571 PMCID: PMC10722206 DOI: 10.1177/0300985820978309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pituitary glands from 141 feline autopsy cases were reviewed histologically. Adenoma and hyperplasia were the most common lesions at 13 cases each. Pituitary adenoma was more likely than hyperplasia to be associated with clinical evidence of endocrinopathy or an intracranial mass (P < .001). A histochemical and immunohistochemical panel was applied to 44 autopsy- or hypophysectomy-derived pituitary adenomas in 43 cats from 2 diagnostic laboratories. Adenomas were differentiated from hyperplasia by the presence of disrupted reticulin fibers. One cat had a double (somatotroph and melanotroph) adenoma. Twenty somatotroph adenomas consisted of periodic acid-Schiff (PAS)-negative acidophils that expressed growth hormone; 16/20 had hypersomatotropism; 17/20 had diabetes mellitus. Eleven melanotroph adenomas consisted of PAS-positive basophils or chromophobes that expressed melanocyte-stimulating and adrenocorticotrophic hormones; 5/11 had hypercortisolism; 6/11 had diabetes mellitus. Eleven gonadotroph adenomas consisted of PAS-negative chromophobes that expressed follicle-stimulating and/or luteinizing hormones. Two thyrotroph adenomas consisted of PAS-negative basophils or chromophobes that expressed thyroid-stimulating hormone. Pituitary-dependent disease was not recognized in cats with gonadotroph or thyrotroph adenomas. The Ki-67 proliferation index in hypophysectomy specimens was lower in somatotroph than in melanotroph adenomas. Fourteen cats with hypophysectomy-treated somatotroph or melanotroph adenoma had an 899-day median survival time versus 173 days in 17 nonsurgical cases. After adjusting for age, adenoma size and type, hypophysectomized cats had an overall better survival time than nonsurgical cases (P = .029). The study results underscore the value of hypophysectomy and trophic hormone immunohistochemistry in the treatment and classification of feline pituitary adenomas.
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Affiliation(s)
| | - Stacey L. Piotrowski
- Purdue University, West Lafayette, IN, USA
- Comparative Biomedical Scientist Training Program, National Institutes of Health, Bethesda, MD, USA
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Sanders K, Galac S, Meij BP. Pituitary tumour types in dogs and cats. Vet J 2021; 270:105623. [PMID: 33641809 DOI: 10.1016/j.tvjl.2021.105623] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/25/2022]
Abstract
Pituitary tumours are common in dogs and are being increasingly recognized in cats. Pituitary tumours are usually classified as adenomas and should only be classified as carcinomas when there is evidence of metastatic spread of the tumour, which is rare. Despite the benign nature of most pituitary tumours, they can still compress or invade neighbouring tissues. Pituitary tumours can be functional (hormonally active) or non-functional (hormonally silent). The aim of this review was to provide an overview of the different pituitary tumour types in dogs and cats that have been reported in the literature. In dogs, the most common pituitary tumour type is the corticotroph adenoma, which can cause pituitary-dependent hypercortisolism. In cats, the most common pituitary tumour is the somatotroph adenoma, which can cause hypersomatotropism, and the second-most common is the corticotroph adenoma. A lactotroph adenoma has been described in one dog, while gonadotroph, thyrotroph and null cell adenomas have not been described in dogs or cats. Hormonally silent adenomas are likely underdiagnosed because they do not result in an endocrine syndrome. Tools used to classify pituitary tumours in humans, particularly immunohistochemistry for lineage-specific transcription factors, are likely to be useful to classify canine and feline pituitary tumours of unknown origin. Future studies are required to better understand the full range of pituitary adenoma pathology in dogs and cats and to determine whether certain adenoma subtypes behave more aggressively than others. Currently, the mechanisms that underlie pituitary tumorigenesis in dogs and cats are still largely unknown. A better understanding of the molecular background of these tumours could help to identify improved pituitary-targeted therapeutics.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
| | - S Galac
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - B P Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
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Owen TJ, Martin LG, Chen AV. Transsphenoidal Surgery for Pituitary Tumors and Other Sellar Masses. Vet Clin North Am Small Anim Pract 2017; 48:129-151. [PMID: 29056398 DOI: 10.1016/j.cvsm.2017.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Transsphenoidal surgery is an option for dogs and cats with functional and nonfunctional pituitary masses or other sellar and parasellar masses. An adrenocorticotropic hormone-secreting tumor causing Cushing disease is the most common clinically relevant pituitary tumor in dogs, and the most common pituitary tumor seen in cats is a growth hormone-secreting tumor causing acromegaly. Transsphenoidal surgery can lead to rapid resolution of clinical signs and provide a cure for these patients. Because of the risks associated with this surgery, it should only be attempted by a cohesive pituitary surgery group with a sophisticated medical and surgical team.
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Affiliation(s)
- Tina J Owen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, PO Box 647060, Pullman, WA 99164-7060, USA.
| | - Linda G Martin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, PO Box 646610, Pullman, WA 99164-6610, USA
| | - Annie V Chen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, PO Box 646610, Pullman, WA 99164-6610, USA
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Boland LA, Barrs VR. Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment. J Feline Med Surg 2017; 19:933-947. [PMID: 28838299 PMCID: PMC11128894 DOI: 10.1177/1098612x17723245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Practical relevance: Hyperadrenocorticism (HAC) is a relatively uncommon endocrinopathy of older cats, with a mean age at diagnosis of 10 years. In addition to pituitary-dependent and adrenal-dependent hypercortisolism, clinical signs of HAC can result from adrenal sex steroid-producing tumours. Clinical challenges: While HAC in cats has many similarities to canine HAC, there are key differences in presentation, diagnosis and response to therapy. Most, but not all, cats with HAC have concurrent diabetes mellitus, which is often insulin resistant. Up to a third of cats with HAC have extreme skin fragility and are at high risk of debilitating iatrogenic skin tears during diagnostic or therapeutic interventions. Infections of the skin and nail beds, and urinary, respiratory and gastrointestinal tract, secondary to cortisol-induced immune suppression, are also common. Cats respond differently to dogs to adrenal function tests including adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression tests; a 10-fold higher dose of dexamethasone is recommended in cats to screen for HAC. Curative treatment options include adrenalectomy or transsphenoidal hypophysectomy. Radiation or medical treatment may improve clinical signs. The response to mitotane therapy is poor. While trilostane is the medical treatment of choice based on retrospective studies, investigations into the pharmacokinetics of this drug in cats are lacking. Global importance: Feline HAC occurs worldwide and is not associated with any purebreed predisposition. Although uncommon, adrenal sex steroid-producing tumours have a higher prevalence in cats than in dogs. Evidence base: The information in this review is drawn from over 180 reported cases of feline HAC. Reports investigating clinical presentation, clinicopathological findings and treatment outcomes are observational, retrospective multiple case series (EBM grade III) or single case reports (EBM grade IV). While most endocrine testing studies for diagnosis are cohort controlled analytical studies (EBM grade III), prospective, randomised, placebo-controlled studies have been performed (EBM grade I).
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Affiliation(s)
- Lara A Boland
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, and Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, 2006, Australia
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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: 24] [Impact Index Per Article: 3.4] [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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Meij BP, van der Vlugt-Meijer RH, van den Ingh TSGAM, Flik G, Rijnberk A. Melanotroph Pituitary Adenoma in a Cat with Diabetes Mellitus. Vet Pathol 2016; 42:92-7. [PMID: 15657280 DOI: 10.1354/vp.42-1-92] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 13-year-old male, castrated, crossbred cat was referred for insulin-resistant diabetes mellitus. The cat had a ravenous appetite and a dull coat. Basal urinary corticoid/creatinine ratios were normal. In the low-dose dexamethasone suppression test there was no suppression of the (nonelevated) plasma cortisol concentration, whereas the (nonelevated) plasma adrenocorticotropic hormone (ACTH) concentration declined to low values. Basal plasma α-melanocyte-stimulating hormone (α-MSH) concentrations were highly elevated (> 1,500 ng/liter). Computed tomography revealed a pituitary tumor originating from the pars intermedia (PI). After microsurgical transsphenoidal hypophysectomy, the clinical signs resolved and the cat no longer required insulin administration. Microscopic examination of the surgical specimen revealed a pituitary adenoma originating from the PI with infiltration into the neural lobe. The adenoma immunostained intensely positive for α-MSH and only weakly for ACTH. It is concluded that the ACTH-independent cortisol production was probably due to the (weak) glucocorticorticotropic effects of the extremely high plasma concentration of α-MSH and related peptides.
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Affiliation(s)
- B P Meij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, PO Box 80.154, NL-3508 TD Utrecht, The Netherlands.
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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: 18] [Impact Index Per Article: 2.3] [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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13
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Valentin SY, Cortright CC, Nelson RW, Pressler BM, Rosenberg D, Moore GE, Scott-Moncrieff JC. Clinical findings, diagnostic test results, and treatment outcome in cats with spontaneous hyperadrenocorticism: 30 cases. J Vet Intern Med 2014; 28:481-7. [PMID: 24433386 PMCID: PMC4858028 DOI: 10.1111/jvim.12298] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/07/2013] [Accepted: 12/05/2013] [Indexed: 12/25/2022] Open
Abstract
Background Spontaneous hyperadrenocorticism (HAC) is rare in cats. Clinical findings, diagnostic test results, and response to various treatment options must be better characterized. Objectives To report the clinical presentation, clinicopathologic findings, diagnostic imaging results, and response to treatment of cats with HAC. Animals Cats with spontaneous HAC. Methods Retrospective descriptive case series. Results Thirty cats (15 neutered males, 15 spayed females; age, 4.0–17.6 years [median, 13.0 years]) were identified from 10 veterinary referral institutions. The most common reason for referral was unregulated diabetes mellitus; dermatologic abnormalities were the most frequent physical examination finding. Low‐dose dexamethasone suppression test results were consistent with HAC in 27 of 28 cats (96%), whereas ACTH stimulation testing was suggestive of HAC in only 9 of 16 cats (56%). Ultrasonographic appearance of the adrenal glands was consistent with the final clinical diagnosis of PDH or ADH in 28 of 30 cats (93%). Of the 17 cats available for follow‐up at least 1 month beyond initial diagnosis of HAC, improved quality of life was reported most commonly in cats with PDH treated with trilostane. Conclusions and Clinical Importance Dermatologic abnormalities or unregulated diabetes mellitus are the most likely reasons for initial referral of cats with HAC. The dexamethasone suppression test is recommended over ACTH stimulation for initial screening of cats with suspected HAC. Diagnostic imaging of the adrenal glands may allow rapid and accurate differentiation of PDH from ADH in cats with confirmed disease, but additional prospective studies are needed.
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Affiliation(s)
- S Y Valentin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
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Sharman M, FitzGerald L, Kiupel M. Concurrent somatotroph and plurihormonal pituitary adenomas in a cat. J Feline Med Surg 2013; 15:945-52. [PMID: 23553410 PMCID: PMC11383157 DOI: 10.1177/1098612x13483461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
An 8-year-old, male neutered, domestic longhair cat was referred for investigation of insulin-resistant diabetes mellitus. Routine haematology, serum biochemistry, urinalysis (including culture), total T4 and urine creatinine:cortisol ratio were unremarkable, but markedly increased insulin-like growth factor-1 concentration was identified and a pituitary mass was subsequently documented. The cat was treated conservatively with the dopamine agonist L-deprenyl and was re-presented 16 months later for worsening polyuria, polydipsia, polyphagia, marked lumbar muscle atrophy, development of a pendulous abdomen and marked thinning of the abdominal skin. Hyperadrenocorticism was diagnosed based on abdominal ultrasonography, dexamethasone suppression testing and endogenous adrenocorticotropic hormone (ACTH). The cat was treated with trilostane (30 mg q24h PO) and showed some clinical improvement, but developed an opportunistic fungal infection and skin fragility syndrome 4.5 months after commencing treatment, and was euthanased. A double-pituitary adenoma comprising a discrete somatotroph adenoma and a separate plurihormonal adenoma (positive immunoreactivity for ACTH, melanocyte-stimulating hormone and follicle-stimulating hormone) was identified on post-mortem examination. These two pituitary adenomas were suspected to have arisen as independent neoplastic entities with the plurihormonal tumour either being clinically silent at the initial presentation or having developed over the subsequent 16 months.
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Affiliation(s)
- Mellora Sharman
- 1Department of Veterinary Clinical Sciences, School of Veterinary and Biomedical Sciences, Murdoch University, Murdoch, WA, Australia
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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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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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Cross E, Moreland R, Wallack S. Feline Pituitary-Dependent Hyperadrenocorticism and Insulin Resistance Due to a Plurihormonal Adenoma. Top Companion Anim Med 2012; 27:8-20. [DOI: 10.1053/j.tcam.2011.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 12/05/2011] [Indexed: 11/11/2022]
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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. [PMID: 20417901 PMCID: PMC11318759 DOI: 10.1016/j.jfms.2010.03.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2010] [Indexed: 11/16/2022]
Abstract
UNLABELLED 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 microg/l, reference range 0.8-7.2 microg/l) and insulin-like growth factor 1 (IGF-1) (3871 microg/l, reference range 39-590 microg/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 microg/l and 113 microg/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.
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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.
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Slingerland LI, Voorhout G, Rijnberk A, Kooistra HS. Growth hormone excess and the effect of octreotide in cats with diabetes mellitus. Domest Anim Endocrinol 2008; 35:352-61. [PMID: 18801640 DOI: 10.1016/j.domaniend.2008.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 06/20/2008] [Accepted: 07/30/2008] [Indexed: 11/21/2022]
Abstract
In this prospective study 16 cats with diabetes mellitus were examined for concurrent acromegaly by measuring plasma growth hormone (GH) and insulin-like growth factor-I concentrations, and magnetic resonance imaging (MRI) of the pituitary fossa. Additionally, the effects of octreotide administration on the plasma concentrations of glucose, GH, alpha-melanocyte-stimulating hormone (alpha-MSH), adrenocorticotrophic hormone (ACTH), and cortisol were measured. Five cats were diagnosed with hypersomatotropism. The pituitary was enlarged in these 5 cats and in 2 other cats. Six cats that required a maximum lente insulin dosage >or=1.5 IU/kg body weight per injection had pituitary enlargement and 5 of these cats had acromegaly. Plasma concentrations of GH, ACTH, and cortisol decreased significantly after single intravenous administration of the somatostatin analogue octreotide in the acromegalic cats. The effect on GH concentrations was more pronounced in some of the acromegalic cats than in others. In the non-acromegalic cats only ACTH concentrations decreased significantly. In both groups plasma glucose concentrations increased slightly but significantly, whereas alpha-MSH concentrations were not significantly affected. In conclusion, the incidence of hypersomatotropism with concomitant pituitary enlargement appears to be high among diabetic cats with severe insulin resistance. Some of these cats responded to octreotide administration with a pronounced decrease in the plasma GH concentration, which suggests that octreotide administration could be used as a pre-entry test for treatment with somatostatin analogues.
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Affiliation(s)
- L I Slingerland
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
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Fracassi F, Mandrioli L, Diana A, Hilbe M, Grinwis G, Gandini G. Pituitary Macroadenoma in a Cat with Diabetes Mellitus, Hypercortisolism and Neurological Signs. ACTA ACUST UNITED AC 2007; 54:359-63. [PMID: 17718809 DOI: 10.1111/j.1439-0442.2007.00962.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 13-year-old neutered male European short-hair cat was presented because of blindness and behavioural abnormalities. On physical examination, abnormal behaviour, compulsive walking, circling, continuous vocalization and blindness were the main neurological signs. In addition, abdominal alopecia, thin and inelastic skin, weight loss despite polyphagia, polyuria and polydipsia were present. Laboratory investigation revealed diabetes mellitus and pituitary-dependent hypercortisolism. Diagnostic imaging showed bilaterally enlarged adrenals and a large pituitary mass. Histopathological and immunohistochemical examination confirmed the clinical diagnosis of an ACTH-producing pituitary macroadenoma.
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Affiliation(s)
- F Fracassi
- Veterinary Clinical Department, University of Bologna, Via Tolara di Sopra 50, 40064 Ozzano dell'Emilia (Bologna), Italy.
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Ohlerth S, Scharf G. Computed tomography in small animals – Basic principles and state of the art applications. Vet J 2007; 173:254-71. [PMID: 16516508 DOI: 10.1016/j.tvjl.2005.12.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2005] [Indexed: 10/24/2022]
Abstract
Since its clinical introduction, computed tomography (CT) has revolutionized veterinary medicine and is considered to be one of the most valuable tools for the imaging work-up of neurological, oncological and orthopaedic canine and feline patients. In small animals with acute trauma, particularly those involving complex anatomic areas such as the head, spine or pelvis, CT has been established as a standard imaging method. With the increasing availability of radiation therapy in veterinary medicine, CT has also become the principal tool to stage a tumour, assess response, and guide radiation therapy. The increasing availability of helical CT in veterinary medicine has allowed novel techniques such as spiral CT angiography and high-resolution CT. This review provides a brief overview of the historical and technical development of CT and literature reviews of the major clinical CT applications in small animals such as intracranial and extracranial lesions, the spine, the appendicular skeleton, and abdominal and thoracic diseases.
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Affiliation(s)
- Stefanie Ohlerth
- Section of Diagnostic Imaging and Radio-Oncology, Vetsuisse Faculty, University of Zürich, Winterthurerstrasse 260, 8057 Zürich, Switzerland.
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