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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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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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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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Miceli DD, García JD, Pompili GA, Rey Amunategui JP, Ferraris S, Pignataro OP, Guitelman M. Cabergoline treatment in cats with diabetes mellitus and hypersomatotropism. J Feline Med Surg 2022; 24:1238-1244. [PMID: 35133181 PMCID: PMC10812327 DOI: 10.1177/1098612x221074924] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the safety and efficacy of cabergoline to control hypersomatotropism (HST) and diabetes mellitus (DM) in cats. METHODS This was a prospective cohort study. Twenty-three cats with HST and concurrent DM were enrolled. Cats received a dose of 10 μg/kg cabergoline q48h PO for 6 months. Serum insulin-like growth factor 1 (IGF-1) and fructosamine concentrations, insulin dose and Insulin Resistance Index (IRI) were measured at the time of diagnosis of HST and at the start of cabergoline treatment (t0), and 3 months (t1) and 6 months (t2) during cabergoline treatment. RESULTS A decrease and normalization of serum IGF-1 concentration was observed in 35% and 26% of cats, respectively. Median IGF-1 (t0: 1350 ng/ml [range 832-1501]; t1: 1284 ng/ml [range 365-1501]; t2: 1240 ng/ml [range 263-1501]; P = 0.016) decreased significantly. Twelve cats underwent diagnostic imaging of the pituitary area. The median pituitary height at t0 of cats that experienced an IGF-1 reduction (n = 5/12) was significantly lower compared with those that did not experience an IGF-1 reduction (n = 7/12) (3.2 mm [range 3.1-3.7] vs 6 mm [range 3.5-9.5]; P = 0.011). Median fructosamine (t0: 628 µmol/l [range 400-963]; t1: 404 µmol/l [range 249-780]; t2: 400 µmol/l [range 260-815]; P <0.0001), insulin dose (t0: 1.3 IU/kg [range 0.5-4.6]; t0: 0.5 IU/kg [range 0-2.3]; t2: 0.4 IU/kg [range 0-2.1]; P <0.0001) and IRI (t0: 800 µmolIU/kgl [range 257-2700]; t1: 300 µmolIU/kgl [range 0-1498]; t2: 250 µmolIU/kgl [range 0-1498]; P <0.0001) decreased significantly during cabergoline treatment. Eight cats achieved diabetic remission between months 1 and 6 of cabergoline treatment (median time to achieve remission: 3 months [range 1-6]). Three cats experienced asymptomatic hypoglycemia. CONCLUSIONS AND RELEVANCE Cabergoline was effective in normalizing IGF-1 concentration in 26% of cats. Cabergoline improved diabetes control and was associated with remission of DM in 35% of cases. Cabergoline could be a treatment option for cats with HST and DM, especially in those cases with a relatively small pituitary tumor.
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Affiliation(s)
- Diego D Miceli
- Hospital School of Veterinary Medicine, University of Buenos Aires, Faculty of Veterinary Sciences, Buenos Aires, Argentina
- 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
| | | | - Sergio Ferraris
- Veterinary Science Center, Maimonides University, Buenos Aires, Argentina
| | - Omar P Pignataro
- Laboratory of Molecular Endocrinology and Signal Transduction, Institute of Experimental Biology and Medicine – CONICET, Buenos Aires, Argentina
| | - Mirtha Guitelman
- Endocrinology Unit, Hospital Carlos G Durand, 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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Miceli DD, Vidal PN, Pompili GA, Castillo VA, Soler Arias EA, Niessen SJ. Diabetes mellitus remission in three cats with hypersomatotropism after cabergoline treatment. JFMS Open Rep 2021; 7:20551169211018991. [PMID: 34158968 PMCID: PMC8186120 DOI: 10.1177/20551169211018991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Case summary Three diabetic cats presented with polyuria, polydipsia, polyphagia and poor glycemic control. Cat 1 displayed prognathia inferior and had a body condition score (BCS) of 4/5; cat 2 had a BCS of 5/5; and cat 3 had broad facial features. Serum insulin-like growth factor 1 concentrations were compatible with hypersomatotropism in cat 1 and cat 2 (>1500 ng/ml and 1200 ng/ml, respectively) and just below the cut-off of 1000 ng/ml (947 ng/ml) in cat 3; in this last cat diagnosis was further supported by the presence of pituitary enlargement on MRI. Oral cabergoline (10 μg/kg q48h) was initiated. Insulin requirements progressively reduced, as evidenced by daily blood glucose monitoring and weekly blood glucose curves. Diabetic remission occurred in all three cats between the second and third months of cabergoline treatment. At the time of writing, remission has persisted thus far (cat 1: 23 months; cat 2: 14 months; cat 3: 38 months). Relevance and novel information To our knowledge, these are the first reported cases of diabetic remission in cats with hypersomatotropism after cabergoline treatment, despite previous reports of this being an ineffective treatment. Further work is indicated to determine why some cats do, and others do not, respond to this treatment.
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Affiliation(s)
- Diego D Miceli
- Endocrinology Unit, Hospital School of Veterinary Medicine, University of Buenos Aires, Buenos Aires, Argentina.,Laboratory of Molecular Endocrinology and Signal Transduction, Institute of Experimental Biology and Medicine - CONICET, Buenos Aires, Argentina
| | - Patricia N Vidal
- Endocrinology Unit, Hospital School of Veterinary Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Gustavo A Pompili
- Cardiology Unit, Hospital School of Veterinary Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Víctor A Castillo
- Endocrinology Unit, Hospital School of Veterinary Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Elber A Soler Arias
- Endocrinology Unit, Hospital School of Veterinary Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Stijn Jm Niessen
- Department of Clinical Science and Services, The Royal Veterinary Collage, Hatfield, UK.,Veterinary Specialist Consultations, Hilversum, The Netherlands
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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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