Page 5 - Clinical Connections - Summer 2022

Advancements

TEN YEARS OF HYPOPHYSECTOMY AT THE
RVC

Joe Fenn, Senior Lecturer in Veterinary Neurology and Neurosurgery
T he UK’s first successful feline decade ago, commented: "I am immensely advantage over radiation therapy. Medical
management of cats with acromegaly and
was
proud of my team at the RVC and the
hypophysectomy
surgery
performed at the RVC in April 2012,
and can be extremely challenging for owners
extremely gratifying, not only in seeing the
to treat a cat with acromegaly and diabetes programme we have set up. It has been diabetes mellitus is typically cost prohibitive
mellitus. Since then, the RVC team has marked benefits to our patients and their to maintain effectively.
treated 120 cats and 25 dogs with pituitary families, but also to know we have been at
tumours, providing treatment for pets and the forefront of a paradigm shift in how these
owners for which there have traditionally common and debilitating conditions are
been limited options. treated in our pets."
Over the past decade, collaboration Over the six years since Patrick left the
between skilled neurosurgeons, critical RVC, we have developed a great deal
care, internal medicine and anaesthesia of experience with the technique and
specialists has enabled RVC Small Animal have seen a range of challenging cases.
Referrals to deliver hypophysectomy Hypophysectomy is most frequently
treatment regularly and remain a global performed at the RVC in patients suffering
leader in this area. from acromegaly and pituitary-dependent
Cushing’s syndrome, caused by hormone-
producing pituitary tumours.

Acromegaly and diabetes mellitus in cats Rusty, an acromegaly patient treated in 2019
Although it is a technically challenging,
surgical hypophysectomy is now considered The team at the RVC has also recently
the optimal treatment option for feline successfully performed hypophysectomy for
acromegaly. Over the past 10 years of the first time to treat a rare case of a dog with
performing the procedure, the team at the acromegaly, marking another landmark in
RVC have placed great emphasis on using the use of this procedure in pets.
their experience to maximise patient safety
Hypophysectomy surgery and outcome, with the mortality rate falling Pituitary-dependent Cushing’s syndrome
from around 15% initially to 6% for the past Hypophysectomy is also an excellent
Transsphenoidal hypophysectomy 50 cats treated. treatment option for pituitary-dependent
involves the removal of a tumour affecting In cats with acromegaly and diabetes Cushing’s syndrome, most often seen in
the pituitary gland from the base of the mellitus, hypophysectomy is associated dogs with pituitary tumours. Dogs typically
brain through the soft palate in the mouth. with a 70% rate of surviving cats achieving recover very quickly post-operatively and are
Access to this area of the brain is technically complete diabetic remission post-operatively, often discharged within five days. Resolution
difficult and the team at the RVC is helped by with significant improvements in insulin of the clinical signs of Cushing’s is typically
cutting-edge diagnostic imaging and surgical responsiveness seen in the vast majority of dramatic and dogs demonstrate an excellent
equipment, such as the Brainsight neuro- the other 30% of patients. Cats typically stay quality of life post-operatively. Although
navigation system head frame. at the Queen Mother Hospital for Animals for less frequently encountered, the team has
This approach was pioneered at the RVC a week to 10 days post-operatively while the also treated a handful of cats with pituitary-
in 2012 by Neurology and Neurosurgery team stabilises their diabetes mellitus. dependent Cushing’s syndrome.
specialist, Patrick Kenny, who when Hypophysectomy only involves one Although other options are available for
reflecting on this achievement starting a general anaesthetic procedure, providing an treatment of pituitary dependent Cushing’s
syndrome, including life-long trilostane
therapy and radiotherapy, hypophysectomy
confers advantages over these options,
including the removal of the growing tumour
and potential for complete cessation of
hormone production. Whilst radiation therapy
results in a reduction of tumour size and
associated neurological signs, improvements
in hormone production remain very variable.

For small animal referrals, please call:
01707 666399
Email:
Pituitary dependent Cushings syndrome caused by a tumour was resolved by hypophysectomy qmhreception@rvc.ac.uk

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