Evaluation of hypophysectomy for treatment of hypersomatotropism in 25 cats

Abstract

Background: Successful treatment of cats with hypersomatotropism by transsphenoidal hypophysectomy is described in small numbers of cats. Objectives: To describe the endocrine profile, survival, and remission rates of hypersomatotropism and diabetes mellitus in a cohort of cats with hypersomatotropism that underwent hypophysectomy between 2008 and 2020. Animals: Twenty-five client-owned cats with spontaneous hypersomatotropism. Methods: Retrospective study. Diagnosis of hypersomatotropism was based on clinical signs, plasma insulin-like growth factor-1 (IGF-1) concentration, and imaging of the pituitary gland. Growth hormone (GH) and IGF-1 concentrations were measured repeatedly after surgery. Survival times were calculated based on follow-up information from owners and referring veterinarians. Results: Median postoperative hospital stay was 7 days (range, 3-18 days). One cat died within 4 weeks of surgery. Median plasma GH concentration decreased significantly from 51.0 ng/mL (range, 5.0-101.0 ng/mL) before surgery to 3.8 ng/mL (range, 0.6-13.0 ng/mL) at 5 hours after surgery. Remission of hypersomatotropism, defined as normalization of plasma IGF-1 concentration, occurred in 23/24 cats (median, 34 ng/mL; range, 14-240 ng/mL) and 22/24 cats entered diabetic remission. Median survival time was 1347 days (95% confidence interval, 900-1794 days; range, 11-3180 days) and the overall 1-, 2-, and 3-year all-cause survival rates were 76%, 76%, and 52%, respectively. Conclusions and Clinical Importance: This study shows the beneficial outcome of hypophysectomy in cats with hypersomatotropism, marked by low death rate and a high percentage of diabetic remission and definitive cure.

Cabergoline treatment in cats with diabetes mellitus and hypersomatotropism

“…Nevertheless, in this report, cabergoline did not normalize IGF-1 concentration, despite the improvement of diabetic control. 9 Considering that the effectiveness of feline HST treatment with surgery and radiotherapy involves invasive modalities, which require specialized centers, and that pasireotide is an expensive drug, [11][12][13] it is necessary to evaluate new effective and accessible treatments. Therefore, the aim of this study was to evaluate the safety and efficacy of cabergoline in controlling glycemic disorder and IGF-1 concentration in cats with HST and DM.…”

Endocrine response and outcome in 14 cats with insulin resistance and acromegaly treated with stereotactic radiosurgery (17 Gy)

“…On the other hand, improvements in IGF-1 concentrations have been shown to be associated with improved glycemic control and remission of diabetes mellitus after surgery. 18,19 For these reasons, serum IGF-1 concentrations were not monitored after treatment in the present study, so no further conclusions can be drawn regarding IGF-1 concentrations and diabetic response after SRS.…”

“…[14][15][16][17] For those patients requiring additional treatment, medical treatment is most often pursued next, with radiotherapy typically relegated to third-line treatment. 14 Two recent publications 18,19 describe transsphenoidal hypophysectomy in cats and report diabetes mellitus remission rates of 71% and 92%. However, serious complications (hypothermia, hypotension, and airway obstruction) were common, and the periprocedural mortality rate reportedly ranged from 4% to 15%.…”

“…However, serious complications (hypothermia, hypotension, and airway obstruction) were common, and the periprocedural mortality rate reportedly ranged from 4% to 15%. [18][19][20][21][22] Medical treatment consisting of somatostatin analogs, dopamine agonists, or growth hormone receptor antagonists in cats is also generally unrewarding and cost prohibitive. [23][24][25][26] However, the use of both short-and long-acting pasireotide (a somatostatin analog with binding affinity for somatostatin receptor subtypes 1, 3, and 5) has been associated with decreased serum IGF-1 concentrations and increased insulin sensitivity in acromegalic cats.…”

Clinical characteristics and outcome in 15 dogs treated with transsphenoidal hypophysectomy for nonfunctional sellar masses

“…Transsphenoidal hypophysectomy (TSH) is an effective therapy for the treatment of functional pituitary adenomas resulting in pituitary‐dependent hypercortisolism (PDH) in dogs and hypersomatotropism in cats. Transsphenoidal surgical removal of functional pituitary tumors in dogs and cats can be performed by experienced surgeons with low morbidity and mortality 10–16 . Pituitary adenoma is the most common tumor of the pituitary fossa in dogs, but other sellar masses can occur, including meningioma, craniopharyngioma, ependymoma, germ cell tumors, and metastatic neoplasms 17–20 .…”