Sticky Acromegaly and Other High Dose Conditions: What We Know

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Carolynn FletcherGA & RobbieGA, Dec 30, 2009.

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  1. Carolynn FletcherGA & RobbieGA

    Carolynn FletcherGA & RobbieGA Member

    Joined:
    Dec 28, 2009
    Acromegaly and Other High Dose Conditions: What We Know

    What is Acromegaly:

    Acromegaly is long-term excessive secretion of growth hormone (GH) from a tumor in the pituitary gland in the brain. In cats, these tumors grow slowly and may be present for a very long time before you notice any changes in your cat. The medical term for acromegaly is hypersomatotropism. The excess growth hormone causes the liver to make another hormone called Insulin-Like Growth Factor -1 (IGF-1). It's this hormone that causes the problems seen in acromegalic cats, such as diabetes.


    How Common is Acromegaly in Cats?

    In a lecture by Dr. Lunn from Colorado State University at the 2011 ACVIM Forum Proceeding, she stated:

    Feline acromegaly has historically been regarded as a rare condition, however recent findings suggest that it may be significantly under diagnosed. In a study of 184 diabetic cats, 59 had markedly increased IGF-1 concentrations, and acromegaly was confirmed in 17 of 18 cats that were examined by computerized tomography (CT), magnetic resonance imaging (MRI), or necropsy. These findings have suggested that any cat with clinical features of acromegaly including insulin resistance, should be screened for this disorder.

    At the same forum, Dr. Niessan from London, UK stated:

    “Feline acromegaly is now being recognized as an important cause of feline DM, largely as a result of two remarkable prevalance studies. Both these studies suggested that feline acromegaly occurs in a significant proportion of diabetic cats with estimates ranging from 1 in 3 to 1 in 4. Even when adhering to the more conservative estimate, this has justified the initiation of several studies on various aspects of this endocrinopathy, including more careful evaluation of etiology, clinical presentation, and management aspects.”


    How do we spot a potential acromegalic cat? Questions we ask.

    *Cats are normally flagged up as potentially not being 'normal diabetics' when they are getting higher than normal doses of insulin and/or it's proven difficult to get control over their BGs.

    *Just like a 'normal' diabetic cat we think/ask the same questions of a cat’s mom/dad before we think of acromegaly – basics such as appropriate diet, right insulin and doses, and hometesting need to be sorted out first. For example:

    1) How long has your cat been on insulin?
    2) At what insulin dose did you start?
    3) How was the insulin increased and by how much, and over how long a period of time?
    4) How did you determine that an increase was needed?
    5) Are you home testing now, and if so, have you kept a record?
    6) What food are you feeding?

    *Once the more common causes of having a cat on high insulin doses have been dealt with, for example dry food, too fast dose rises, infection, etc., - then we start thinking that something else might be going on.

    *Acromegalic cats typically have certain patterns or issues going on with them that act as 'red flags' to point us towards thinking 'acromegaly'. It's a collection of these issues that just aren't 'right'. We then start asking more hi-dose specific quesitons such as:

    7) Have you noticed changes in the way your cat breathes? Any changes in their eye sight?
    8) Have you noticed any behavioral changes in your cat? For example, appearing to be in pain, avoiding bright light.
    9) Have you noticed any physical changes in your cat's appearance?
    10) Has your cat had a tendency to gain weight despite no increases in amount of food you are feeding?


    Link to have blood sent for IGF-1 testing:

    For the USA and Canada – costs vary depending where you live: https://www.animalhealth.msu.edu/Bin/Catalog/Catalog_Test.exe?Action=Print&ID=1401
    UK - (no longer free, but can be requested at): https://www.rvc.ac.uk/pathology-and...s/diagnostic-laboratories#panel-diabetic-cats


    In the US – a result > 100 is considered + for acromegaly; in Great Britain a result > 1000 is positive.

    Link to have blood sent for Growth Hormone test (Newest blood test being asked for by Colorado State University for documentation of acromegaly):
    *currently this test is unavailable - we will update with further news*


    Once diagnosed:

    It is IMPORTANT to remember – there is nothing weird or wonderful about how a high dose cat's diabetes is managed. However, we do recommend that one should NOT 'go it alone' without the support of the FDMB and/or the vet in caring for these cats. Although their care follows basic common sense it also tends to involve more insulin.


    Some falicies about acrocats:

    *They never get DKA – NOT TRUE! Several of our acrokitties have been quite ill with DKA – Jennifer’s Spunky, Dale Ann’s Snuggle’s are just a couple of them.
    *They ALWAYS have large heads, feet, bodies. – NOT TRUE – oftentimes the physical features aren’t seen until much later in the disease process!
    *Acromegalic cats won't suffer from hypoglycemia. No, acromegalic cat's BGs can drop to extremely low levels if the IGF-1 levels in their bodys reduce, their own insulin is working and we give them 'extra' insulin.


    And if we can't get a diagnosis for a hi-dose cat?

    Ultimately if a cat is on the correct diet and insulin regimen, the owner is hometesting, there are no other factors that could be causing raised BGs (infection, pain) and all lab tests have come back negative (IGF-1, Cushings, IAA etc) then it can be a case that the cat is just a hi-dose cat, plain and simple. If that's the case then giving the insulin and doses the cat needs, however large to gain control of the BGs is what needs to be done.


    Some of our acrocat’s stories:

    Beth and Pickles, Stephanie and Pheobe, and Lara and Paddy: http://petdiabetes.wikia.com/wiki/Category:Insuvet_PZI_cases
    Carolynn and Fletcher: http://www.blogster.com/carolynn/
    Patti and Merlin: http://petdiabetes.wikia.com/wiki/Case:Merlin http://www.blogster.com/pattiandjoe/1173654980




    Further Information:

    *Feline Acromegaly: An Underdiagnosed Endocrinopathy?
    Journal of Veterinary Medicine
    http://www.catacromegaly.com/education/niessen_article.pdf

    *Feline Acromegaly: An essential differential diagnosis for the difficult diabetic
    http://www.ncbi.nlm.nih.gov/pubmed/20123483

    Acrotracker link: https://docs.google.com/spreadsheet...Gt3RUpYWmRoR2Q5SWRSV1dUUElwUlE&hl=en_US#gid=0



    Cats with Insulin Auto Antibodies (IAA)

    http://petdiabetes.wikia.com/wiki/Insulin_antibodies
    When insulin is injected into a diabetic cat, the body views it as a foreign substance and the immune system sets out to destroy the "invader" insulin, just as it would destroy cold and flu viruses. When this happens to injected insulin - most of it never reaches the bloodstream thus being unable to control blood glucose. Insulin doses may be increased but the immune system only goes into higher gear and continues to effectively destroy any additional injected insulin. Over time this becomes officially known as insulin resistance.

    Sharyn and Fiona states: One article on humans suggests that changing insulin doesn't work. IAA is supposed to be self-limiting, meaning it goes away at some point. (See article link below) “We have a couple of anecdotal reports of kitties who, by continuing to raise the insulin doses, were able to overwhelm the antibodies, eventually lower the insulin doses and gain control of the BG’s.”

    Currently 10/09 Sandy and Black Kitty seem to have done just that. At one point Black Kitty was needing 27 units of Lantus insulin/day. He is now OTJ. GREAT JOB BK!!!!

    Link to have blood sent for IAA testing:
    https://www.animalhealth.msu.edu/Bin/Catalog/Catalog_Test.exe?Action=Print&ID=1494
    A result > 20% is considered positive for IAA.


    Further Information:

    *Extreme insulin resistance (IAA)
    http://www.faqs.org/faqs/diabetes/faq/p ... on-24.html

    *Beta cell and insulin antibodies in treated and untreated diabetic cats
    http://www.sciencedirect.com/science?_o ... archtype=a

    Cushing's disease:

    http://www.cat-health-guide.org/felinecushingsdisease.html
    http://www.cat-lovers-only.com/cushings-disease-in-cats.html

    Cushing’s disease is caused by a tumor of either the pituitary or adrenal glands, causing the production of excess cortisol. Cortisol is a naturally-occurring chemical in the body, which helps the body respond to stress such as infection or pain. With Cushing’s disease, however, the body continues producing cortisol even when the stressor has been removed. This causes a number of problems one of which is insulin resistant diabetes.

    One particular symptom that helps differentiate this disease from acromegaly so quickly is that Cushing’s causes very thin fragile skin that may tear easily and/or not heal well. Females are most often the target.



    Running count of acrocats and their moms:
    2004 - 1
    2005 - 5
    2006 - 2
    2007 - 20
    2008 - 16
    2009 - 21
    2010 - 24
    2011 - 16
    *Unconfirmed cases (since 2006) 6
    These 6 are listed as they were/are all very hi dosed cats that for various reasons could not have the acro test but it was felt that acromegaly was the probable cause of the high insulin needs.


    Males = 79 Females = 27


    Running count of IAA cats and their moms:
    2008 – 2
    Sandy and Black Kitty
    Sharyn and Fiona

    2009 – 3
    Christina and Stormy(also + for acro)
    Laur and Cole (also + for acro)
    Jan and Buddy

    2010 - 5
    Karen and Obie 3/10 (also + for acro)
    Gayle and Oliver 5/10 (also + for acro)
    Susan and Lanky 5/10 (also + for acro)
    Claudia and Makita
    Kristen and Emma 12/10

    2011 - 2
    Pattie and Harley 1/11
    Lisa and Do Lou 2/11


    Running count of Cushing’s cats and their moms:
    2008 - 2
    Linda and Bear
    Tammy and Mika

    2009 - 2
    Mari and Punk
    Lisa and Franklin

    2010 - 4
    Ashley and Tigger
    Amy and Pedro
    Cheryl and Whiskers
    Lisa and Miss Murray



    ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
    ALL our acrokitties 2004-2011

    Dale and Snuggles...Diana and Orion...Teresa and Olivia... Donna and Spike... Tara and Martin... Andreana and Jen...Beth and Pickles...Ralph and Snowball...Carolynn and Fletcher...Patti and Merlin... Lara and Paddy... Tobycats Momma...Stephanie and Pheobe...Kathy and Pepper...Carol and Oscar...Nina and Jaska...Lyn and George...Pilar and Big John...Jennifer and Dylan...Jacqui and Binghi...Kiwi and Tortie... Jo and Oscar...Ellen and Antony...Anji and Charli...Ulrike and Sasha...Diana and Thomas...Jonathon and Toby...Magnus and Willi...Jennifer and Spunky...Judy and Orphan...Vanassa and China...Shelly and Callie...Phoebe and Norton...Shannon and Little Bit...Linda and Sugar...Caprice and Henrietta...Joan and Madison...Lorna and Girlcat...Jakki and Jake...Wendi and Milo...Laurie and Sammy...Doug and Thomas...Sandy and Cecil...Susan and Wilson...Libby and Sterling...Carolyn and Leo...Sarah and Dusty...Christina and Stormy... Nina and KB...Bonnie and Porscha... CD and Shadow...Dani and Lehmann...Heather and Jester...Bobbiecat...KT and Buckwheat...Heather and Boo...Dawn and Toby...Laur and Cole...Lisa and Mouf...Juanita and Chika...Barbara and Mischa...Amy and Prince...Linda and Rupert...Sarah and Chester...Trish and Isabel...Leslie and Baylee...Nancy and Cody...Holly and Pablo...Elise and Pony...Gayle and Shadoe...Karen and Obie...Jen and Milo Pirahna......Norma and Tony...Gayle and Oliver...Debbie and Bryce...Susan and Lanky...Sue and Buddy...Bronwen and Bodmin...Johanna and Loki...Libby and Jazzy...Amber and Meadow....Lotti and Charlie...Claudia and Henry...Perry and Sooty...Stephanie and Teddy...Jane and Silverado...Debbie and Cindy...Ingrid and TC...Kristen and Calvin...Claudia and Charlie...Andrea and Coco...Lorretta and Leo...Shirley and Jasper...photosquirrel Tommy...Bev and Gus...Julie and Punkin...Amy and Bogey... Charisse and Snuggles...Linda and Guinness...Frances and Boysie...Beth and Josie...Brent and Tigger...Sheree and Jondahl...Steve and Kitty...Sandy and Baloo...


    Probables: Ruthe and Smokey...Paul and Celti...Caroline and Sir...Suzie and Spook...CJ and Bailey...Joanne and BarnBuddy...

    This document was written in honor and loving memory of ALL hi dose kitties. For despite all the difficulties they face - they continue to teach their moms/dads daily, purr the loudest, and give us such unconditional love!

    The above groups will be updated monthly by Patti and Merlin (always in my heart)

    last update 9/28/11
     
    Last edited by a moderator: Dec 20, 2017
    Reason for edit: replaced several dead links per Wendy&Neko
  2. Venita

    Venita Well-Known Member

    Joined:
    Dec 28, 2009
    Many of the links in this post are broken and not working. If someone wants to PM me the proper links, I will restore them.
     
    Cindy De Vries likes this.
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