Efficacy of hypophysectomy for the treatment of hypersomatotropism‐induced diabetes mellitus in 68 cats

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.

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.…”

A 3-Dimensional Printed Patient-Specific Surgical Guide to Facilitate Transsphenoidal Hypophysectomy in Dogs

“…Anecdotally, we have used the surgical guide for one feline acromegalic patient undergoing hypophysectomy, a treatment previously described ( 2 , 3 , 6 , 22 ). We obtained the same precision as in the dogs of this study to locate the entry point in the basisphenoid bone.…”

“…All dogs were positioned in sternal recumbency with their head held by hooking the canine teeth on a bar supported by a metal frame secured to the surgical table ( n = 4, Figure 2 ) or using a commercially available surgical headframe ( n = 4; Brainsight TM , Rogue Research, Canada), while avoiding pressure to the jugular veins, as previously described ( 1 , 8 , 15 , 16 , 20 , 22 ). The mandible was kept hanging to allow opening of the mouth during the different steps of the surgery.…”