Is acro likely here?

[Nan & Amber (GA)]

Hello Acro Folks!

I've been weighing testing my Amber for acromegaly (and IAA of course, while I'm at it, but mostly the acro), and I wanted to put the case to you guys (because I figure you've been in the trenches and know the condition far better than most vets!). I might just be grasping at straws here.

Question first, then the details.

Is it possible for an acro tumor to behave in the following way: pulse on briefly, inducing a short period of insulin dependence, go dormant for an extended period (1.5yrs), then turn back on again? Or does that long an OTJ period make an acro diagnosis really unlikely?

Details: Amber's on her second go-round with insulin. First time around, she zipped pretty quickly down the dosing ladder to remission, and then spent a year and a half in excellent numbers (generally 50's-70's). The FD came back with a bang-- essentially overnight, she was back up in the 200's. Now, we've been on insulin for a few months again, and she's gone far higher on the dosing ladder (4.25U, Lantus) than she ever was before, with absolutely no sign of any physical problems. No infection, no pancreatitis flares, she just had a dental last week that revealed no issues other than a "tip fracture" that was (according to x-rays) surface-only and not causing any pain.

There have been hints along the way this time of stepwise changes in insulin needs-- see early-mid April, when she looked like she was poised to go back down the dosing ladder from 2.0U, then suddenly started signalling she actually wanted more...).

In addition to her current high (-ish) dose, there's at least one physical symptom that might point to acro. She's always snored a bit, but it seems like lately she's snoring a lot, it's quite noticably more pronounced. Hmmm......

So that's why I'm starting to think of things like acro, even if it's jumping the gun in terms of her current dose. But does it even seem like a likely diagnosis given her history, or am I being silly? What do you think?

 

[Wendy&Neko]

I do know of at least a couple of cases of kitties being OTJ but being acro. The first (Milo - his SS ), was OTJ for 5 years. He came back and although he didn't get up to 6 units, I had suspected from his SS and some symptoms that he might be acro. He tragically did not make it out of dental surgery. An post mortem afterwards found a pituitary tumour. The second case was part of Jacquie Rand's study on predictors of replapse on diabetic cats in remission. She first tested all the OTJ cats for acro, as she didn't want them in her study, one was found. An interesting quote from that paper "A small minority of diabetic cats with acromegaly are not clinically insulin resistant and occasionally achieve remission (S. Neissen,personal communication)"

People who have a cat go OTJ, generally do not test it for acromegaly, so we don't have good statistics on that. If it would answer the question for you, why not get the IGF-1 test as part of your next bloodwork?

My civvie snored, Neko did not. Her only sign early on was one tearing eye, from soft tissue growth in her tear duct. Of course, I didn't recognize it as a sign when it started, neither did the vet. ECID when it comes to symptoms. Another paper by Neissen stated that around only 35% of acrocats show symptoms on diagnosis.

 

[Nan & Amber (GA)]

Thanks, Wendy. That's really really helpful. So, very rare to see (or at least, identify) these cases, but not impossible. 5yrs OTJ for Milo, wow. That is incredibly sad about the dental-- it's one of my big fears when I send one of mine in. How awful.

I probably will request testing on next bloodwork or maybe even sooner depending on how the summer goes (she might be settling into a good dose now, but if she starts climbing again...). I'd really like to know, one way or the other, and if she does have acro, maybe think about whether any of the treatment options would make sense for her.

Thanks again, definitely food for thought here!

 

[JeffJ]

Yes, that is really sad for Milo. I was not on the forum then. I have the same fear.

Those are some tight numbers for Amber. I can't do that with Leo - he would hypo everyday. If Amber doesn't go higher, you could just treat with insulin. The treatments for Acro are generally expensive, except for Cabergoline. But it has mixed results.

Leo snores like a sailor. Our other 2 cats (Little Dude and Chinus) barely snore. Leo definitely has throat growth(s). He has trouble eating. Often he will eat a little then it gets stuck and he runs from the bowl. Then I put in more water and take it to him and hold it up to head-level. So that is a cruddy side effect from the Acro which occurred before his SRT.

Plus Leo has arthritis now. I think from the Acro. And he is not even 12 yet, his BD is in late June.

So there are side effects from Acro. If Amber has Acro and you have the fund, you could proceed with one of the Acro treatments.

 

[Nan & Amber (GA)]

Those are some tight numbers for Amber. I can't do that with Leo - he would hypo everyday. If Amber doesn't go higher, you could just treat with insulin. The treatments for Acro are generally expensive, except for Cabergoline. But it has mixed results.

Yeah, I think this might be the equivalent of the forum dosecrease threat happening here. As soon as I resigned myself to the "new reality" of her climbing ever-higher in dose and started posting questions related to that, she flipped the switch and started turning things around. Who knows, maybe that dental had an effect, even if the vet didn't find anything or do anything other than a cleaning. No matter what she does from here, though, I think I'll get the acro test done at her next bloodwork, for data-gathering if nothing else.

Aw, poor little guy on the eating! It probably feels scary to have food stuck like that. And arthritis, too .