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Miceli DD, Jaliquias A, Gallelli MF, García JD, Vecino C, Rey Amunategui JP, Pompili GA, Espiñeira IM, Más J, Pignataro OP. Increased insulin-like growth factor 1 concentrations in a population of non-diabetic cats with overweight/obesity. Domest Anim Endocrinol 2024; 89:106858. [PMID: 38830275 DOI: 10.1016/j.domaniend.2024.106858] [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: 02/23/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
Feline hypersomatotropism (HST) is typically associated with diabetes mellitus (DM), whereas HST without concurrent DM has only been reported in a few cases. Weight gain may be observed in cats with HST. The aims of this study were to evaluate circulating insulin-like growth factor-1 (IGF-1) in non-diabetic cats with overweight/obesity, to screen this population for the presence of HST, and to assess whether there is a correlation between body weight/body condition score (BCS) and serum IGF-1 concentration in overweight/obese cats. In this prospective study, 80 overweight/obese cats from referral centers in Buenos Aires (Argentina) were evaluated. Serum IGF-1 was measured as part of the routine tests for overweight/obesity. Non-diabetic cats were included in the study if they had a BCS>6/9. Twenty-nine cats were classified as overweight (BCS 7/9), whereas 51 were classified as obese (BCS 8-9/9). Median serum IGF-1 concentrations of cats with BCS 7/9, 8/9, and 9/9 were 570 ng/ml (range 123-1456 ng/ml), 634 ng/ml (range 151-1500 ng/ml), and 598 ng/ml (range 284-2450 ng/ml), respectively. There was a positive linear correlation between serum IGF-1 concentrations and body weight (r= 0.24, 95% CI 0.01-0.44 P=0.03), and between IGF-1 and BCS (r= 0.27, 95% CI 0.08-0.44 P=0.004). In total, 8.75% (95% confidence interval 3.6-17.2%) of the cats with overweight/obesity had IGF-1 concentrations >1000 ng/ml. Pituitary enlargement was detected on computed tomography in 4/7 cases. These seven cats showed varying degrees of phenotypic changes consistent with acromegaly. A proportion of 8.75 % of overweight/obese non-diabetic cats from referral centers in Buenos Aires had serum IGF-1 concentration in a range consistent with HST in diabetic cats. Likewise, 5% of overweight/obese cats were likely to be diagnosed with HST, supported by evidence of pituitary enlargement. Serum IGF-1 concentrations were positively correlated with body weight and BCS in this population of cats. This study highlights the relevance of screening different populations of non-diabetic cats to increase the detection of HST/acromegaly.
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Affiliation(s)
- D D Miceli
- Veterinary Science Center, Maimonides University, Buenos Aires, Argentina; Laboratory of Molecular Endocrinology and Signal Transduction, Institute of Experimental Biology and Medicine - CONICET, Buenos Aires, Argentina.
| | | | | | - J D García
- Private practice, Buenos Aires, Argentina
| | - C Vecino
- Private practice, Buenos Aires, Argentina
| | - J P Rey Amunategui
- Veterinary Science Center, Maimonides University, Buenos Aires, Argentina; Private practice, Buenos Aires, Argentina
| | | | | | - J Más
- Diagnotest Laboratory, Buenos Aires, Argentina
| | - O P Pignataro
- Laboratory of Molecular Endocrinology and Signal Transduction, Institute of Experimental Biology and Medicine - CONICET, Buenos Aires, Argentina
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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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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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Güssow A, Thalmeier S, Gostelow R, Langenstein J, Foerster G, Bauer N, Hazuchova K. Method Validation and Establishment of Reference Intervals for an Insulin-like Growth Factor-1 Chemiluminescent Immunoassay in Cats. Vet Sci 2023; 10:575. [PMID: 37756097 PMCID: PMC10534906 DOI: 10.3390/vetsci10090575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Previously, radioimmunoassay (RIA) has been the only assay to measure insulin-like growth factor-1 (IGF-1) to diagnose hypersomatotropism (HS). Due to radiation concerns, availability, and the cost of IGF-1 RIA, validation of assays for automated analysers such as a chemiluminescent immunoassay (CLIA) is needed. The aim of this study was to validate a CLIA for measurement of feline IGF-1 (IMMULITE 2000® XPi, Siemens Medical Solutions Diagnostics, Malvern, PA, USA) compared to IGF1 RIA, establish reference interval (RI), and determine a cut-off value for diagnosis of HS in diabetic cats. Validation of assay performance included precision, linearity, and recovery studies. Right-sided RI was determined using surplus serum of 50 healthy adult cats. Surplus serum samples of diabetic cats with known IGF-1 concentration with (n = 32/68) and without HS (n = 36/68) were used for method comparison with RIA. The cut-off for diagnosis of HS was established using receiver operating characteristic (ROC) analysis. The intra-assay coefficient of variation (CV) was ≤4.7%, and the inter-assay CV was ≤5.6% for samples with low, medium, and high IGF-1 concentration. Linearity was excellent (R2 > 0.99). The correlation between CLIA and RIA was very high (rs = 0.97), with a mean negative bias for CLIA of 24.5%. The upper limit of RI was 670 ng/mL. ROC analysis showed an area under the curve of 0.94, with best cut-off for diagnosis of HS at 746 ng/mL (sensitivity, 84.4%; specificity, 97.2%). The performance of CLIA was good, and the RI and cut-off for HS diagnosis established in this study allow for CLIA to be used in routine work-up of diabetic cats.
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Affiliation(s)
- Arne Güssow
- Clinic for Small Animals (Internal Medicine, Clinical Pathology and Clinical Pathophysiology), Justus-Liebig-University, 35392 Giessen, Germany
| | - Sabine Thalmeier
- Clinic for Small Animals (Internal Medicine, Clinical Pathology and Clinical Pathophysiology), Justus-Liebig-University, 35392 Giessen, Germany
| | - Ruth Gostelow
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield AL9 7TA, UK
| | | | | | - Natali Bauer
- Clinic for Small Animals (Internal Medicine, Clinical Pathology and Clinical Pathophysiology), Justus-Liebig-University, 35392 Giessen, Germany
| | - Katarina Hazuchova
- Clinic for Small Animals (Internal Medicine, Clinical Pathology and Clinical Pathophysiology), Justus-Liebig-University, 35392 Giessen, Germany
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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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Miceli DD, García JD, Rey Amunategui JP, Pompili GA, Rial LA, Más J, Molina EM, Pignataro OP. Prevalence of hypersomatotropism and hyperthyroidism in cats with diabetes mellitus from referral centers in Buenos Aires (2020-2022). J Feline Med Surg 2023; 25:1098612X221148565. [PMID: 36779783 PMCID: PMC10812081 DOI: 10.1177/1098612x221148565] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVES The aim of this study was to estimate the prevalence of hypersomatotropism (HST) and hyperthyroidism in cats with diabetes mellitus (DM) from referral centers in Buenos Aires, Argentina. METHODS This was a prospective study. Systematic screening of serum insulin-like growth factor 1 (IGF-1) and total thyroxine was performed in all cats diagnosed with DM at referral centers in Buenos Aires between February 2020 and February 2022. RESULTS In total, 154 diabetic cats were evaluated (99 males and 55 females; median age 12 years [range 3-21]; mean body weight 5 kg [range 2-12]). Altogether, there were 115 (75%) domestic shorthairs and one domestic longhair; the remaining 38 cats were purebred (mainly Siamese, n = 25 [16%]). Twenty (12.9%) cats had IGF-1 concentrations >1000 ng/ml, and three (1.9%) had IGF-1 concentrations between 800 and 1000 ng/ml along with pituitary enlargement on CT, resulting in a 14.9% HST prevalence rate in diabetic cats. Intracranial imaging was performed in all cats with HST; median pituitary dorsoventral height was 5.8 mm (range 3.1-9.5). Fourteen of 23 (61%) cats had phenotypic changes consistent with acromegaly at the time of diagnosis of HST. Four of 154 (2.5%) cats had concurrent hyperthyroidism. CONCLUSIONS AND RELEVANCE To date, this is the first study outside of Europe to have evaluated the prevalence of HST and hyperthyroidism in cats with DM. In Buenos Aires referral centers, feline HST is the most common concurrent endocrinopathy in cats with DM but with a lower prevalence than has previously been reported. Hyperthyroidism is a rare concurrent endocrinopathy in diabetic cats from referral centers in Buenos Aires.
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Affiliation(s)
- Diego D Miceli
- Laboratory of Molecular Endocrinology and Signal Transduction, Institute of Experimental Biology and Medicine – CONICET, Buenos Aires, Argentina
- Veterinary Science Center, Maimonides University, Buenos Aires, Argentina
| | - Jorge D García
- Hospital School of Veterinary Medicine, University of Buenos Aires, Faculty of Veterinary Sciences, Buenos Aires, Argentina
| | | | - Gustavo A Pompili
- Hospital School of Veterinary Medicine, University of Buenos Aires, Faculty of Veterinary Sciences, Buenos Aires, Argentina
| | - Laura A Rial
- Department of Animal Welfare and Ethology, University of Buenos Aires, Faculty of Veterinary Sciences, Buenos Aires, Argentina
| | - Javier Más
- Diagnotest Laboratory, Buenos Aires, Argentina
| | - Estela M Molina
- Hospital School of Veterinary Medicine, University of Buenos Aires, Faculty of Veterinary Sciences, Buenos Aires, Argentina
| | - Omar P Pignataro
- Laboratory of Molecular Endocrinology and Signal Transduction, Institute of Experimental Biology and Medicine – CONICET, Buenos Aires, Argentina
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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: 4] [Impact Index Per Article: 2.0] [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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Steele MME, Borgeat K, Payne JR, Coss P, Navarro-Cubas X, Church DB, Niessen SJM, 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 PMCID: PMC11197129 DOI: 10.1177/1098612x20987995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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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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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10
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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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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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12
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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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13
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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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Rivenburg R, Owen TJ, Martin LG, Chen AV. Pituitary Surgery: Changing the Paradigm in Veterinary Medicine in the United States. J Am Anim Hosp Assoc 2021; 57:73-80. [PMID: 33450023 DOI: 10.5326/jaaha-ms-7009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 11/11/2022]
Abstract
Medical management is currently the most common treatment for pituitary-dependent hyperadrenocorticism and hypersomatotropism/acromegaly in veterinary medicine. Medical management does not provide a cure for either disease process, and rarely is pituitary imaging a part of initial diagnostics. Early pituitary imaging in animals with clinically functional pituitary tumors provides a baseline assessment, allows monitoring of tumor changes, and permits radiation and surgical planning. Surgery is the only treatment for pituitary tumors that has curative intent and allows for a definitive diagnosis. Surgical removal of pituitary tumors via transsphenoidal hypophysectomy is an effective treatment for clinical pituitary tumors in patients exhibiting endocrine abnormalities associated with pituitary-dependent hyperadrenocorticism and hypersomatotropism. Surgery, however, is rarely pursued until patients have failed medical management, and often not until they are showing neurologic signs, making surgical success challenging. It is well documented that dogs surgically treated when the pituitary mass is small have a lower mortality, a lower recurrence rate, and a longer survival than those with larger pituitary masses. Providing owners with the option of early pituitary imaging in addition to medical, surgical, and radiation treatment options should be the standard of care for animals diagnosed with pituitary-dependent hyperadrenocorticism or hypersomatotropism.
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Corsini A, Bianchi E, Volta A, Bonazzi M. Sciatic neuropathy in an acromegalic cat without concurrent diabetes mellitus. JFMS Open Rep 2020; 6:2055116920906936. [PMID: 32128232 PMCID: PMC7036516 DOI: 10.1177/2055116920906936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 17-year-old neutered male European Shorthair cat was presented owing to an inability to jump and respiratory stridor. The owner did not report any other clinical signs. On physical examination, the main findings were plantigrade stance, broad facial features and inspiratory stridor. Neurological examination revealed posterior paraparesis, hypotonia and right hindlimb muscle atrophy. Laboratory findings were unremarkable and glycaemia was normal. Serum insulin-like growth factor 1 concentration was elevated (>1000 ng/ml). A total body CT scan showed an enlarged pituitary gland, thickening of the nasal turbinates and an L7-S1 right foraminal stenosis. Electrodiagnostic testing confirmed the presence of a neuropathy affecting both sciatic nerves. The cat was treated with gabapentin only and was still alive and euglycaemic 16 months after the diagnosis. Relevance and novel information This case describes for the first time sciatic neuropathy, an occasional complication of acromegaly in people, as a possible clinical presentation in acromegalic cats without concurrent diabetes mellitus.
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Affiliation(s)
- Andrea Corsini
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Ezio Bianchi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Antonella Volta
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Mattia Bonazzi
- Department of Veterinary Science, University of Parma, Parma, Italy
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16
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Strage EM, Sundberg M, Holst BS, Andersson Franko M, Ramström M, Fall T, Lewitt M. Effect of insulin treatment on circulating insulin-like growth factor I and IGF-binding proteins in cats with diabetes mellitus. J Vet Intern Med 2018; 32:1579-1590. [PMID: 30112786 PMCID: PMC6189377 DOI: 10.1111/jvim.15243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 04/15/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Insulin-like growth factor-I (IGF-I) is used to screen for acromegaly in diabetic cats. In humans, most circulating IGF-I forms ternary complexes (TC) with IGF-binding protein (IGFBP-3) and an acid-labile subunit. Compared to humans, the amount of TC in cats is more variable. Insulin-like growth factor-I concentrations are reported to increase during insulin treatment, more rapidly in cats achieving remission. OBJECTIVES To investigate (i) factors associated with circulating IGF-I concentrations, including IGFBP-profiles (ii) effect of insulin treatment on IGF-I concentrations and (iii) IGF-I as prognostic marker of diabetes mellitus remission. ANIMALS Thirty-one privately owned diabetic cats of which 24 were followed 1 year, and 13 healthy cats. METHODS Prospective study. Serum insulin, IGF-I, glucose, and fructosamine concentrations were measured. IGF-binding forms were determined by chromatography in 14 diabetic and 13 healthy cats; and IGF-I, IGF-II, IGFBP-3, and IGFBP-5 by mass spectrometry in 3 cats achieving remission. RESULTS Insulin-like growth factor-I median (interquartile range) before start of insulin treatment was 300 (160-556) ng/mL. Insulin-like growth factor-I was positively associated with TC (P < .0001) and endogenous insulin (P = .005) and negatively associated with fructosamine (P < .0001). Median IGF-I was higher 2-4 weeks after start of insulin treatment compared with baseline (300 versus 670 ng/mL, P = .0001) and predicted future remission (P = .046). In cats that went into remission, the amount of TC and IGFBP-3 increased, suggesting increase in IGF-I is dependent on TC formation. CONCLUSIONS Insulin treatment should be accounted for when interpreting IGF-I in diabetic cats. Insulin-like growth factor-I 2-4 weeks after initiation of insulin treatment shows promise as prognostic marker for remission in diabetic cats.
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Affiliation(s)
- Emma M Strage
- Department of Clinical Sciences, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden.,Clinical Pathology Laboratory, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Mårten Sundberg
- Department of Chemistry- BMC and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Bodil S Holst
- Department of Clinical Sciences, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Margareta Ramström
- Department of Chemistry- BMC and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Moira Lewitt
- School of Health Nursing and Midwifery, University of the West of Scotland, Paisley, United Kingdom
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Time spent with cats is never wasted: Lessons learned from feline acromegalic cardiomyopathy, a naturally occurring animal model of the human disease. PLoS One 2018. [PMID: 29596445 DOI: 10.1371/journal.pone.0194342.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In humans, acromegaly due to a pituitary somatotrophic adenoma is a recognized cause of increased left ventricular (LV) mass. Acromegalic cardiomyopathy is incompletely understood, and represents a major cause of morbidity and mortality. We describe the clinical, echocardiographic and histopathologic features of naturally occurring feline acromegalic cardiomyopathy, an emerging disease among domestic cats. METHODS Cats with confirmed hypersomatotropism (IGF-1>1000ng/ml and pituitary mass; n = 67) were prospectively recruited, as were two control groups: diabetics (IGF-1<800ng/ml; n = 24) and healthy cats without known endocrinopathy or cardiovascular disease (n = 16). Echocardiography was performed in all cases, including after hypersomatotropism treatment where applicable. Additionally, tissue samples from deceased cats with hypersomatotropism, hypertrophic cardiomyopathy and age-matched controls (n = 21 each) were collected and systematically histopathologically reviewed and compared. RESULTS By echocardiography, cats with hypersomatotropism had a greater maximum LV wall thickness (6.5mm, 4.1-10.1mm) than diabetic (5.9mm, 4.2-9.1mm; Mann Whitney, p<0.001) or control cats (5.2mm, 4.1-6.5mm; Mann Whitney, p<0.001). Left atrial diameter was also greater in cats with hypersomatotropism (16.6mm, 13.0-29.5mm) than in diabetic (15.4mm, 11.2-20.3mm; Mann Whitney, p<0.001) and control cats (14.0mm, 12.6-17.4mm; Mann Whitney, p<0.001). After hypophysectomy and normalization of IGF-1 concentration (n = 20), echocardiographic changes proved mostly reversible. As in humans, histopathology of the feline acromegalic heart was dominated by myocyte hypertrophy with interstitial fibrosis and minimal myofiber disarray. CONCLUSIONS These results demonstrate cats could be considered a naturally occurring model of acromegalic cardiomyopathy, and as such help elucidate mechanisms driving cardiovascular remodeling in this disease.
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18
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Borgeat K, Niessen SJM, Wilkie L, Harrington N, Church DB, Luis Fuentes V, Connolly DJ. Time spent with cats is never wasted: Lessons learned from feline acromegalic cardiomyopathy, a naturally occurring animal model of the human disease. PLoS One 2018; 13:e0194342. [PMID: 29596445 PMCID: PMC5875754 DOI: 10.1371/journal.pone.0194342] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/01/2018] [Indexed: 12/16/2022] Open
Abstract
Background In humans, acromegaly due to a pituitary somatotrophic adenoma is a recognized cause of increased left ventricular (LV) mass. Acromegalic cardiomyopathy is incompletely understood, and represents a major cause of morbidity and mortality. We describe the clinical, echocardiographic and histopathologic features of naturally occurring feline acromegalic cardiomyopathy, an emerging disease among domestic cats. Methods Cats with confirmed hypersomatotropism (IGF-1>1000ng/ml and pituitary mass; n = 67) were prospectively recruited, as were two control groups: diabetics (IGF-1<800ng/ml; n = 24) and healthy cats without known endocrinopathy or cardiovascular disease (n = 16). Echocardiography was performed in all cases, including after hypersomatotropism treatment where applicable. Additionally, tissue samples from deceased cats with hypersomatotropism, hypertrophic cardiomyopathy and age-matched controls (n = 21 each) were collected and systematically histopathologically reviewed and compared. Results By echocardiography, cats with hypersomatotropism had a greater maximum LV wall thickness (6.5mm, 4.1–10.1mm) than diabetic (5.9mm, 4.2–9.1mm; Mann Whitney, p<0.001) or control cats (5.2mm, 4.1–6.5mm; Mann Whitney, p<0.001). Left atrial diameter was also greater in cats with hypersomatotropism (16.6mm, 13.0–29.5mm) than in diabetic (15.4mm, 11.2–20.3mm; Mann Whitney, p<0.001) and control cats (14.0mm, 12.6–17.4mm; Mann Whitney, p<0.001). After hypophysectomy and normalization of IGF-1 concentration (n = 20), echocardiographic changes proved mostly reversible. As in humans, histopathology of the feline acromegalic heart was dominated by myocyte hypertrophy with interstitial fibrosis and minimal myofiber disarray. Conclusions These results demonstrate cats could be considered a naturally occurring model of acromegalic cardiomyopathy, and as such help elucidate mechanisms driving cardiovascular remodeling in this disease.
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Affiliation(s)
- Kieran Borgeat
- Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
- Langford Veterinary Services, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Stijn J. M. Niessen
- Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | - Lois Wilkie
- Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | - Norelene Harrington
- Pathology and Pathogen Biology, Royal Veterinary College, Hatfield, United Kingdom
| | - David B. Church
- Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | | | - David J. Connolly
- Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
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