Cryohypophysectomy used in the treatment of a case of feline acromegaly (original) (raw)
Related papers
Acromegaly in a non-diabetic cat
Journal of Feline Medicine and Surgery Open Reports, 2016
Case summary A 14-year-old, neutered male European shorthair cat was evaluated for a routine health check. The owner did not report any clinical signs except for respiratory stridor. On physical examination the main findings were broad facial features and increased interdental spaces. On haematology, a mild, non-regenerative anaemia was detected, whereas the serum biochemistry profile and urinalysis were unremarkable. The serum glucose concentration was within the reference interval. Serum insulin-like growth factor-1 concentration was markedly elevated (>1600 ng/ml). The basal serum growth hormone concentration was elevated and decreased only mildly after somatostatin administration. Basal serum insulin concentration was high, and the insulin concentration increased considerably after glucose loading, consistent with insulin resistance. CT scanning of the skull showed an enlarged pituitary gland and increased skull bone thickness. The final diagnosis was acromegaly. Relevance an...
Acromegaly in a domestic short-haired cat: first report from Iran
Journal of coastal life medicine, 2017
Acromegaly, a syndrome characterized by overgrowth of bony and soft tissue, is caused following chronic excessive production of growth hormone (GH)[1]. It is a well-recognized but rare condition in cats caused by a functional somatotroph adenoma in the anterior pituitary gland[2,3]. This disorder is encountered most often in middle-aged and elderly, predominantly male, cats[1]. Catabolic and diabetogenic effects of GH, the anabolic effects of IGF-1 and the space-occupying effect of the pituitary adenoma are responsible for clinical signs[4]. The physical changes in cats tend to be less pronounced than in dogs. Increased body size, especially large head and abdominal enlargement are prominent. Affected cats may have respiratory signs, which is due to soft tissue thickening in the pharyngeal region and consequent extrathoracic upper airway obstruction. Moreover, hypertrophic cardiomyopathy is another cause of dyspnea in these cases. Neurological signs resulting from large pituitary ad...
Pituitary Pathology and Gene Expression in Acromegalic Cats
Journal of the Endocrine Society
The prevalence of GH-secreting pituitary tumors in domestic cats (Felis catus) is 10-fold greater than in humans. The predominant inhibitory receptors of GH-secreting pituitary tumors are somatostatin receptors (SSTRs) and D 2 dopamine receptor (DRD2). The expression of these receptors is associated with the response to somatostatin analog and dopamine agonist treatment in human patients with acromegaly. The aim of this study was to describe pathological features of pituitaries from domestic cats with acromegaly, pituitary receptor expression, and investigate correlates with clinical data, including pituitary volume, time since diagnosis of diabetes, insulin requirement, and serum IGF1 concentration. Loss of reticulin structure was identified in 15 of 21 pituitaries, of which 10 of 15 exhibited acinar hyperplasia. SSTR1, SSTR2, SSTR5, and DRD2 mRNA were identified in the feline pituitary whereas SSTR3 and SSTR4 were not. Expression of SSTR1, SSTR2, and SSTR5 was greater in acromegalic cats compared with controls. A negative correlation was identified between DRD2 mRNA expression and pituitary volume. The loss of DRD2 expression should be investigated as a mechanism allowing the development of larger pituitary tumors.
The American Journal of Medicine, 1974
After cryohypophysectomy, fasting levels of growth hormone (GH) fell to less than 10 ng/ml in 38 (76 per cent) of 50 patients with acromegaly. Effects, including lowered serum insulin levels and improved glucose tolerance, were rapid and long-lasting. Optimal endocrine-metabolic results, defined as lowering of the GH level to 10 ng/ml or less and normal glucose tolerance (attained in 60 per cent of patients), were most often achieved when preoperative glucose tolerance was normal or mildly abnormal. Factors that favored optimal lowering of GH were preoperative GH level below 50 ng/ml and moderately, rather than greatly, enlarged sellae turcica. Factors that favored normal carbohydrate balance after treatment were postoperative fasting GH level of 10 ng/ml or less and preoperative symptom duration of 10 years or less. A family history of diabetes was not an important overall factor in glucose intolerance. Although postoperative reduction in 24-hour urinary excretion of 17-hydroxycorticosteroids was associated with adequate GH reduction, adrenal reserve and thyroid function remained normal in most patients. In contrast to the prognostic significance of high GH levels, adrenal and thyroid function could not be related to eventual GH response or to carbohydrate metabolism. Although there are many methods of treating acromegaly [l-14], the condition remains a therapeutic challenge [ 151. Since 1965, the major form of therapy used for acromegaly at the University of California, San Francisco, has been transsphenoidal, stereotaxic cryohypophysectomy [8]. Clinical responses to cryohypophysectomy and the domplications of this procedure have previously been reviewed after long-term follow-up of our first 50 patients [ 161. In this report we describe the effects of cryohypophysectomy upon abnormal endocrine function, and emphasize the relationship between growth hormone (GH) and carbohydrate metabolism seen in this group of patients. In addition, we assess the factors that appear to be associated with the ability of cryosurgery to adequately reduce GH and reverse the abnormal carbohydrate metabolism seen in acromegaly. MATERIAL AND METHODS Patients. Twenty-five men and 25 women, ranging in age from 21 to 68 years (mean 42 years), were evaluated. Mean duration of symptoms was
Cryohypophysectomy for acromegaly
The American Journal of Medicine, 1974
After cryohypophysectomy, fasting levels of growth hormone (GH) fell to less than 10 ng/ml in 38 (76 per cent) of 50 patients with acromegaly. Effects, including lowered serum insulin levels and improved glucose tolerance, were rapid and long-lasting. Optimal endocrine-metabolic results, defined as lowering of the GH level to 10 ng/ml or less and normal glucose tolerance (attained in 60 per cent of patients), were most often achieved when preoperative glucose tolerance was normal or mildly abnormal. Factors that favored optimal lowering of GH were preoperative GH level below 50 ng/ml and moderately, rather than greatly, enlarged sellae turcica. Factors that favored normal carbohydrate balance after treatment were postoperative fasting GH level of 10 ng/ml or less and preoperative symptom duration of 10 years or less. A family history of diabetes was not an important overall factor in glucose intolerance. Although postoperative reduction in 24-hour urinary excretion of 17-hydroxycorticosteroids was associated with adequate GH reduction, adrenal reserve and thyroid function remained normal in most patients. In contrast to the prognostic significance of high GH levels, adrenal and thyroid function could not be related to eventual GH response or to carbohydrate metabolism. Although there are many methods of treating acromegaly [l-14], the condition remains a therapeutic challenge [ 151. Since 1965, the major form of therapy used for acromegaly at the University of California, San Francisco, has been transsphenoidal, stereotaxic cryohypophysectomy [8]. Clinical responses to cryohypophysectomy and the domplications of this procedure have previously been reviewed after long-term follow-up of our first 50 patients [ 161. In this report we describe the effects of cryohypophysectomy upon abnormal endocrine function, and emphasize the relationship between growth hormone (GH) and carbohydrate metabolism seen in this group of patients. In addition, we assess the factors that appear to be associated with the ability of cryosurgery to adequately reduce GH and reverse the abnormal carbohydrate metabolism seen in acromegaly. MATERIAL AND METHODS Patients. Twenty-five men and 25 women, ranging in age from 21 to 68 years (mean 42 years), were evaluated. Mean duration of symptoms was
Molecular and Cellular Endocrinology, 2002
Cushing's disease or pituitary-dependent hyperadrenocorticism (PDH) is common in dogs and rare in cats. PDH is caused by a pituitary tumor producing adrenocorticotropin (ACTH). Pituitary imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is required to assess the size and location of the pituitary adenoma in relation to the surgical landmarks. In a specialized veterinary institution, microsurgical transsphenoidal hypophysectomy has proven to be a safe and effective treatment for dogs (n 0/84) and cats (n 0/7) with Cushing's disease. Pituitary surgery requires a team approach and the neurosurgeon performing hypophysectomies must master a learning curve. The surgical results compared favorably with those for dogs with PDH treated medically with mitotane at the same institution. The recurrence rate after initially successful surgery increases with longer follow uptimes. Pituitary function testing in 39 dogs with PDH treated with hypophysectomy revealed that, much more so than the other adenohypophyseal cell types, residual corticotropes present in the sella turcica after surgery are functional. Such normal ACTH secreting cells may maintain normocorticism whereas residual adenoma cells may lead to mild recurrence after relatively long periods of remission. Microsurgical transsphenoidal hypophysectomy is an effective treatment for canine and feline Cushing's disease. #
Complete Surgical Removal of a Very Enlarged Pituitary Corticotroph Adenoma in a Dog
Journal of the American Animal Hospital Association, 2014
A 13 yr old castrated male vizsla was referred to the authors' institute because of polyuria, polydipsia, polyphagia, and weight loss. Pituitary-dependent hypercortisolism (PDH) was diagnosed by hormone testing and adrenal and pituitary imaging. Computed tomography (CT) revealed a pituitary mass measuring 21 mm in width. Medical therapy was initiated with trilostane. Despite adequate control of the hypercortisolemia, the polyuria and polydipsia persisted and the dog developed neurologic signs due to the pituitary mass effect. Pituitary transsphenoidal debulking surgery was performed and immunocytochemistry confirmed a corticotroph adenoma. The dog survived for 13 mo after surgery. Postmortem examination revealed an empty fossa without pituitary remnants and the presence of a malignant pheochromocytoma in the right adrenal gland. This case report demonstrates, for the first time, that a large pituitary adenoma in the dog may be treated successfully by pituitary surgery. (J Am Anim Hosp Assoc 2014; 50:-------. ACTH adrenocorticotropic hormone; CT computed tomography; HU Hounsfield units; P/B pituitary height/brain area ratio; PDH pituitary-dependent hypercortisolism; PO per os; UCCR urinary corticoid/creatinine ratio ª
2020
Background : Congenital anomalies are an uncommon pituitary hypofunction cause associated to multiple hormone deficiencies. Congenital hyposomatotropism is often related to an inherited anomaly, characterized mainly by delayed growth. It is not uncommon to find associated thyroid-stimulating hormone and gonadotropin deficiencies. Pituitary malformation may be associated to progressive cystic lesion expansion. Central diabetes insipidus (CDI) is another rare disease associated to polyuria (PU) and polydipsia (PD) secondary to antidiuretic hormone (ADH) deficient secretion. The aim of this report is to describe a likely case of pituitary hypoplasia, associated with partial CDI in a cat. Case : A 9-month-old unneutered male Persian cat weighing 2 kg was presented due to severe polyuria and polydipsia associated with growth deficit when compared with its sibling. After clinical and laboratory evaluations during the months in which the patient was monitored, a reduced serum concentration...