Organomegaly cause??? Out of ideas..any thoughts?

[Tuxedo Mom]

My Tuxie is a 14yr old male kitty dx with diabetes Nov 18/14. Tuxie has an enlarged pancreas, liver and adrenal glands. He has had both an ultrasound and an x-ray which both confirm this. The U/S was done January 2/25 and the x-ray was done April 4/15. The findings did not show any irregularities in any of the organs simply the enlargement.

The vet who did the U/S gave a subjective opinion of Cushing's but Tuxie has had the UCCR test done and it comes back as within normal ranges. Although the lab had no set range for cats the range for dogs was anything <35 did not indicate Cushing's. Tuxie was 11.5 nnmo/L. If anyone has an actual number specifically for cats I would appreciate hearing about it. The LDDS and ACTH tests were not done since Tuxie is so prone to stress that the stay at the vets would have played havoc with the numbers. He has an oral HDDS test with dex and he had full suppression.

The other consideration was acromegaly which came back with a reading of 68 nmol/L reference range 12-92. He was also tested for IAA which came back negative.

This has really perplexed me since January as one of the first things I noticed about Tuxie before he was diagnosed was the fact that he was putting on weight..to me I called it "looking like he was pregnant", Other than about a 1/2lb drop in weight when he was diagnosed 3-4 weeks later when the drinking and peeing became obvious, he has held his weight and out on weight even with a controlled feeding schedule. He was 11/85 lb at dx November 18/14 and is now (April 4/15) 13.8 lb.

Tuxie's vet has no idea what could be causing the organomegaly, but I feel that this has a lot to do with the high glucose. Any thoughts on this would be appreciated. I have researched this until my brain is in a total fog and am no further ahead now than the beginning of the year when I started researching.

 

[BJM]

Sometimes, we don't have answers ... or can't afford the testing to get an answer. Does the cause really matter if you know how to and can control his glucose?

Also, lab tests are far from perfect. The test today may say condition not found while the test in a couple of weeks could find it. The cut offs are not as precise as they seem. And with accumulation of data on both healthy and symptomatic cats, sometimes the labs change their reference values/cut off numbers.

 

[Tuxedo Mom]

Sometimes, we don't have answers ... or can't afford the testing to get an answer. Does the cause really matter if you know how to and can control his glucose?

I think that there may just be a piece of a puzzle missing here. If for instance he was to actually be a Cushing's cat there is trilostane which has shown promising results in cats. I would hate to think that he had another condition that was affecting both his glucose levels and his health and I missed it. My vet's only suggestion was to try a round of prednisolone to see if that helps with the organ inflammation, BUT if he were actually Cushing's that could make it worse. So in some ways any additional treatment options are more or less in limbo.

Maybe I am just expecting too much or trying too hard to find an "answer". But I have become very OCD about Tuxie.

 

[BJM]

Maybe give it a month and re-test. Sometimes, a change in test results can provide a clue.
Also, if the clinical symptoms fit and the labs don't, you might consider an empiracle trial of treatment. For example, if the clinical picture fits Cushings, a trial of trilostane could be done. The risk is that if it is the wrong condition, you'll have wasted time and money and possibly caused harm. On the other hand, if it helps, the condition is at least more likely, if not confirmed.
If inflammation is an issue, fish oil may help, plus there are other anti-inflammatory meds that are not steroids, such as Onsior (given for swelling and pain after dentals, and an NSAID).

 

[Tuxedo Mom]

Maybe give it a month and re-test. Sometimes, a change in test results can provide a clue.
Also, if the clinical symptoms fit and the labs don't, you might consider an empiracle trial of treatment. For example, if the clinical picture fits Cushings, a trial of trilostane could be done. The risk is that if it is the wrong condition, you'll have wasted time and money and possibly caused harm. On the other hand, if it helps, the condition is at least more likely, if not confirmed.
If inflammation is an issue, fish oil may help, plus there are other anti-inflammatory meds that are not steroids, such as Onsior (given for swelling and pain after dentals, and an NSAID).

Thank you for your information. I give Tuxie additional Fish oil and Vitamin E besides what I put in his food. I have thought about doing a trial of trilostane...if it is wrong then it could cause Addison's disease symptoms, but they could be countered with steroids, as long as he is monitored carefully. Actually my vet had called just a little while ago to see how Tuxie was doing with his UTI from Saturday. I talked with her about the organomegaly and she also said we could retest in a few months and compare the results. The main problem with testing for Cushing's is there is no cat specific reference ranges for UCCR which is very sensitive for yes or no. The UCCR test with oral dex Tuxie had done rules out adrenal based Cushing's but does not give any determination of pituitary based Cushing's. And as I said doing the LDDS or ACTH stimulation test involves either 4 or 8 hours at the vet having blood drawn every X number of hours. Stress can give false readings so this would not work well for Tuxie. So for the time being I will just deal with the glucose issues, unless something unusual starts up.

 

[Wendy&Neko]

The thing that comes to mind to me with organ growth and weight gain is acromegaly. There can be false negatives in the IGF-1 scores for uncontrolled and early diabetics. Recent studies have shown that 20-30% of diabetic cats have acromegaly. Here is a recent article on acromegaly and Cushing's with some pictures and descriptions of symptoms and also test reference ranges. See if any of the other symptoms make sense. It's not a complete list of symptoms. Neko's first sign was eye tearing (blocked tear ducts), that symptom is not in the paper but is something acros can get. Both acromegaly and Cushings can be caused by a tumor on pituitary, which a U/S will not see - you need at CT scan from that. You could also retry an IGF-1 test later, which is cheaper.

Cushings can be caused by multiple things (tumor on pituitary, adrenal, overuse of steroids) and how you treat depends on the cause. I've know a dog that went Addisons after treatment for Cushings - you don't want to go there.

In the mean time, the best thing you can do for Tuxie is to deal with the high blood sugar.

 

[Tuxedo Mom]

The thing that comes to mind to me with organ growth and weight gain is acromegaly. There can be false negatives in the IGF-1 scores for uncontrolled and early diabetics. Recent studies have shown that 20-30% of diabetic cats have acromegaly. Here is a recent article on acromegaly and Cushing's with some pictures and descriptions of symptoms and also test reference ranges. See if any of the other symptoms make sense. It's not a complete list of symptoms. Neko's first sign was eye tearing (blocked tear ducts), that symptom is not in the paper but is something acros can get. Both acromegaly and Cushings can be caused by a tumor on pituitary, which a U/S will not see - you need at CT scan from that. You could also retry an IGF-1 test later, which is cheaper.

Cushings can be caused by multiple things (tumor on pituitary, adrenal, overuse of steroids) and how you treat depends on the cause. I've know a dog that went Addisons after treatment for Cushings - you don't want to go there.

In the mean time, the best thing you can do for Tuxie is to deal with the high blood sugar.

The acro was really a big question mark for me because of the weight gain and the enlarged belly. It is so hard to say because either early Cushing's or early acro does not give all the "textbook" symptoms. The organomegaly can be a symptom of eithe condition although it is more prevelant in acro.

Tuxie does not have any definite symptoms that would point one way or other. He has very slow regrowth, but that could be the diabetes. He never got his "winter" coat. When I comb and brush him there is very little hair coming off, but that could also be from the diabetes. The physical symptoms of acro don't always show up in the earlier stages. He does not have adrenal based Cushing's. His response to the oral dex UCCR test shows total suppression of cortisol, which if anything would be pituitary based. So if he has either condition it is all to do with the pituitary gland. I just can't afford to do a CT scan..they are around $1500 here. Redoing the IGF1 test is $200. My vet does the blood draw, then it is shipped to Idexx in Ontario, Canada, who do the brokering and ship to Michigan State University. There are no test facilities in Canada for this or the IAA test.

When I spoke with the vet today about still not being 100% convinced that Tuxie is in the clear of both syndromes she said they are both quite rare. Of course I was able to quote some stats about how much more prevalent acro is now being confirmed and that even "rare" diseases still happen. I liked her answer (she is a 25 yr vet) "True, I am learning more things all the time." I am so glad that my vet listens to me and is open to information and questions I have.

BUT, in the meantime as you said, all I can really do is keep working on his glucose levels. I really appreciate your input since I know your Neko is an acro cat so your information levels are far past the average owner and your experiences dealing with it are priceless. Thank you!!