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Pituitary Tumour with no Diabetes

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Wendy & Eric, Jul 13, 2019.

  1. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019
    Hi, I'm not sure I have the right forum but there is very little information out there about Cushing cats. My 10 year old cat Eric has been polydipsia, polyuria & polyphagia since September 2018. After loads of tests the only abnormality was the urine creatine ratio which was initially 0.4 and now 0.27, also his pancreas markers were slightly high. So he's been on Simentra for protein in urine and Royal Canine Gastric Intestinal Moderate Calorie since February this year where he had an ultrasound on his adrenal glands at Dick White Referrals (UK). I will also add because of polyphagia he was piling on the weight 6.45kgs, after a strict diet he in now 4.6kgs. As none of the symptoms were disappearing all tests were repeated in April these included several low dex tests and 1GF-1 blood test which all returned normal. Finally a MRI was performed in May and this has diagnosed a large pituitary tumour. I have now been referred to RVC (UK) but initial discussions between them and Dick White Referrals say the tumour is slightly bigger than they would like for surgery and RVC want to have consult with Eric and I on 16th July. Does anyone else have experience of a cat with Cushings but not diabetes or agromegaly diagnosed? This is my second cat diagnosed with cushings Elsa was diagnosed in 2008, she was semi feral so never picked up the polydipsia and polyuria but I noted the polyphagia along with breathing difficulty. Within weeks she went to the skin tearing stage which was awful but we managed with baby grows, she was started on 30mg Vetoryl but 4 days later collapsed and died before I could get to the vets. Again she had no diabetes and we never got chance to do a scan. In the whole of my vet practice they have only seen two cats with cushings and I have both of them! Cats are rescued DSH not related.
     
  2. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    I don’t know much about Cushings, but I’ll tag @Tuxedo Mom hopefully she can give you some insight
     
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  3. Jerry dutchboy

    Jerry dutchboy Well-Known Member

    Joined:
    Mar 27, 2019
    Sorry to hear about little Eric. I'm sure that someone on here with experienced will be along to help. I'll keep an eye on your post during the day and bump it up if no response. It's weekend so folks may not be online too much. Hang in there.
     
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  4. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
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  5. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    There have been cats with acromegaly but not diabetes, so I imagine it’s possible for Cushing’s too. We also had one Cushing’s kitty go into diabetic remission, here is the last part of her story http://www.felinediabetes.com/FDMB/threads/an-unfortunate-update.215766/

    Good luck with the visit to RVC. Keep us posted. I like to hear about the unusual, which often becomes the not so unusual here.
     
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  6. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019
    Thank you everyone for the useful information I can definitely relate to the extreme hunger Eric tried to swipe a slice of melon out of my hand previously, he will eat anything even a screwed up piece of paper which he used to ping around playing with. It's like he is always living on the edge wondering where he can get food and water from next, it must be awful to feel like that 24/7.

    I will let you all know what the RVC advise.
     
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  7. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019
    Well Eric come home with me today . The tumour is big and to complicate matters more they showed me a black area on MRI about the same size as mass above it. They don’t know what this is or if cells of tumour could be carried over into it, one suggestion was it could be blood from a previous bleed? The question I didn’t ask was if they managed to remove pituitary and tumour would they get a sample/biopsy of this black area. So if you treat the cushings symptoms only with adrenalectomy, you leave tumour to own devices. in their experience they were not always seeing good results with radiotherapy or Vetoryl options.

    After discussing all the options and weighing up Eric is a nervous cat for numerous visits were of the opinion that surgery on pituitary was the way to go but no guarantees and the unknown with black area above mass . For those who have had the operation what is the approximate cost of the hormone replacement tablets given after?

    Surgery can be done in the next 2 weeks, I need to discuss all with my home vet now as I value her opinion greatly having been through this with my previous cat Elsa.
     
  8. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    @sbluhrs is still active on the forum, and her cat Sophie had hypophysectomy last year. She would know the price of the meds.

    I'm curious what they quoted you for the adrenalectomy?

    I hope you can find a good solution for Eric, he looks very sweet in the picture.:bighug::bighug::bighug:
     
  9. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019
    I didn't get a price for the adrenalectomy but can try and find out. Eric's option to do hypophysectomy was because the tumour is large and we don't know if the excess Cortisol the adrenal glands are producing now is slowing/shrinking tumour (like treating an inoperable brain tumour with steroids). If we remove adrenal glands we remove the cortisol in his system so felt best to tackle tumour.

    Eric is to be admitted to RVC on 29th July for CT scan and operation planned for Wednesday 31st July. So far RVC have done about 90 cats but all were acromegaly with tumours less than 7mm. Eric is the first with Cushings and tumour 11mm.
     
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  10. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    @John Irene and TITAN used to post about Titan, who had hypophysectomy at RVC, not sure he's still active now. Here is is post with the story: http://www.felinediabetes.com/FDMB/...t-diabetes-cured-by-pituitary-removal.200701/

    There is another thread that discusses meds post surgery, you will note that the exact meds differs somewhat between the UK and the US:
    http://www.felinediabetes.com/FDMB/...ussion-of-medication-and-other-issues.207078/
    The thyroid replacement tablets in Canada are cheap. I know some people you use them for hypothyroid cats.

    I wish you and Eric the best of results with the surgery. I thought RVC had done pituitary removal on one Cushings cat, but maybe it was other treatment. Anyway, I do remember somewhere reading about successful results from hypophysectomy and Cushings, but can't remember where. I think getting rid of the tumour is a good plan. We do see some kitties with neurological issues and blindness if the tumour is not treated.
     
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  11. sbluhrs

    sbluhrs Member

    Joined:
    Jun 7, 2012
    Sophie gets levothyroixine and Prenisolone. She gets 1/4 pill of the .3 mg levo pill am and 1/2 pm, and 1/4 of the 5mg pred pill pm. The Levl costs $14.40 for 60 from 1800 Pet Meds, and the Pred costs $10.80 for 90 from the same source. The 90 pred is enough for a year. So, you see, it is pretty cheap.

    Soph is still on desmopressin, but only gets needle juice pm. That costs a tad over $84, including shipping, for 5ml of .01% injectible. We have been tinkering with Sophie's thyroid levels and her last test showed that she is just a tad higher than we want her to be. So, instead of giving her the thyroid pill 1 hr before meals, she is getting it in her meal (same as we do with the Pred). Hoping that this pushes her to the point where she is finally off the Desmo, but, all in all, she is doing so much better than pre-surgery.

    Hasn't had insulin, except for a couple of days where a steroid ear drop made her bg go up, but her numbers are steady in the 70s 3 hrs after her noontime meal. Went up the other day, when she had a blood draw, but she had a bit of an upset stomach on the way to the vet to get her blood drawn, and puked. Checked her after the vet gave me the results, and she was still in the 70s....

    You can see her most recent lab results - last blood draw was 7/13/19. Her kidneys are doing great, her liver is great, her electrolytes and blood values are fine. Her coat is so much better than pre-surgery and she acts like a normal cat. She is still very food oriented, but that is probably her and could just be due to what she had to deal with in life before I got her in 2017.

    Cost for her is much, much less than pre-surgery. Even with my association with DCIN, I expect that I was easily spending $150 a month, between insulin, syringes, and testing strips. Now, if it is $10 or $20 a month, that is a lot.

    Oh, and I don't have to be ridiculous and get the absolutely lowest carb food I could find (not that it made a difference with acromegaly). She was eating Tikicat chicken or chicken with egg, and had no control over her appetite in that I had to make sure all the human food was totally out of her reach, etc., etc. Now, she understands no, understands that she has to sit in her spot and wait for things, if she is to get a treat. I've changed her diet to the Friskies pates and FF pates and, after a short transition period, she is doing fine on them. I think they are actually better for her coat as she had some dandruff problems for a while pre-surgery, and that is just about gone. Figure that is because the pates have some nutrients that she needed.

    Yes, we do spoil her somewhat. She LOVES freezedried chicken necks and gets a bit as a treat from time to time.

    Would I go through the surgery again. In a minute! I know that not everyone has the same results. I am just lucky that Sophie is a very easy going cat and dealt with the travel to NYC well and absolutely LOVED the staff there. (The feeling was mutual, I am told). However, for a cat who doesn't travel well, even when well medicated, the experience could be traumatic, like Amanda found with Shmee.

    In all of this, you have to know your cat, you have to be informed of the possibiities post surgery. Behavior post surgery seems to be something that is really not discussed, probably due to the fact that people generally don't come back to the FDMB after their cats have gone through the surgery. Well, that is why I continue to report on Sophie's progress. The more information you have, the better decision you can make.

    And the best advice I have when considering a major surgery like Sophie had or similar surgery, is to read as much as you can, ask questions of your vet. No question is a stupid question. They might not know the answer, but they will probably do their best to give you information so that you can make an educated decision.
     
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  12. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    What a great report about Sophie. I am so glad to hear she is doing so well. What a great hypophysectomy success story.:bighug::bighug::bighug:
     
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  13. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019
    Thank you everyone for all the positive feedback and @sbluhrs for cost and quantities of tablets etc. I feel so much more reassured we are doing the right thing.

    The Cushings has so given Eric a dramatic behaviour change already, 10 years and he's finally decided to be everyones friend but I'm sure the food drive is over riding that! Lets get over the op first then see what lies ahead. I will let you all know how it goes on the 31st
     
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  14. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

    Joined:
    Jan 19, 2018
    Hey, I don’t come here much, but one thing I want to comment on is if you choose to treat with Vetoryl, starting dose for cats is 10 mg. It’s been a while, but I think 30 mg is an appropriate dose for dogs. In cats, they metabolize the drug differently, so they need to be careful and slow with initiating and advancing the dose, as too high of a dose can have adverse effects and he life threatening.
    Can’t comment on surgery, although I did speak with a vet in NYC about possible surgery but a few months later Frosty was found to have a serious heart condition, so he would have never qualified for it.
     
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  15. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Hi Ana - I hope you are doing well. It is good to see some great advice from you here. I hope your "new" kitteh is doing well too.
     
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  16. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019
    Eric had his hypophysectomy op today and so far recovering as expected phew . The tumour was large pushing right next to the brain upwards and forwards but the surgeon said it come away well and it appears they have got it all followed up with a post op CT scan. Still very early days for recovery but he is recovering as expected, a bit spaced out but moving and responding well. I'll update all in a few days time. Thanks again for all your advise and answers.

    Would you believe it my other cat Ellie only went and ruptured her cruciate ligament so she had surgery last week and is now on crate rest for the next 4 to 6 weeks!
     
  17. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Paws crossed for a speedy recovery for Eric. Did you get pictures of the tumour? I got one of Neko’s CT scan, my geek vet loved it.

    Oh no on Ellie! Some people have all the luck. At least she has the best of caregivers.:bighug:
     
  18. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019

    I have the MRI images of tumour which Dick White Referrals did, the RVC did a pre and post CT scan for operation mapping etc so I will ask if I can have a copy of them. Eric is in ICU for the 1st 24 to 48hrs, if all goes well they anticipate he will be with them for 7 to 10 days.
     
  19. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Best of luck to Eric for his recovery over the operation. It sounds like it was perfect timing on a very troublesome pituitary. And it sounds like RVC has some good experience with this, so the future bodes very well for Eric.:bighug:

    Leo's MRI pre-SRT at Colorado State University
     
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  20. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019
    Well 2 months on since Eric's post pituitary/tumour removal and I have to say the little man appears to be back to his normal self. On the downside the tumour was found to be malignant which the RVC have not had previously but the surgeon tends to sit on the fence with the pathology test and at this stage feels he managed to remove all during the operation and post op CT. The black area shown on the MRI they still believe was a previous bleed or part of the tumour that had died, all come away during the operation. (Sorry I still have to work out how to attach MRI images of tumour!) Eric lost some more weight after op and stayed in the hospital for just over a week a bit anaemic and slightly high temp at one stage his BG rose! the vet came to the conclusion more stress related and best he came home. Within 3 weeks his appetite was good but not ravenous and at 4 week check his weight was going up again 4.45kg and results as follows;

    - Haematology: Lymphopaenia (0.5 x10e9/l). PCV normalised at 35%.
    - Biochemistry: Mildly increased sodium (160.5 mmol/l) and chloride (124.2 mmol/l), mildly increased urea (11.8 mmol/l) and increased ALT (93.6 U/l, decreased from last visit (209.4 U/l)).
    - Total T4 (6-7 hours post levothyroxine): 46.5 nmol/l (ref 19-65 nmol/l).
    - Urinalysis (cystocentesis): USG 1.015, pH 6, trace protein, blood 1+, RBC 10-20 per HPF (x400), WBC < 5 per HPF (x400), epithelial cells 10-15 per LPF (x100), no casts.
    - Urine protein:creatinine ratio: 0.4 (previously increased).
    - Urine cortisol:creatinine ratio (~30 hours post hydrocortisone): 6 x10e6 (ref 0-10 x10e6).
    - Endogenous ACTH (~30 hours post oral hydrocortisone): 27 pg/ml (38-176 pg/ml).

    RVC were very pleased with Eric's progress at home, and with his laboratory results. His previous non-regenerative anaemia has resolved and his ALT has decreased significantly. He was found to be mildly hypernatraemic with dilute urine, and we were advised to continue administering his DDAVP (desmopressin) eyedrops three times daily. Eric's total T4 is in the higher end of the normal range, and therefore we were advised to reduce his Leventa (levothyroxine) dose from 0.1 ml (100 micrograms) to 0.08 ml (80 micrograms) once a day. His hydrocortisone is to be continued as before (a quarter of a 10mg tablet once a day).

    They are pleased that Eric's endogenous ACTH remains stable (and low) following his procedure. This hopefully indicates that there has not yet been re-growth of his pituitary tumour.

    We are scheduled for another check up in 2 months to repeat bloods and the option of repeating advanced imaging (CT or MRI) of Eric's brain at this stage (3 months post op), to monitor for recurrence of disease given the concern for carcinoma on Eric's pituitary histopathology.
     
  21. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Good news and fascinating stuff on Eric’s Recovery. I bet RVC is glad to further their understanding of this procedure with different conditions. It’s amazing how many different parts of his system are improved with the tumour gone. As a layperson, I find it amazing how much the endocrine system does.

    I do hope there were clean margins on Eric’s tumour. Neko just had SRT (radiation therapy), so not quite as complete as surgery, and her tumour started to come back after three years. At that point, it was still smaller than the original one on imaging. For kitties undergoing SRT, return of tumour is not common. Hopefully less so for surgery.
     
  22. Wendy & Eric

    Wendy & Eric New Member

    Joined:
    Jul 13, 2019
    Yes I have learnt so much about the endocrine system for Eric and myself! The jury is out at the moment whether it is money well spent to repeat scans at 3 months, CT will be less expensive than MRI. I was going to discuss further with my vet tomorrow when I see her with one of the rescue cats health check (I foster cats for the Blue Cross UK charity).
     
  23. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    With SRT, I was told not to bother with repeat scans, unless curious. I just did CT three years later because her insulin dose was ramping up fast. But it was a benign tumour so completely different. I know the acro tumour is slow growing, don’t know about PDH tumour. I was also told CT scan was sufficient, unless tumour didn’t show on it. Again, acro tumour is a different shape. Colorado State University,where I went, had a couple acrocats where there was no sign on either CT or MRI, but they proceeded with radiation because of symptoms and insulin dose.
     
  24. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Two months is a long time, and I bet Eric will probably be stable at this point. It is great to hear that he is doing so well after the surgery, and he has returned to normal. The RVC surgeons did a great operation on your furkid.

    I never had rescans done on Leo. He seemed fine, and the diabetic part of his Acro responded to the SRT. So there was no point to pay for any followup scans.
     

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