Hypoglicemia - 9 year old Spaniel

RE: Hypoglicemia - 9 year old Spaniel

Edward Jones — Thu, 09 May 2019 14:22:56 GMT

Thank you for updating. Good for us to know you were able to confirm the diagnosis.

Commiserations on the outcome, I hope it doesn't get you down excessively.

RE: Hypoglicemia - 9 year old Spaniel

Dinu Catilina — Thu, 09 May 2019 13:47:54 GMT

Update.

Certainly an insulinoma. We did an exploratory laparatomy and found an irregular mass in the left limb about 3 cm long and 1 cm wide. Unfortunately it was deeply sitted on the dorsal abdominal wall and the dog died intraoperatively after I damaged a blood vessel and couldn't control the bleed. I'll ask for a copy of the CT scan and review it and maybe we can spot it when we know where to look.

Thank you everyone for your input

RE: Hypoglicemia - 9 year old Spaniel

Beats — Mon, 22 Apr 2019 20:55:58 GMT

[quote user="Dinu Catilina"]Insulinoma test at FINN[/quote]

I always get this test done at Idexx - code AIGR. I know nothing of Finn's offering, but I know some labs insist on freezer packs and other stuff that rather complicates matters unecessarily... And I send them a fluoride oxalate tube for the glucose as well as the spun serum-gel tube even though they only ask for the latter.

RE: Hypoglicemia - 9 year old Spaniel

Beats — Mon, 22 Apr 2019 20:51:31 GMT

It's (almost certainly) an insulinoma.

CT just hasn't identified it.

Triple-phase angiographic CT is (I believe) the most sensitive modality, but standing at the end of a long bit of tubing outside of blast radius and injecting and imaging at correct points ain't feasible for everyone.

I'm a fan of simply surgically exploring these cases, if so, then to access left limb of pancreas make tear through greater omentum to open it up (as well as the right limb running down side of duodenum) [I hope I've explained that correctly]. Obviously there are risks to weigh-up with that approach.

My summary for owners is:

Recommend that we open up and have a look for a suspected small lump on pancreas. If it can be identified and is on a bit of the pancreas that can reasonably be removed without heroics, then that will be done - the recovery can be a bit bumpy and there is a risk of death (over-rated I reckon with well planned care). Otherwise, will stitch back up again and shouldn't be any worse off after a few days.

Alternatively, for about the same price, can try to image the lump - might not find it, but benefit is that if find it is an area that can't safely be removed then won't subject to needless surgical procedure.

Finally, can just feed little and often and give some drugs (I tend to jsut offer pred, but other options including that hiddeously expensive one beginning with strep are technically available - I reckon if not interested in imaging or surgery then unlikely to be interested in that either and just complicates the dsicussion) and when quality of life not good euthanase [clarifying that waiting until quality of life not good and then attempting surgery is NOT a recommendation I would make, so decide from outset].

RE: Hypoglicemia - 9 year old Spaniel

Dinu Catilina — Mon, 22 Apr 2019 11:10:50 GMT

[quote user="Kate Richardson"]

Worht checking liver function as well, is the dog worse after feeding re confusion?

[/quote]

My apologies If I was unclear. The confusion appears first thing in the morning and improves immediately with feeding so most likely is a consequence of hypoglicemia.

Thank you everyone for your suggestions. Will see him tomorrow morning and start him on preds as soon as the blood samples are taken. Will update you on the final results and outcome.

Any other suggestions are still very welcome.

RE: Hypoglicemia - 9 year old Spaniel

Kate Richardson — Mon, 22 Apr 2019 09:05:09 GMT

Worht checking liver function as well, is the dog worse after feeding re confusion?

RE: Hypoglicemia - 9 year old Spaniel

Virginia Campbell — Mon, 22 Apr 2019 04:33:15 GMT

I remember seeing one a good few years ago in a middle aged Westie. No nodule found on ultrasound, didn't want to refer for CT. E/lytes normal, just episodes hypoglycemia.

Gave a guarded prognosis but it did well for years on low dose pred- think we used 1mg sid in 10kg- ish dog, plus small frequent meals.

RE: Hypoglicemia - 9 year old Spaniel

Anthony Dennison — Sun, 21 Apr 2019 22:45:56 GMT

Hi Dinu,

We had a similar case - couldn't see anything on a CT scan, had someone come in and do an ultrasound scan on the dog who couldn't be certain. We ended up doing an ex-lap, and found a tiny nodule on the pancreas that wasn't visible, could only be felt by touch.

That was about 3 years ago. Dog is still alive and doing well, as long as she doesn't miss a steroid dose! (Does have horrific calcinosis cutis though).

RE: Hypoglicemia - 9 year old Spaniel

Andreia Dias — Sun, 21 Apr 2019 21:45:02 GMT

Interesting, looks very typical... Did they use contrast on the CT scan? I think insulinomas can be really stupidly small and very hard to pick up and maybe you got it really early? (so much so that you still don't have overt hyperinsulinsm?) Lytes sound like a good idea anyway (maybe include calcium and phosphorus too, can't tell you why, just something in the back of my mind...). Any possibility of drug toxicity, or something like low grade xylitol exposure?

Since patient is hypoglycaemic despite feeding, maybe whack it with some steroids to boost insulin resistance? And maybe in 2 weeks time it will be visible on repeat scan? :p

If not... I would say scan the brain. I was told that whenever you've dug around and can't find your answer, it's probably in the brain xD And I guess in theory if you have a pituitary issue it could cause hypoglycaemia? Maybe check with the lab about the usefulness of pairing insulin with IGF-1? I know we normally use it for the opposite, but I would expect IGF1 to be elevated if you have persistent hypoglycaemia to try to counteract it, or low if you have a pituitary problem or an exhausted gland.

Just throwing in some ideas :)

RE: Hypoglicemia - 9 year old Spaniel

Emily Rainbow — Sun, 21 Apr 2019 21:36:35 GMT

Acth stim as well as electrolytes incase of atypical addisons.

if not trial treatment with pred?