Diagnosis and Management of Feline Hypersomatotropism: Alison Khoo, BSc, BVMS, DACVIM

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Acromegaly and
Hypersomatotropism
in cats
DR. ALISON KHOO
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SPEAKER INFORMATION
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 Akron= extremity mega=large
 ‘Acromegaly’ was first described in 1886 and linked to a distinct clinical disease with a characteristic clinical
picture.
 Pituitary enlargement was noted in almost all patients with acromegaly (eventually linked to pituitary
hyperfunction)
 20th century: treated with surgery/ radiotherapy
 After 1970: treatment with medical therapy introduced
ACROMEGALY IN HUMANS
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https://en.wikipedia.org/wiki/Acro
megaly

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 Aims to increase FFA in the blood (available
for energy)
 Decreases rate of glucose utilization
 Decreases insulin’s action to stimulate
glucose uptake
 Leads to increased BG and compensatory
increase in insulin secretion
PHYSIOLOGICAL FUNCTIONS OF GROWTH HORMONE:
CATABOLIC
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 Anabolic effects exerted through somatomedins/ insulin-like
growth factor
 Most important: somatomedin C aka insulin-like growth factor (IGF-
1)
 IGF-1’s actions
 Increase lean body mass
 Proliferation of bone, cartilage and soft tissue
 Organomegaly
 Increase glucose uptake by adipocytes (like insulin)
PHYSIOLOGICAL FUNCTIONS OF GROWTH HORMONE:
ANABOLIC
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https://www.memorangapp.com/flashcards/123684/9-
27+Pituitary+Dsyfunction/

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 Acromegaly
 A syndrome of bony and soft tissue overgrowth and insulin resistance due to excessive
growth hormone secretion
 Results from overexposure of tissues to GH and IGF-1
 Hypersomatotropism
 Refers to the pathologic overproduction and subsequent secretion of growth hormone
which leads to the clinical syndrome of acromegaly
 Terms often used interchangeably
 Excess GH is dx in a large proportion of cats that do not yet show the typical acromegalic
phenotype. Therefore, using the term hypersomatotropism instead of acromegaly might be
more appropriate
ACROMEGALY VS. HYPERSOMATOTROPISM
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 Majority are due to a functional adenoma of the somatotropic cells
of the pituitary pars distalis
 Minority are due to hyperplasia of the cells of the pituitary pars
distalis
 Possible explanations:
 Interrelationship between these 2 etiologies (hyperplasia
transforming to adenoma?)
 Suprahypophyseal process (possibly located in the
hypothalamus) driving the disease
PATHOGENESIS
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http://sites.tufts.edu/progressnotes/catego
ry/clinical-case-challenge/

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SIGNALMENT
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Hypersomatotropism
Median age in years (range) 11 (4-19)
Gender Male bias
Breed DSH bias (other breeds documented)

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Early + late stages Usually only in late stages
Polyuria/ polydipsia/ polyphagia Prognathia inferior
Weight gain Broad facial features
Enlarged kidneys Respiratory stridor
Enlarged liver
Systolic cardiac murmur
Plantigrade stance
CLINICAL SIGNS
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 Insulin-resistant diabetes mellitus
 However, there is a net weight gain of lean body mass
MOST COMMON CLINICAL SIGN
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http://todaysveterinarypractice.navc.co
m/consider-case-uncontrolled-diabetic-
cat/

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 Less pronounced than dogs
 Absence of acromegalic appearance
should not decrease index of suspicion
in an insulin-resistant cat
 Polyphagia might be extreme
 Snoring/ stridor: increase soft tissue in
the oropharynx and soft palate
disturbed airflow
PHYSICAL CHANGES
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 Growth of flat bones of skull and
mandible prognathia inferior
and increased interdental
spaces
 Approximately 50% have
proliferative changes in joints
progressive arthropathy and
lameness
OSSEOUS SIGNS
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 Cardiomegaly (radiographic +
echocardiographic)
 85% mild to moderate in first few months
 Worsen in 50%
 Systolic murmurs (60% within first few months
of diagnosis)
 Congestive heart failure late in the course
CARDIOVASCULAR CHANGES
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 Cause not fully understood
 Lesions resemble hyperfiltration injury
 Hypertension
 Reported but…
 Large studies have not detected an increased prevalence
(based on Doppler measurements and fundic exams)
NEPHROPATHY
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https://au.pinterest.com/pin/112238215685993470/

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 Develops late in course of disease
 Blindness, depression, anisocoria,
circling
 Resolve after radiation therapy
NEUROLOGICAL SIGNS
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http://www.pophangover.com/34600/simon-the-depressed-cat-is-my-new-favorite-meme/

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Large pituitary tumor in a cat with acromegaly

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DIAGNOSIS
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 Does not differentiate from type 2 diabetes
 Identifies comorbidities
 Ketosis is rare, but can occur
 No greater incidence of azotemia among acromegalic vs. nonacromegalic cats
 Azotemia and chronic renal failure develop late in the course of the disease in approx. 50%
acromegalic cats
 Total protein
 Significantly higher in acromegalic group
 BUT, large amount of overlap between groups
ROUTINE CLINICAL PATHOLOGY
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 Only available for research purposes
 Sensitivity: 95%; specificity: 84%
 If elevated
 Acromegalic
 Secretory pulse in normal animal
 Cats with HCM (mild elevation compared to cats with acromegaly)
 If within reference range
 Non acromegalic
 Mild/ beginning of disease
 Should be determined by a species specific radioimmunoassay
BASAL PLASMA GROWTH HORMONE
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http://www.thecatclinic.co.uk/pet-health-club/4578080486

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 Produced by the liver
 Protein bound so much less subject to fluctuation than GH
 Assay offered at Michigan State University
 Sensitivity:80-100% Specificity 70-92%
 Production induced by growth hormone BUT only in the presence of
sufficient portal insulin –significance??
INSULIN-LIKE GROWTH FACTOR-1 (IGF-1)
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Modified from: http://genf20plus.info/igf1.php

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 Duration of exogenous insulin administration plays a crucial role in false negative IGF-
1 results
 During treatment, hepatic IGF-1 production is stimulated via insulin-dependent
hepatic GH receptors
 An insulin deficient state can act as an inhibitor of IGF-1 production
 Consider repeating IGF-1 concentration 6-8 weeks into treatment OR measure once,
6-8 weeks after institution rather than at the time of diagnosis
IGF-1: WHEN TO MEASURE?
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 A mild elevation in the presence of severe
insulin resistance could justifiably trigger
further diagnostic studies
 Liver and kidney disease increases IGF-1 in
humans
 Short term fasting can decrease IGF-1
concentrations
IGF-1
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http://www.funnyordie.com/topic/cute-cat-pictures

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 Do Not Use
 Gold standard in humans
GLUCOSE SUPPRESSION TEST
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ADVANCED IMAGING
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 MRI more sensitive than CT
 Can have false negatives
 Structural pituitary abnormality strengthens evidence for dx of
hypersomatotropism
 Can have concurrent increases in frontal bone thickness and/or evidence
of soft tissue accumulation in the nasal cavity, sinuses and pharynx
 Does not differentiate from non-functional tumor
DIAGNOSTIC IMAGING
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 As an attempt to confirm disease
 Preradiation planning
 Presurgical planning
 NOT as a screening test
WHEN SHOULD I CONSIDER MRI OR CT SCAN?
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 Thicker skull bones
 Thicker skin and subcutis
 Narrow nasopharynx (thickening of surrounding tissues)
 66% have increased bone measurements
 24% had prognathia inferior
CT SCAN FEATURES IN CATS WITH HYPERSOMATOTROPISM
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 Spectrum of changes
 No structural abnormalities
 Diastolic dysfunction most common
 Other common changes: left ventricular hypertrophy and left atrial
enlargement
ECHOCARDIOGRAPHY
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http://www.allevamentosiberiani.it/media/k2/items/cache/9f6
d22dec5a20bcdd01cd84e98637764_XL.jpg

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 Cats with hyperadrenocorticism can present similarly to cats with
hypersomatotropism
 UCCR can be elevated in acromegalic cats
 LDDST is the preferred test in cats
 Pay attention to specific clinical differences
OTHER TESTS TO CONSIDER: UCCR/ LDDST/ACTH
STIMULATION
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 0.1mg/kg Dexamethasone
 Sample collection at 4 and 8 hours post
administration
 Cortrosyn: 125ug/cat
 Sample collection at 1 hour +/- 30
minutes
LDDST AND ACTH STIMULATION PROTOCOL IN CATS
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Hypersomatotropism (HS) Hyperadrenocorticism (HAC)
Frequent weight GAIN Frequent weight LOSS
Lack of dermatologic signs apart from unkempt
coat
Frequent dermatologic signs
Lack of muscle wasting Frequent muscle wasting
Severe or extreme insulin resistance Lack of or modest insulin resistance
Infrequent generalized poor condition Frequent generalized poor condition
Absence of diabetes very rare Absence of diabetes possible
IGF-1 elevated IGF-1 usually not elevated
DIFFERENTIATING DIABETIC CATS WITH HS SV. HAC
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 Medical treatment
 Definitive treatment
 Conservative treatment
 Radiation therapy
 Surgery
TREATMENT
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http://www.fanpop.com/clubs/scrubs/images/19521610/title/j
d-turk-photo

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 With ANY definitive treatment, clinicians and owners need to be vigilant for rapid changes in insulin
demands if treatment is proven effective
 Iatrogenic hypoglycemia is frequently encountered
 Consider home blood or urine glucose measurements
 Cats with these signs should be immediately evaluated
 Negative urine glucose
 Dramatic decline/ resolved pu/pd
MONITORING DURING TREATMENT
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http://www.peteducation.com/article.cfm
?c=1+2130&aid=201

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 Aimed at inhibiting pituitary secretions of growth hormone
 Somatostatin analogues
 Pasireotide shows the most promise
 Octreotide and lanreotide: no convincing clinical
improvement
 Dopamine agonist did not result in clinical improvement
 GH-receptor antagonists: requires more research
MEDICAL TREATMENT
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 Currently the most widely applied treatment modality
 Disadvantages:
 Multiple fractions required (frequent anesthesia)
 Slow rate of tumor shrinkage (>3 years)
 Possibility of relapse and unpredictable clinical response
 IGF-1 and GH concentrations decrease but not to normal levels in seemingly successfully treated animals
 Negative sequelae of HS might continue to develop (cardiac, joint and renal changes)
 Extended hospitalization, depigmentation and radiation injury
 Hypopituitarism, optic nerve damage
RADIATION THERAPY
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 Transsphenoidal hypophysectomy results in an immediate decrease in GH levels postoperatively and
normalization of IGF-1 concentration
 Possible resolution of DM within weeks
 Perioperatively and postoperatively, desmopressin, thyroxin and GC supplementation req
 Iatrogenic diabetes insipidus is transient; hypocortisolism and hypothyroidism is life long
 Risk of regrowth of tumor in 30-40% cases
 Niessen’s preferred treatment option
 Method of choice in humans
SURGICAL TREATMENT
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https://www.researchgate.net/profile/Stijn_Niessen

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 Ignores the underlying disease mechanism and focuses on gaining maximal control over DM
 Will require very high dosages of insulin or combinations of short and long acting insulin types
 High doses employed with gradual increases guided by BG curves +/- fructosamine concentrations
 Feed a balanced diet that is low in carbs and high in protein (may require 3-4 feedings a day)
 Palliate arthropathies with analgesia
 Treat CHF with diuretics and ace-inhibitors
CONSERVATIVE TREATMENT
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 Short-term
 Fair to good
 Long-term
 Relatively poor
 Benefit with any treatment modality compared with tx of DM alone has yet to be
documented
 1990 study: 11/14 cats were euthanized/ dead 4-42 months after onset of
hypersomatotropism because of renal failure, CHF, progressive neurologic signs,
persistent anorexia and lethargy and owner’s unwillingness to treat
PROGNOSIS
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CASE EXAMPLE
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 Harry
 9 yo MC DSH
 Presented with a 1 year history of diabetes mellitus
 Receiving between 25 and 30 units PZI insulin daily
 Eating a low carbohydrate, high protein diet
 Spot glucose tests revealed BG between 50 and
250mg/dl
MEET THE PATIENT
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 Large cat : 7kg (gained 1kg in the past 5 months)
 Snoring occasionally
 Before and after photos revealed potential enlargement of paws but
owners think he looks unchanged
PHYSICAL EXAMINATION
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 Target tissues cannot respond to insulin due to peripheral antagonism
 Due to:
 Degradation of insulin
 Insulin receptor defects
 Post-receptor defects
 Glucose transport defects
WHAT DOES INSULIN RESISTANCE MEAN TO YOU?
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 Persistent hyperglycemia in the face of insulin dosages >2-2.5 units/kg
 Note: This may or may not reflect true insulin resistance at the cellular
level
 Harry was receiving ~4units/kg
WHEN DO WE WORRY ABOUT INSULIN RESISTANCE
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 Inappropriate handling and storage of insulin
 Improper administration of insulin
 Improper care and feeding
 Using the wrong type of insulin
 Insulin-induced hyperglycemia
WHAT CAN MIMIC INSULIN RESISTANCE?
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INSULIN RESISTANCE- WHO IS AT FAULT?
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OWNER?
VETERINARIAN?
CAT?
http://www.petmd.com

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 Ensure owners can mix, draw up and administer
insulin
 Ensure insulin syringe is correct (40-U syringe)
 Check expiration date
 Ensure owner is varying the injection site
 All family members involved in insulin administration
should be investigated
OWNER?
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 Interpret the following data before arriving at a diagnosis of true
insulin resistance
 CLINICAL SIGNS!!
 Blood glucose curves
 +/- Fructosamine
 Underdosing?
 Overdosing? Somogyi??
 Concurrent administration of diabetogenic drugs
VETERINARIAN?
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/www.cartoonstock.com

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 Determine the lowest blood glucose concentration (nadir)
 Range of blood glucose concentration (ideal for cat: 90-350mg/dL)
 Duration of insulin effect (only assess if nadir is >90mg/dL and BG has not decreased
rapidly)
BLOOD GLUCOSE CURVES
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 8am: fed and insulin administered: 350mg/dl
 9am: 70mg/dl
 10am:60mg/dl
 11am: 60mg/dl
 12pm: 50mg/dl cat was offered food and BG curve aborted
BLOOD GLUCOSE CURVE PERFORMED IN CLINIC
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 Concurrent endocrinopathy
 Hyperadrenocorticism
 Hyperthyroidism
 Acromegaly
 Glucagonoma
 Phaechromocytoma
 Anti-insulin antibodies (very rare)
 Severe obesity
 Concurrent disease
 Liver, renal, cardiac insufficiency
 Neoplasia
 Infection
 Especially skin, oral cavity and
urinary tract
CAT?
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 CBC, chemistry, urinalysis
 URINE CULTURE!!
 T4
 Blood pressure
 Abdominal ultrasound
INITIAL WORKUP
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www.dreamstime.comhttp://www.ironmagazine.com

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 T4 and BP: WNL
CBC, CHEMISTRY, UA AND CULTURE
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URINALYSIS AND CULTURE
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 IGF-1 level was elevated: 578nM/L (range 12-
92nM/L)
 MRI
 Pituitary is enlarged
FURTHER DIAGNOSTICS
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http://sites.tufts.edu/progressnotes/category/clinical-
case-challenge/

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 Why was Harry hypoglycemic when in hospital?
HYPOGLYCEMIA?
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 Due to the pulsatile nature of GH secretion, cats may present with exogenous insulin
induced hypoglycemia
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 Owner did not want to pursue radiation therapy or surgery
 What are our options?
TREATMENT
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Insulin type Concentration Brand name (s) To shake or not to
shake
Duration of action
Insulin zinc
suspension (lente)
40U/ml Vetsulin/ Caninsulin Shake vigorously Intermediate
PZI 40U/ml Prozinc NO, roll between
palms
Long (~8h)
Glargine 100U/ml Lantus NO Long
Detemir 100U/ml Levemir NO Long
INSULIN CHOICES FOR HARRY
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 Reduce PZI dose and owner to measure glucose at home and give regular insulin if
BG is >270mg/dl
MEDICAL MANAGEMENT
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 Niessen et al. Hypersomatotropism, Acromegaly and Hyperadrenocorticism and Feline Diabetes Mellitus. 2013. Vet Clinics Small Anim. 43:319-
350
 Niessen et al. Feline acromegaly: an underdiagnosed endocrinopathy? Journal of Veterinary Internal Medicine. 2007. 21 (5): 899-905
 Elliot et al. Prevalence of pituitary tumors among diabetic cats with insulin resistance. J Am Vet Med Assoc. 2000. 216 (11): 1765-8
 Berg et al. Serum insulin-like growth factor-1 concentration in cats with diabetes mellitus and acromegaly. Journal of Veterinary Internal Medicine.
2007. 21(5): 892-898
 Niessen et al. Routine screening of diabetic cats for acromegaly: overdue or overkill? Journal of Veterinary Internal Medicine. 2011. 25: 1489-90
 Guyton and Hall. 2011. Textbook of Medical Physiology. Pituitary hormones and their control by the hypothalamus. 895-896. Canada: Elsevier
 Myers J et al. Echocardiographic Findings in 11 cats with Acromegaly. Journal of Veterinary Internal Medicine. 2014. 28: 1235-1238
 Greco, D. Feline Acromegaly. Topics in Copan An Med. 2012. 31-35
 Meij et al. Transsphenoidal hypophysectomy for treatment of pituitary dependent hyperadrenocorticism in 7 cats. Vet Surg. 2001. 30:72-86
 Blois SL et al. Cryophypophysectomy used in the treatment of a case of feline acromegaly. J Small Anim Pract. 2008. 49:596-600
 Lamb et al. Computed tomographic signs of acromegaly in 68 diabetic cats with hypersomatotropism. 2014. Journal of feline medicine and
surgery. 16 (2): 99-108
 Niessen S. Feline acromegaly: An essential differential diagnosis for the difficult diabetic. 2010. Journal of feline medicine and surgery.12: 15-23
REFERENCES
11/14/2017CE FALL 2017 | ACROMEGALY & HYPERSOMATOTROPISM IN CATS

68. WWW.UVSONLINE.COM
QUESTIONS?
11/14/2017CE FALL 2017 | ACROMEGALY & HYPERSOMATOTROPISM IN CATS