Acromegaly

RE: Acromegaly

Ian Ramsey — Sat, 23 Mar 2019 21:27:17 GMT

Hi,

I am not sure where the idea of 15 units as limit came from. For me I would use as much as is necessary. I know Mike Herrtage had one case at Cambridge that needed 60 (yes six-zero) units of insulin to control the hyperglycaemia -and the group at the RVC have had some cases like that as well. Cases that need that much insulin are a rarity and most of the ones I have dealt with have needed 5 -10 units like the others reported in this thread.

I think the important thing to remember is that only a small proportion actually look acromegalic so you really should try to test all cats who are not stabilising well or needing high doses. Some would argue that all diabetic cats should be tested a few weeks after starting insulin as the knowledge will help the long term stabilisation process even if they are not going to be candidates for hypophysectomy. Don't go quite that far but reach for the IGF-1 very quickly if things are not 100% smooth!

Best wishes

Ian

RE: Acromegaly

Neil Wheadon — Sat, 23 Mar 2019 12:12:02 GMT

Growth Hormone from these cases comes in pulses.

There is a theory not to go above 15IU BID regardless as you risk hypoglycaemia

Neil

RE: Acromegaly

Anthony Dennison — Fri, 15 Mar 2019 09:12:30 GMT

The vet who last saw the cat put no clinical notes on the record, just dispensed some prozinc. In the 2 weeks I was off it just says 'will wait until Anthony is back' repeatedly.

RE: Acromegaly

Rob Loxley — Mon, 11 Mar 2019 21:50:36 GMT

[quote user="Anthony Dennison"]everyone has just left it for me to sort when I came back . Looks like he's been switched to ProZinc and dose has increased. [/quote]

so they've adjusted the dose and insulin (which you also asked about), but equally they have just left it for your to sort out??

RE: Acromegaly

Anthony Dennison — Mon, 11 Mar 2019 13:35:45 GMT

Update,

I've been off for last 2 weeks and unfortunately, despite leaving instructions on the record and speaking to some of my colleagues, everyone has just left it for me to sort when I came back . Looks like he's been switched to ProZinc and dose has increased.

RE: Acromegaly

Kate Richardson — Mon, 04 Mar 2019 17:32:12 GMT

[quote user="madeline pike"]

1 in 4 diabetic cats is due to underlying acromegaly based on the research by feline diabetic remission clinic at RVC/Steinn Neison.

[/quote]

I remain to be convinced that it is clinically significant in all of these cats though.....

RE: Acromegaly

madeline pike — Mon, 04 Mar 2019 11:13:27 GMT

1 in 4 diabetic cats is due to underlying acromegaly based on the research by feline diabetic remission clinic at RVC/Steinn Neison.

RE: Acromegaly

Julian Earl — Mon, 04 Mar 2019 10:44:58 GMT

Please could someone enlighten me? Just how common or otherwise, is Acromegaly? I can remember seeing cats like his when I was either unqualified or newly qualified and no tests were feasible then but is it ridiculous to assume that I saw several over the years? Or are they like hen's teeth really?

Thanks in anticipation for your wisdom.

RE: Acromegaly

listhestar — Fri, 01 Mar 2019 21:50:02 GMT

[quote user="Anthony Dennison"]So, apart from sending the cat down to the RVC for a hypophysectomy (bit far considering the cat is in Lancashire) or sending for potentially ineffective radiotherapy, is it just a case of continually increasing the insulin d[/quote]

I had a similar case a few years back. The owner's didn't want surgery (was a higher mortality back then). She managed well on quite high doses of insulin and did OK for 2 years or so. She liked like a classic textbook case of acromegaly at the end of life mind.

RE: Acromegaly

Kate Richardson — Thu, 21 Feb 2019 22:02:06 GMT

Short answer Anthony Dennison is yes. (Assuming it is on Caninsulin currently). Or glargine but I don’t think it offers any more than Prozinc and isn’t licensed, although this wouldn’t stop me using it if needed, but I’m a big fan of Prozinc.

I’m not up to date with latest data but had a really good chat with David Church a few years ago about the ethics of Hypophysectomy and have to say it’s not as awful as I first thought but there are serious risks and they also need post op treatment with thyroid supplementation and ADH, usually long term, poss corticosteroids as well from memory, so owners need to be prepared for that.

I had one acromegalic diabetic cat that stabilised on about 8 units of Prozinc so def worth a change if surgery not an option for this cat.

As an aside, all diabetic cats should ideally be started on Prozinc in my opinion, better control and better chance of remission.

RE: Acromegaly

David Mills — Thu, 21 Feb 2019 01:11:54 GMT

Look at the videos of the surgery...very crude through soft palate and grab... Looks very "unskilled".

RE: Acromegaly

ebedford — Wed, 20 Feb 2019 21:10:37 GMT

We had case with very high igf, we just kept increasing insulin, I think he was on 18iu prozinc twice a day at one point (definitely using two syringes each time), no real change in glucose curve values, always high 20s. We ended up stopping increasing and went down to a more manageable dose in the theory that we may never get good control. Not sure if it was the right thing in the end - he ended up being quite ill and funds limited so was pts, don't know if it was acromegaly related in the end.

Would be interested to see how your case goes - perhaps contact rvc to see if they have any medical management advice.

RE: Acromegaly

KathW — Mon, 18 Feb 2019 22:34:57 GMT

I had one on glargine many years ago. Confirmed acromegaly case in a receptionist’s cat. Did fairly well for well over 12 months from memory. Never great control but reasonable QOL

Did better on the glargine than on the PZI insulin.