? 3/8 Sebastian PMPS 252 +2 221 +3 228 +11 245. IGF/IAA. Hyperadrenocorticsim/Hyperaldosteronism?

Better start, he may have been flat all night, if that's the case we might expect an interesting cycle this morning.
Guess you didn't get anymore tests after the +2 last night that might enlighten us?
 
287@+3

Gill & George said:
Better start, he may have been flat all night, if that's the case we might expect an interesting cycle this morning.
Guess you didn't get anymore tests after the +2 last night that might enlighten us?
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Nope, no other tests last night

Olive & Paula said:
Today is Friday, you should have results today. I would be calling the vet to ask.
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I just emailed asking again. If I don't hear from them by midday I'll call.
 
Tonight will be cycle 5 since the depot reducing shot, as the depot fills we expect to start to see what the full effect of the dose will be.
I'd be looking to spot an active cycle tonight or tomorrow. We consider it takes upto 6 cycles for the depot to fill.

Of course if last night was an active cycle, which is possible since pmps may have been falling, and the +2 lacked a food spike, you might find that he actually ends up in pink today/tonight.

You'll be able to make a more informed observation over the next couple of cycles.
 
264@+6.

Got the IGF/IAA results. IGF-1: 21 (ref range 12-92) unit nmol/L. IAA: 85 H (ref range <=20) unit %.

In the results the Endocrinology Interpretation says the normal range of IGF-1 does not support a diagnosis of acromegaly. However the elevated IAA would indicate the need for increased dosage to break through it followed by possible hypo. But I think we have that under control.
The interesting part is, and I don't know if I mentioned it here yet, but his hair has not fully grown back around his belly and neck where it was shaved at the end of November for the pancreatitis attack. They ask if there are any physical changes or laboratory anomolies that would raise the possibility of hyperadrenocorticsim or hyperaldosteronism. I don't know what other physical symptoms we'd be looking for, but I would consider the fact that he's been unable to gain weight back despite being at a high calorie load to be a physical change.
 
So I did a little more digging on the two hypers. Here's my thoughts on the listed symptoms

hyperadrenocorticism
  • Excessive drinking (polydipsia) and excessive urination (polyuria) - Yes, though as I understand it these are also symptoms of unregulated diabetes. His drinking and urination have actually gotten a lot better since we've made the diet change and gotten his BG down. He's not drinking nearly as much, maybe only 1-2 trips to the water fountain a day compared to 4-5 in the past. Urine volume is also coming down.
  • Increased appetite - Kind of hard to tell with his ketone requirements. We're feeding him 364 kcal/day and he's eating all of that. He's hungry come meal time but not ravenously so and doesn't instantly devour all the food when it's given.
  • Enlargement of the abdomen (a pot-bellied appearance) - Definitely not
  • Lethargy - Yes, though not to an extreme. And he's gotten better since getting over the p'titis flare and getting his numbers down.
  • Muscle wasting and weakness - Doesn't seem like. He's able to jump up on the couch back and counters, run around, etc.
  • Poor coat condition - Not overly. He fluctuates between being soft and fluffy to sometimes a bit oily, but nothing too bad. He used to have dandruff but that's also gone away since we've gotten the BG under control.
  • Hair loss - No loss, just the very, very slow regrowth. It is coming back in, it's just taking its sweet time.
  • Curling of the ear tips - Nope
  • Thin and fragile skin - Don't think so, he doesn't seem to get scratched overly easily and it's not like he's super easy to get the blood for BG checks from.
hyperaldosteronism
Harder to find physical symptoms listing for this one. It sounds like it'd be more urinary, or possibly vision related issues. His urinalysis and cultures have come back pretty clean, potassium is in a normal range. And I don't think he's having any vision problems. He tracks really well and well catch his squirrel when I toss it to him and will fling it around and catch it in mid-air.
 
Justin & Sebastian said:
Hair loss - No loss, just the very, very slow regrowth. It is coming back in, it's just taking its sweet time.
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We had a civie that had to have an op to repair his leg and clean out a gunshot wound and got shaved around his tummy, the fur took absolutely for ever to grow back, much longer than I'd noticed with our other two civies following their spay/neuter. I happened to mention it to the vet, and he said that it depends where in the cycle of fur growth they are. Apparently they have periods of more active growth and periods of rest.
 
Found a better listing of symptoms for hyperaldosteronism:
Clinical signs
Clinical signs are typically associated with potassium depletion and systemic arterial hypertension. Owners may report signs of episodic or acute muscle weakness including the inability to jump on and off surroundings, plantigrade stance of the hindlimbs, inability to raise the head (cervical ventroflexion), and lateral recumbency or collapse. Presenting complaints may also include concerns of sudden blindness, mydriasis, and hyphema.

I don't see any of those. He's jumping up and off stuff fine, I've been watching for him walking on his haunches since I learned that was a sign of diabetic neurological decline and there's none of that, head movement is fine, and like I mentioned before his vision seems great.
 
FYI hyperadrenocorticism is also known as Cushings. We have a separate forum with more information on it (and IAA). Tagging @Tuxedo Mom and @Ana & Frosty (GA) , two recent members whose kitties had Cushings. Note that a kitty can be in early stage Cushings for a while before all the symptoms show. I don’t know much about hyperaldosteronism aka Conn’s syndrome. If you search FDMB for it, you'll find the odd reference to a kitty with it.

Did your vet suggest any follow on tests?

The IAA 85% goes a long way to explaining Sebastian's thirst for insulin. @Sandy and Black Kitty BK also had a similarly high IAA. My Neko also had IAA, but a lower number and in conjuction with acromegaly. Good to hear you aren't dealing with the latter. IAA is supposed to be self limiting over time, about a year. @Amanda and a Loudogg Loudogg is also an IAA kitty.
 
Wendy&Neko said:
Did your vet suggest any follow on tests?
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Not yet, though I got the impression they don't know how to follow up themselves. Here's the response I got from the vet tech:

"Here are the results. Dr. Maureen did speak to the critical care doctor at AVS and they don't usuallygets excited about the elevated RIA. As I said she has been trying to connect with internists at UF still and will try again today. She may also contact the Vetsulin doctors to consult with them as well."

AVS is the hospital were he was treated for pancreatitis. I'm pretty sure she meant they talked to the internal specialist there, I'm not sure why she'd be talking to the critical care docs. And I already know the internal specialists at AVS don't know what they're talking about. They're the ones who suggested Vetsulin and suggested that we didn't need to do the IGF and IAA tests in the first place. Between that and then them trying to contact internists at UF gave me the impression they need outside assistance on how to proceed.
 
Justin & Sebastian said:
Found a better listing of symptoms for hyperaldosteronism:
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In the case of two of my cyvies that have high levels of aldosterone the only visible signs in one of them were extreme hunger and losing some weight, drinking more than usual and the coat became more scarce, bit oily and it takes a lot of time to grow which in her case was very unusual I could actually shave her in summer and in less than a month her coat would be long and thick again, also her potassium levels were showing a tendency to decrease so the vet tested her aldosterone and renin levels in blood, and the aldosterone did came elevated, her renin levels are even now normal not even on the lower range and her blood pressure is normal

The other one even now is not showing any visible symptoms we tested her after the discovery in the other one since she is her daughter, so the vet ordered blood tests for aldosterone levels and renin, and we got pretty much the same result high aldosterone levels, normal renin levels and in her case she's not even showing a decrease in her potassium levels and her blood pressure is also normal
 
Wendy&Neko said:
Here's a post to start learning about tests: http://www.felinediabetes.com/FDMB/threads/how-to-diagnose-cushings.207776/
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Okay, I read that. So the only symptom that stands out as maybe being similar is "What I found was that Tuxie's levels could go from extremely high to extremely low to non-responsive all within a few cycles. This is because the excess cortisol production can wax and wane with PDH. PDH appears to be the most common with kitties.". @Gill & George has been paying the most attention to Sebastian's readings and I think would probably be best to comment on if we're seeing that. It kind of seems like it to me, with Sebastian being low and flat, then high and flat and not coming down. But that just might be a bounce, I don't have enough experience to know myself.

So and then also from that thread I see that "The cheapest and least invasive test is the UCCR (Urine cortisol creatinine ratio) test". And then from Veronica's reply above, it sounds like we should also test the aldosterone and renin levels in blood. We do have potassium levels from the various superchems we've done, all have been in range except for the test they did when he was in with the pancreatitis.
 
Here's some information on Hyperaldosteronism https://www.vin.com/apputil/content/defaultadv1.aspx?id=7054873&pid=12886& I really don't know how the high levels of aldosterone could influence their BG since both my cats that have this problem are not diabetic and their BG has luckly always come out normal if by any chance they make an ultrasound it could be good if they include the adrenal glands just to make sure they both look normal
 
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Justin & Sebastian said:
. @Gill & George has been paying the most attention to Sebastian's readings and I think would probably be best to comment on if we're seeing that.
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With the variables that we have had with Sebastian, kibble, gravy food, pancreatitis flare and the fact that we were missing a lot of PM data (you're getting on top of that now) I think it would be to early to comment, a lot of what we have seen up until now could be attributed to the food changes and the Ptitis.
Other IAA kitties (without cushings) have had similar patterns.
 
Justin & Sebastian said:
Yeah and I'm going to try to get more. Not every night, but maybe like 3-4 nights a week I'm going to start setting an alarm and getting a +6 just so we have a reference point of night time mid-point.
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Remember getting a +10 or +11 when you get up is also helpful when you are looking for patterns of BG.

I would get the +6 on days when the before bed test suggests he might be up to something.
 
PMPS 252. I'll get a +2 but still not looking like they'll be much action tonight. At what point does a bounce turn into a dose reduction that didn't take?
 
221@+2. +2 definitely seems to be tracking downwards over the past couple nights. I'll stay up and get a +3 just to make sure he doesn't nosedive at onset.
 
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