BooBoosMom
Member Since 2014
Good morning - I wanted to introduce my baby boy Groot. He is about 10 years old. He was diagnosed with acromegaly in June 2025 and my vet had never treated a cat with acro so this has been quite the journey for both of us. Currently Groot is on Lantus 10 units morning and evening. He was put on Cabergoline 500mcg/ml from Westwood and he gets 0.15mls every other day. He had originally been on 13 units of Levamir bid and am hoping that the Cabergoline is the reason why we have been able to cut back a bit. He is also on Benazepril for his Kidneys and Clopidogrel to prevent blood clots. He is also now Lactulose and Miralax. I have my own spreadsheet that I have been keeping with his daily BG number and the curves I am able to do. I will create the google spreadsheet and post it sometime after this week. Because of the cost of SRT we had to save up for it. On January 9th Groot went for his MRI and CT and will start SRT tomorrow morning. It's about a 3-hour drive to the University one way so this will be a very long week. I've copied his last discharge information. I didn't want to attach the original pdf file as I am not sure if we want the University or the Dr's names on the thread without their permissions. Thank you for your time to read my post and I am very fortunate that you all are here and may be able to help Groot and I through this journey.
Thanks,
Nadine
DIAGNOSES/PROBLEMS
1. Diabetes mellitus (definitive) - insulin resistant
• Currently receiving 10U Lantus q12h
2. Acromegaly (definitive)
3. Proteinuria (definitive)
4. Chin acne (definitive)
DIAGNOSTICS/TREATMENTS PERFORMED
1. CBC: increased platelets and increased monocytes
2. Chemistry: moderately increased glucose (356 mg/dL), mildly increased phosphorous, normal
creatinine (1.4 mg/dL)
3. Urinalysis: specific gravity 1.029, 2+ glucose, 3+ protein, negative ketones
4. Urine protein to creatinine ratio: 2.8 (normal <0.2)
5. Head and chest CT Scan (final report pending):
1. Mild pituitary enlargement likely due to macroadenoma causing secondary clinically
diagnosed hypersomatotropism.
2. Multifocal lymphadenopathy. Differentials include reactive versus infiltrative disease
(lymphoma).
3. Mild asymmetric enlargement of the left thyroid gland. Differentials include normal
variant versus adenoma.
4. Left atrial enlargement causing mild compression of the left principal bronchus.
Differentials include underlying cardiomyopathy and/or early cardiac decompensation.
5. Described soft tissue attenuation of the right cranial and cranial subsegment of the left
cranial lung lobe may be secondary to recumbency atelectasis (previous MRI) versus
aspiration.
6. Bone, joint, liver, and pancreatic changes consistent with acromegaly and diabetes
mellitus.
6. Brain MRI (final report pending):
1. Pituitary nodule with pituitary gland enlargement is most consistent with clinically
diagnosed with hypersomatotropism.
2. Right mandibular and bilateral retropharyngeal lymphadenopathy, rule out reactive vs
infiltrative disease.
7. Rabies vaccine was administered under the skin of the right rear leg.
CASE NOTES
Groot presented to the MU-VHC Internal Medicine Service for evaluation of hypersomatotropism
Print Date: 01/12/2026 Status:COMPLETE Patient: Groot Page 1 of 3
(acromegaly), and difficulty controlling diabetes mellitus. On presentation, Groot was bright, alert and
responsive with normal vitals. His physical exam showed Groot to be mildly overweight, with mild muscle
wasting noted on his spine. His pupils were very slightly different sizes (anisocoria). We palpated a miniscule
thyroid slip, however, this is not uncommon in older cats, and his total T4 in October was normal so no further
intervention is needed at this time other than annual measurement of his thyroid hormone concentration. No
heart murmurs were auscultated. Lungs auscultated normally, however we did appreciated stertor, a snoring like
upper respiratory sound. Abdomen was compliant and non-painful. His coat had a mild amount of
dandruff. The rest of his exam was within normal limits.
Today, Groot is undergoing anesthesia in order to facilitate his MRI, head CT, and thoracic CT. These image
modalities will help the radiation team form a plan and next steps in Groot's treatment for his acromegaly. Prior
to receiving any drugs for anesthesia, Groot did vomit a small volume of liquid in his kennel. This is a new
change as you have reported he has not been vomiting at home. Additionally, he loudly meowed while
urinating in his kennel, which is also new. We suspect these behaviors are due to stress in hospital, but please
monitor for continued behavior changes at home.
Brain MRI confirmed a left-sided pituitary mass, which would explain his hypersomatotropism. Given the
location of his enlarged pituitary gland, this also could explain the very mild difference in size in his pupils.
Head and CT showed several change to his bones, joints, liver, and pancreas consistent with acromegaly and
diabetes mellitus. His left atrium (chamber of the heart) appeared enlarged, which could be suggestive of
underlying heart disease (such as hypertrophic cardiomyopathy or HCM). Acromegaly could additionally
contribute to HCM. Alternatively, the changes to Groot's heart seen on CT could be secondary to general
anesthesia and IV fluid administration while anesthetized. To better diagnose any underlying heart disease for
Groot, the next step would be a cardiology consult and echocardiogram. This would need to be scheduled
sometime before the start of his radiation therapy, if you are interested. We could not facilitate a cardiology
consult today due to Groot having undergone general anesthesia and potential changes/artifacts induced by
this.
Recheck bloodwork today was largely static from when last measured in October 2025. The amount of protein
in Groot's urine has increased (urine protein to creatinine ratio was 2.8 today and was 1.1 in October; normal
< 0.2). One of the proteins that can be lost through the kidneys into the urine is a protein that is important in
the breakdown of blood clots, making Groot at an increased risk of developing clots, or stroke-like events, so
we are prescribing on a blood thinner (clopidogrel). Groot should continue receiving benazepril as previously
prescribed.
Finally, radiation oncology policy requires all cats receiving radiation therapy to be up to date on their rabies
vaccination. As such, we administered a rabies vaccine under the skin of Groot's right rear leg. If Groot has
been vaccinated for rabies before, this vaccine is effective for 3 years. If this was his first rabies vaccine, he
will need a booster in 1 year.
SPECIAL INSTRUCTIONS/MONITORING
Groot was anesthetized today in order to facilitate his CT scan and MRI. He tolerated sedation well and
recovered uneventfully. He may be groggy when he gets home this evening - please keep him away from any
potential hazards such as stairs and furniture. He should also be restricted from running, jumping, or other
high impact activities that could cause him to injure himself. He should be less groggy and more like his
normal self by tomorrow morning - please call us if this is not the case or if you have any other concerns.
Please monitor Groot for signs of a vaccine reaction such as vomiting, diarrhea, facial swelling, or difficulty
breathing. If any of these occur, call us or return to the hospital as emergency treatment may be required.
There may be localized heat and swelling at the vaccination site. If this lasts longer than two days please call
us. Groot may be lethargic following vaccinations. Should the lethargy persist longer than two days, please
call us.
MEDICATIONS
1. *NEW* Clopidogrel (Plavix®) 75 mg tablets: Please give 1/4 tablet (18.75 mg) orally once daily.
This medication is used for preventing the formation of clots. Side effects are rare but can include
excessive bleeding. NEXT DOSE DUE: when convenient
2. *REFILLED TODAY* Maropitant (Cerenia) 16 mg tablets: Give 1/2 tablet (8 mg) orally once daily
as needed for control of vomiting. Groot received an injectable dose of this medication this
morning.
3. Please continue Lantus (insulin) as previously prescribed.
4. Please continue benazepril as previously prescribed.
Print Date: 01/12/2026 Status:COMPLETE Patient: Groot Page 2 of 3
5. Please continue cabergoline as previously prescribed.
Thanks,
Nadine
DIAGNOSES/PROBLEMS
1. Diabetes mellitus (definitive) - insulin resistant
• Currently receiving 10U Lantus q12h
2. Acromegaly (definitive)
3. Proteinuria (definitive)
4. Chin acne (definitive)
DIAGNOSTICS/TREATMENTS PERFORMED
1. CBC: increased platelets and increased monocytes
2. Chemistry: moderately increased glucose (356 mg/dL), mildly increased phosphorous, normal
creatinine (1.4 mg/dL)
3. Urinalysis: specific gravity 1.029, 2+ glucose, 3+ protein, negative ketones
4. Urine protein to creatinine ratio: 2.8 (normal <0.2)
5. Head and chest CT Scan (final report pending):
1. Mild pituitary enlargement likely due to macroadenoma causing secondary clinically
diagnosed hypersomatotropism.
2. Multifocal lymphadenopathy. Differentials include reactive versus infiltrative disease
(lymphoma).
3. Mild asymmetric enlargement of the left thyroid gland. Differentials include normal
variant versus adenoma.
4. Left atrial enlargement causing mild compression of the left principal bronchus.
Differentials include underlying cardiomyopathy and/or early cardiac decompensation.
5. Described soft tissue attenuation of the right cranial and cranial subsegment of the left
cranial lung lobe may be secondary to recumbency atelectasis (previous MRI) versus
aspiration.
6. Bone, joint, liver, and pancreatic changes consistent with acromegaly and diabetes
mellitus.
6. Brain MRI (final report pending):
1. Pituitary nodule with pituitary gland enlargement is most consistent with clinically
diagnosed with hypersomatotropism.
2. Right mandibular and bilateral retropharyngeal lymphadenopathy, rule out reactive vs
infiltrative disease.
7. Rabies vaccine was administered under the skin of the right rear leg.
CASE NOTES
Groot presented to the MU-VHC Internal Medicine Service for evaluation of hypersomatotropism
Print Date: 01/12/2026 Status:COMPLETE Patient: Groot Page 1 of 3
(acromegaly), and difficulty controlling diabetes mellitus. On presentation, Groot was bright, alert and
responsive with normal vitals. His physical exam showed Groot to be mildly overweight, with mild muscle
wasting noted on his spine. His pupils were very slightly different sizes (anisocoria). We palpated a miniscule
thyroid slip, however, this is not uncommon in older cats, and his total T4 in October was normal so no further
intervention is needed at this time other than annual measurement of his thyroid hormone concentration. No
heart murmurs were auscultated. Lungs auscultated normally, however we did appreciated stertor, a snoring like
upper respiratory sound. Abdomen was compliant and non-painful. His coat had a mild amount of
dandruff. The rest of his exam was within normal limits.
Today, Groot is undergoing anesthesia in order to facilitate his MRI, head CT, and thoracic CT. These image
modalities will help the radiation team form a plan and next steps in Groot's treatment for his acromegaly. Prior
to receiving any drugs for anesthesia, Groot did vomit a small volume of liquid in his kennel. This is a new
change as you have reported he has not been vomiting at home. Additionally, he loudly meowed while
urinating in his kennel, which is also new. We suspect these behaviors are due to stress in hospital, but please
monitor for continued behavior changes at home.
Brain MRI confirmed a left-sided pituitary mass, which would explain his hypersomatotropism. Given the
location of his enlarged pituitary gland, this also could explain the very mild difference in size in his pupils.
Head and CT showed several change to his bones, joints, liver, and pancreas consistent with acromegaly and
diabetes mellitus. His left atrium (chamber of the heart) appeared enlarged, which could be suggestive of
underlying heart disease (such as hypertrophic cardiomyopathy or HCM). Acromegaly could additionally
contribute to HCM. Alternatively, the changes to Groot's heart seen on CT could be secondary to general
anesthesia and IV fluid administration while anesthetized. To better diagnose any underlying heart disease for
Groot, the next step would be a cardiology consult and echocardiogram. This would need to be scheduled
sometime before the start of his radiation therapy, if you are interested. We could not facilitate a cardiology
consult today due to Groot having undergone general anesthesia and potential changes/artifacts induced by
this.
Recheck bloodwork today was largely static from when last measured in October 2025. The amount of protein
in Groot's urine has increased (urine protein to creatinine ratio was 2.8 today and was 1.1 in October; normal
< 0.2). One of the proteins that can be lost through the kidneys into the urine is a protein that is important in
the breakdown of blood clots, making Groot at an increased risk of developing clots, or stroke-like events, so
we are prescribing on a blood thinner (clopidogrel). Groot should continue receiving benazepril as previously
prescribed.
Finally, radiation oncology policy requires all cats receiving radiation therapy to be up to date on their rabies
vaccination. As such, we administered a rabies vaccine under the skin of Groot's right rear leg. If Groot has
been vaccinated for rabies before, this vaccine is effective for 3 years. If this was his first rabies vaccine, he
will need a booster in 1 year.
SPECIAL INSTRUCTIONS/MONITORING
Groot was anesthetized today in order to facilitate his CT scan and MRI. He tolerated sedation well and
recovered uneventfully. He may be groggy when he gets home this evening - please keep him away from any
potential hazards such as stairs and furniture. He should also be restricted from running, jumping, or other
high impact activities that could cause him to injure himself. He should be less groggy and more like his
normal self by tomorrow morning - please call us if this is not the case or if you have any other concerns.
Please monitor Groot for signs of a vaccine reaction such as vomiting, diarrhea, facial swelling, or difficulty
breathing. If any of these occur, call us or return to the hospital as emergency treatment may be required.
There may be localized heat and swelling at the vaccination site. If this lasts longer than two days please call
us. Groot may be lethargic following vaccinations. Should the lethargy persist longer than two days, please
call us.
MEDICATIONS
1. *NEW* Clopidogrel (Plavix®) 75 mg tablets: Please give 1/4 tablet (18.75 mg) orally once daily.
This medication is used for preventing the formation of clots. Side effects are rare but can include
excessive bleeding. NEXT DOSE DUE: when convenient
2. *REFILLED TODAY* Maropitant (Cerenia) 16 mg tablets: Give 1/2 tablet (8 mg) orally once daily
as needed for control of vomiting. Groot received an injectable dose of this medication this
morning.
3. Please continue Lantus (insulin) as previously prescribed.
4. Please continue benazepril as previously prescribed.
Print Date: 01/12/2026 Status:COMPLETE Patient: Groot Page 2 of 3
5. Please continue cabergoline as previously prescribed.
