False Positive Acro??

[CaitlynMF]

Hey everyone! My baby girl Morticia has recently had pneumonia and with that has had higher than normal BG’s, this was attributed to her pneumonia but since her pneumonia symptoms have improved quite a bit, her BG has remained elevated her specialist had us test her for Acro. Unfortunately, today he called with the results and said she was positive but that he was a little suspicious due to having so many positives in a short amount of time, he told us to hold off while he looks into things further this week. My question is, has anyone ever experienced a false positive, or know anything that could cause a false positive? I know that it’s becoming more prominent and not considered as rare as it once was which obviously could be the reason they’ve had more positives, so i’m not getting my hopes up that it’s a false but I can’t really find anything specifically online that states the percentage of false positives. I did read a few articles on things that potentially cause false positives in humans like hyperthyroidism but I don’t know if that would really translate to animals.

 

[Wendy&Neko]

I've heard of false negative tests if you test too soon after starting insulin (less than 73 days), but not false positives. Did the vet tell you the IGF-1 number from the test? There is a range that is positive. MSU recently changed their reference ranges so just want to make sure what the number is.

Something is causing insulin resistance in Morticia.

 

[CaitlynMF]

I've heard of false negative tests if you test too soon after starting insulin (less than 73 days), but not false positives. Did the vet tell you the IGF-1 number from the test? There is a range that is positive. MSU recently changed their reference ranges so just want to make sure what the number is.

Something is causing insulin resistance in Morticia.

I was honestly so shocked and upset that I forgot to ask so i’m going to call tomorrow morning for the report because I did see they changed the range but also that MSU will make remarks on the report so I had assumed it’s pretty straightforward, unless something on their remark made him question it but again, I think he would say that vs saying he’s concerned by the fact they’ve gotten all positives on every cat they have tested recently. I also agree that something is causing her new found resistance and I feel like it is probably a true positive because of that but I may also just be wanting an answer even if it’s really not the one I wanted.

 

[Wendy&Neko]

One in four diabetics is how common it is. Good for your vet on testing more often. Back in the day, I had to beg my vet to get the "exotic" tests done. Since it's fairly early days, if it is acro, chances are treatment will have better results that if you'd waited.

 

[CaitlynMF]

One in four diabetics is how common it is. Good for your vet on testing more often. Back in the day, I had to beg my vet to get the "exotic" tests done. Since it's fairly early days, if it is acro, chances are treatment will have better results that if you'd waited.

Her vet is an incredible vet truly, I guess he even speaks at the vet seminars and is pretty renowned in the internal medicine field per some of the other vets we have seen. But regardless her vet was very honest that because Acro was once thought to be so rare he’s not as knowledgeable as he’d like but that he doesn’t want it to be caught late anymore. He did speak with us about radiation therapy today and when she got the test done since he said that is really the only treatment that is widely studied but it all just seems so scary. Morticia is like my baby, I don’t want her to suffer through anything. From what i’ve seen radiation seems like it is great short term but still not long term, I guess those statistics could be because of the fact that it’s typically being treated in the later stages though so if it already caused damage to their organs, they would still have issues in the long run.

 

[Wendy&Neko]

Cabergoline is another and more common option for treatment now, as of 2017. It's a daily medication, given at home. We've even had a few cats go into diabetic remission on it. You'll see a few posts on this forum about it too. If you get to the point of discussing treatments, I can give you more papers or information. The issues with surgery or radiation therapy is that the cost is higher and typically involves longer distance travel. I drove 3 days each way to get Neko her radiation therapy, which was the only treatment at the time. I was happy with the results, and it was a lot cheaper then. I got 4.5 more years with her, most of it good quality.

 

[CaitlynMF]

Cabergoline is another and more common option for treatment now, as of 2017. It's a daily medication, given at home. We've even had a few cats go into diabetic remission on it. You'll see a few posts on this forum about it too. If you get to the point of discussing treatments, I can give you more papers or information. The issues with surgery or radiation therapy is that the cost is higher and typically involves longer distance travel. I drove 3 days each way to get Neko her radiation therapy, which was the only treatment at the time. I was happy with the results, and it was a lot cheaper then. I got 4.5 more years with her, most of it good quality.

I would love more information on treatments if you could, I have been looking through posts on the board since she got her test done and I did see people talking about the Cabergoline but I get so nervous about it because it seems like it may be hit or miss, I suppose radiation could be the same though. Surgery just seems extremely risky to me even though it sounds ideal. Her vet said that he knows an oncologist at one of the VCA Hospitals about an hour from us in Austin, TX that he would refer us to which wouldn’t be too bad considering we drive an hour just to see her specialist now. I’m not sure how much it would cost but from what i’ve seen the radiation doesn’t really have a lot of side effects from it and the tumor could potentially go away completely depending on how her body responds, right?

 

[Wendy&Neko]

Cabergoline works best if the tumour is small - which you can't tell without an expensive CT scan. Given that acro, if present, is probably pretty new, there's a good chance it's small. Note, I'm not fond of procedures on our acros that need anesthesia unless medically necessary or part of treatment. Too many acros get heart issues, sometimes before we know about it. CT scans need anesthesia. This is a relatively new paper on it with a larger scale study, see the paper I attached to this thread:
New paper on: Cabergoline treatment in cats with diabetes mellitus and hypersomatotropism

A general overview of options and some links to them in this post:
https://felinediabetes.com/FDMB/threads/mister-has-very-high-igf-1-what-are-my-options.262196/ post 24 starts the SRT discussion

You don't need an oncologist to treat acro. I stayed with my regular vet until Neko got more complicated (heart and SCL) on top of the CKD the regular vet treated. However, a radiation oncologist would be involved, with an IM, for SRT (radiation therapy).

SRT neuters the tumour cells, and providing that all of them were radiated, it's possible the tumour goes away once those cells die off. I heard 25% of cases but the numbers seem a little bit smaller with what we've seen here. Small insulin doses and otherwise healthy is also a good goal that I was happy with.

 

[CaitlynMF]

Cabergoline works best if the tumour is small - which you can't tell without an expensive CT scan. Given that acro, if present, is probably pretty new, there's a good chance it's small. Note, I'm not fond of procedures on our acros that need anesthesia unless medically necessary or part of treatment. Too many acros get heart issues, sometimes before we know about it. CT scans need anesthesia. This is a relatively new paper on it with a larger scale study, see the paper I attached to this thread:
New paper on: Cabergoline treatment in cats with diabetes mellitus and hypersomatotropism

A general overview of options and some links to them in this post:
https://felinediabetes.com/FDMB/threads/mister-has-very-high-igf-1-what-are-my-options.262196/ post 24 starts the SRT discussion

You don't need an oncologist to treat acro. I stayed with my regular vet until Neko got more complicated (heart and SCL) on top of the CKD the regular vet treated. However, a radiation oncologist would be involved, with an IM, for SRT (radiation therapy).

SRT neuters the tumour cells, and providing that all of them were radiated, it's possible the tumour goes away once those cells die off. I heard 25% of cases but the numbers seem a little bit smaller with what we've seen here. Small insulin doses and otherwise healthy is also a good goal that I was happy with.

Thank you for all the information! In reading through some of the above links it kind of looks like in terms of effects and the results you could expect Cabergoline and SRT are about the same, at least if caught early enough which brings me to my next question, is there really any way to know if the Acro was truly caught “early” would that just mean it has had no effects on the organs and/or physically? Morticia would seem as though she is being diagnosed early since this is the first time we have had any kind of insulin resistance since her diabetes diagnosis in April and she’s had numerous tests and blood work for her heart, kidney’s and liver which always turn out perfectly fine which makes me think maybe she would be a good candid for the Cabergoline and if that doesn’t work SRT? I just hate that treatments for Acro just seems like playing the long game and in the time you’re waiting to see what works, the growth hormone does more damage, it all seems so scary.

 

[CaitlynMF]

@Wendy&Neko Since you are very knowledgeable about Acro cats and keeping up with studies, do you ever compare the human treatment studies with the feline studies? I’ve been reading up on the use of Cabergoline and since there’s limited information on it’s use for cats i’ve been reading some of the responses from people on this drug as well as studies and it would seem as though results are extremely comparable at least with the little bit of information there is on the usage for felines, which has made me think that the potential success rate in cats could be higher if more broadly used as it has a 73% to 90% chance of success in humans. Out of curiosity, do you think the studies for humans would be worth mentioning to her vet when I talk to him about potentially using Cabergoline for Morticia?

 

[Wendy&Neko]

I'd give your vet that new paper on cabergoline I linked above. It's a good sized study on cats. I wouldn't refer the vet to human studies, as there have been some drugs used for human acros that haven't worked in cats. For example octreotide studies didn't go well. Though I did hear that the Royal Vet Clinic did do a study with cabergoline and octreotide, just haven't seen a paper on the results. Just informal discussion that it worked.

 

[CaitlynMF]

I'd give your vet that new paper on cabergoline I linked above. It's a good sized study on cats. I wouldn't refer the vet to human studies, as there have been some drugs used for human acros that haven't worked in cats. For example octreotide studies didn't go well. Though I did hear that the Royal Vet Clinic did do a study with cabergoline and octreotide, just haven't seen a paper on the results. Just informal discussion that it worked.

I did save that study to provide to him. Would it be worth it to also get feedback from group members who have/had their cats on it experiences to present? I’m just nervous that he may be reluctant with a medication since he’s only really mentioned the radiation and though we haven’t gotten any quotes, I know radiation will be expensive and we’ve already spent over $15,000 in a few months to finally have an answer of what’s going on with her and I don’t want to give up on her now because we can’t afford radiation at this moment.

 

[Wendy&Neko]

Another paper to read and possibly pass onto your vet:
Paper on QOL and response to treatment for acros This paper was a large survey of owners and their experiences.

One possible approach with your vet, especially if cost is an issue, is to try cabergoline first for several months. If it doesn't help, then think about SRT. We've had one or two members go that route.

 

[CaitlynMF]

That’s a very good read, I’ll definitely pass that along to him! I think that is the route we are going to go, I feel like it will hopefully give us time to save for SRT while also attempting to slow the progression of the tumor and growth hormone down to not cause any damage since at this point her only issue is high BG, her heart and other organs are still in good standing. Has anyone had their kitties show progress on the Cabergoline and still moved forward with SRT or was it only when they did not show improvement on Cabergoline?

 

[Wendy&Neko]

Has anyone had their kitties show progress on the Cabergoline and still moved forward with SRT or was it only when they did not show improvement on Cabergoline?

The latter. The time it takes for cabergoline to work varies a lot between kitties. From 2 cases of 8-10 days on cabergoline before going completely into diabetic remission, to three months before insulin doses start coming down, to no impact at all even over time.

If you haven't already, take a look through this thread: Cabergoline treatment for acromegaly - side effects It's about an acrokitty who has not yet developed diabetes - which is considered a later stage effect. And mentions a study in the UK of 9 acrocats (non diabetic) who have been put on cabergoline.

 

[CaitlynMF]

The latter. The time it takes for cabergoline to work varies a lot between kitties. From 2 cases of 8-10 days on cabergoline before going completely into diabetic remission, to three months before insulin doses start coming down, to no impact at all even over time.

If you haven't already, take a look through this thread: Cabergoline treatment for acromegaly - side effects It's about an acrokitty who has not yet developed diabetes - which is considered a later stage effect. And mentions a study in the UK of 9 acrocats (non diabetic) who have been put on cabergoline.

That’s VERY interesting, I wonder if a big chunk of the ones who did have success from Cabergoline really did have any correlation with how early diabetes was caught, I guess that’d be really hard to tell though since it seems not every case of diabetes was caused by acro. Have any group members who had success with it specified how long their kitties were diabetic for before starting Cabergoline? I ask not only out of curiosity but because i’ve always wondered how Morticia could be so young and in such great health till one day in April we noticed she was sleeping more and would urinate tooonss which we suspected was a uti which we obviously found out was diabetes but it always seems so off to me.

 

[Wendy&Neko]

Have any group members who had success with it specified how long their kitties were diabetic for before starting Cabergoline?

I've seen one kitty who was 4 when she was Dx'ed. She lived another 6 years with cabergoline. Search for kitty Amethyst on here or the Lantus forum if you want more details. And you can look up her spreadsheet to see when she started insulin and when she started cabergoline and when she started to see cabergoline results. Other two kitties with extreme reactions were Marvin (member Marvin's Mom - Nat) and Mr. Kitty (member FrostD). Search through the posts on this forum about cabergoline, and you'll get a lot of information and see posts by people who used it, or still are.