Acromegaly

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Sex predisposition, Breed predisposition, Pathogenesis, Etiology, Pathophysiology, Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Standard treatment, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Carmel Mooney MVB MPhil DECVIM PhD MRCVS
Dr David Bruyette DVM DipACVIM
Synonyms Growth hormone excess, hypersomatotropism

Introduction

  • Relatively rare endocrine disease.
  • Chronic overgrowth of connective tissue, bone and viscera.
  • Cause : syndrome due to persistent excessive growth hormone (GH) secretion from pituitary adenoma  Pituitary gland: neoplasia  .
  • Signs :
    • May be mild glucose intolerance or overt diabetes mellitus.
    • Cardiomyopathy  Heart: hypertrophic cardiomyopathy  ; systolic murmur; gallop rhythm.
    • Chronic heart failure  Congestive heart failure  ; pleural effusion, pulmonary edema  Lung: pulmonary edema  .
  • Insulin-resistant diabetes mellitus  Diabetes mellitus  (can be controlled by increasing insulin dose).
  • Prognosis : survival time 8-30 months. Most die of complications, eg congestive heart failure  Congestive heart failure  , renal failure  Kidney: chronic kidney disease  , neurological signs.

Print off the owner factsheet on Acromegaly  Acromegaly in cats   to give to your client.

Diagnosis

Clinical signs

  • Organomegaly (hepatomegaly   →   cardiomegaly   →   renomegaly)  Abdominal organomegaly  .
  • Skin folding and thickening, especially on head, neck and distal extremities  Acromegaly  .
  • Increased interdental spaces and inferior prognathia.
  • Cardiac murmur.
  • Dyspnea if congestive heart failure.
  • Stertorous breathing.
  • Enlarged head (coarse facial features), abdomen, limbs and paws.
  • Congestive heart failure  Congestive heart failure  .
  • Macroglossia.
  • Neurological and other endocrine signs if caused by pituitary or hypothalamic neoplasia.
  • Arthritis with fibrous thickening of joint.

Diagnosis

Differential diagnosis

Other causes of insulin resistance
  • Hyperadrenocorticism  Hyperadrenocorticism  (more common in females).
  • Hyperthyroidism  Hyperthyroidism  .
  • Uremia  Uremia  .
  • Obesity  Obesity  .
Other causes of left ventricular hypertrophy
  • Hyperthyroidism  Hyperthyroidism  .
  • Hypertension  Hypertension  .
  • HCM   Heart: hypertrophic cardiomyopathy  .

Sequelae

Prognosis

  • Survival 4 months to 3 years (median about 21 months).
  • Diabetes usually persists (even if acromegaly successfully controlled) because of beta-cell exhaustion and persistent hypoinsulinemia.
  • Most animals die of complications, eg chronic renal failure  Kidney: chronic kidney disease  or congestive heart failure  Congestive heart failure  .

Expected response to treatment

  • Rapid fall in [GH] after surgery.
  • Regression of soft tissue changes over several months.
  • If diabetic, decreased insulin requirement with improved diabetic stability.

Reasons for treatment failure

  • Severe complications present at time of diagnosis.

Sources

Publications

Refereed papers

  • Recent references fromPubMed.
  • Elliot D A, Feldman E C, Koblik P D, Samii V F & Nelson R W (2000)Prevalence of pituitary tumors among diabetic cats with insulin resistance.JAVMA216, 1765-1768.
  • Norman E J & Mooney C T (2000)Diagnosis and management of diabetes mellitus in five cats with somatotrophic abnormalities.JFMS2, 183-190.
  • Feldman E C & Nelson R W (2000)Acromegaly and hyperadrenocorticism in cats - a clinical perspective.JFMS2, 153-158.
  • Goossens M M C, Feldman E C, Nelson R Wet al(1998)Cobalt irradiation of pituitary gland tumors in three cats with acromegaly.JAVMA213, 374-376.
  • Merchant S Ret al(1995)Systemic diseases with cutaneous manifestations.Vet Clin North Am Small Anim Pract25(4), 945-959.
  • Peterson M E, Taylor R S, Grecoet al(1990)Acromegaly in 14 cats.JVIM4, 192-201.
  • Morrison S A, Randolph J, & Lothrop C D (1989)Hypersomatotropism and insulin resistant diabetes mellitus in a cat.JAVMA194, 91-94.
  • Wolf A M (1989)Feline endocrinology.Tijdschr Diergeneeskd114(Suppl 1), 15S-18S.

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