Efficacy of hypophysectomy for the treatment of hypersomatotropism‐induced diabetes mellitus in 68 cats. (24th February 2021)

• Record Type: Journal Article
• Authors: Fenn, Joe; Kenny, Patrick J.; Scudder, Christopher J.; Hazuchova, Katarina; Gostelow, Ruth; Fowkes, Robert C.; Forcada, Yaiza; Church, David B.; Niessen, Stijn J. M.
• Is Part Of: Journal of veterinary internal medicine. Volume 35:Number 2(2021)
• Page Start: 823
• Page End: 833
• Publication Date: 2021-02-24
• Subjects: acromegaly -- cat -- diabetic -- pituitary -- remission -- transsphenoidal; Veterinary medicine -- Periodicals; 636.0896
• DOI: 10.1111/jvim.16080
• Languages: English
• ISSNs: 0891-6640

Abstract

Abstract: Background: Hypersomatotropism (HST) is an increasingly recognized endocrinopathy in cats and is mostly described associated with diabetes mellitus (DM). Objectives: To evaluate the efficacy and safety of transsphenoidal hypophysectomy in treating HST and DM in cats. Animals: Sixty‐eight client‐owned cats with HST and DM treated by transsphenoidal hypophysectomy. Methods: Retrospective cohort study. Medical records were reviewed for glycemic control and serum insulin‐like growth factor‐1 (IGF‐1) concentrations. Postoperative complications, death within 4 weeks, and proportion achieving diabetic remission were recorded. Survival times and DM‐free intervals were calculated. Results: Fifty‐eight cats (85.3%) were alive 4 weeks postoperatively with 10 (15%) postoperative deaths. Complications included hypoglycemia (n = 9), electrolyte imbalance (n = 9), and transient congestive heart failure (n = 5). Fifty‐five cats (95% of 58 surviving cats [81% of all cats undergoing surgery]) had improved control of diabetes. Diabetic remission occurred in 41 cats (71% of 58 surviving cats [60% of all cats]) with insulin administration discontinued after a median of 9 days (range, 2‐120). Postoperative 4‐week serum IGF‐1 concentration nadir was significantly lower in cats achieving diabetic remission (median 20 ng/mL [15‐708] than those that did not (324 ng/mL [15‐1955]; P = .03). All cats received long‐term levothyroxine and hydrocortisone PO, alongside desmopressin (conjunctival) in 38 of 53 cats (72%). Recurrence of DM occurred in 5 of 41 cats (12%) after a median of 248 days (range, 84‐1232). Median survival time of all cats was 853 days (range, 1‐1740). Conclusions and Clinical Importance: Transsphenoidal hypophysectomy is an effective treatment for cats with HST and DM, with a long‐term outcome that compares favorably to existing options.