Feline Hypersomatotropism – more common than we realise?

This month Nathalie Dowgray, Head of ISFM, talks with Vicky Halls from iCatCare about her work focusing on unowned cats and the new developments in the Cat Friendly Homing program. Later in the episode, Dr Chris Scudder is invited to discuss hypersomatotropism-induced diabetes in cats as part of our JFMS clinical spotlight series.

Vicky talks us through the work she has been leading on unowned cats over the past few years and they discuss the exciting Global Enablers Grant received from Battersea which will aid in the expansion of this program. Vicky's role as Head of Unowned Cats not only involves carrying the Cat Friendly Homing model forward, but also includes developing training courses, consulting about cat population management, and
resource creation.

Hypersomatotropism is becoming increasingly recognised as a comorbidity in cases of feline diabetes. Nathalie and Chris delve into the clinical signs, testing procedures, and management of this condition in feline patients.

For further reading material please visit:

https://icatcare.org/unowned-cats/

https://journals.sagepub.com/doi/epub/10.1177/1098612X241226690

For ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org


Host:
Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK

Speakers:
Vicky Halls, RVN Dip Couns, Head Of Unowned Cats for International Cat Care and published author

Chris Scudder, BVSc MVetMed PhD DACVIM-SAIM DECVIM-CA MRCVS, Senior Lecturer, Researcher and Mentor Liason at SAMSoc, JFMS Published Author

Creators & Guests

Host

Nathalie Dowgray

What is Chattering With ISFM?

Welcome to Chattering With ISFM, the official monthly podcast of the International Society of Feline Medicine, hosted by Nathalie Dowgray (Head of ISFM). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to ISFM members at portal.icatcare.org. If you would like access to our full episodes, would like to become an ISFM member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Nathalie Dowgray: Hello, welcome to the
February episode of Chattering with ISFM.

I'm Nathalie Dowgray, Head of ISFM
and host of this month's podcast.

First up this month, I'm going to be
speaking with iCatCare's own Vicky

Halls about her work in unowned cats
and also some exciting news about

the cat friendly homing program.

We're also featuring our monthly
JFMS Clinical Spotlight interview.

And this month, we're
focusing on hyposomatotropism

induced diabetes in cats.

I'm going to be speaking with Dr.

Chris Scudder about this
comorbidity that might be a bit

more common than we realize.

So, to start with Vicky, I wondered if
you'd introduce yourself and explain your

role at International Cat Care because a
lot of our veterinary audience will know

you as Vicky Hall's feline behaviourist.

But they won't necessarily know
about the work that you've been

doing with International Cat Care.

Vicky Halls: My relationship with
International Cat Care goes back

to the Feline Advisory Bureau days,

it was a conversation between
myself and Claire Bessant, who

at the time was our cchief exec.

I said to her, do you know, I've been
to a few homing centres and shelters.

And I'm so sad to see some
cats have been there for years.

How can that be?

If we could start from scratch about
how we care for unowned cats, and

we allowed the cat to come into the
conversation, what would it look like?

And then we realized that there was
a way to do things that was more

strategic and more efficient, use
resources more efficiently, put

cats front and centre of everything.

This is no critique of the tens of
thousands of people all over the

world that are working in shelters.

Their passion, their devotion, their
hard work is absolutely extraordinary.

But when we started to look at
how this model was developing, we

realized we can support you with a
way of working that will take what

you're doing from good to even better
with regards to your productivity.

That traditional model of
rescue reactive is painful.

It's psychologically difficult.

It leads to burnout.

But this new way of working
allows things to work in a

more strategic, proactive way.

The great thing about that is that
the cats benefit, but the people who

are working in the sector benefit too.

So we developed these ideas.

Key players have contributed
their incredible skills and

understanding of the sector.

So it's like all this wonderful
knowledge, all coming together.

So this was going on for years with me
as a sort of consultant, working with

various other people in the project.

And then in 2019, there was an opportunity
for me to start the new phase of my

career, to close my behaviour practice
and actually become an employee for the

first time in a few decades, and actually
to work with International Cat Care.

So I consider that to be
a huge joy and privilege.

So here I am, four and a half
years later, an employee still.

And my title is Head of Unowned
Cats, which means that I continue

to develop the cat friendly homing
model, develop training courses,

coaching courses, the website content,
resources, that kind of thing.

And also expanding beyond the homing
centre side of things and looking at

cat population management in general.

And that's very much a sort of global
thing, talking to people around

the world who do this wonderfully
and understanding what good and

effective looks like and trying to
pass on good practice information.

Nathalie Dowgray: We had some
exciting news coming into the

charity at the end of last year.

So I was wondering if you'd be happy to
tell us about the Battersea grant that

we've been lucky enough to receive.

And what the next three years with that
grant is really going to hold for us

as a charity, but specifically for your
work in the cat friendly homing program?

Vicky Halls: I couldn't be more excited.

We've had a long standing collaborative
relationship with Battersea over the

years, and we had the opportunity to
apply for a grant last year and we

were awarded that grant as part of
Battersea's Global Enabler program.

And that grant is for three years
work and we're calling the program

Lucy the Cat Friendly Homing Program.

And it gives us the opportunity to
take all our collective learning and go

forward over the next three years with
more people and more resources to spread

the cat friendly homing internationally,
to develop more courses, more training

opportunities, both online and face to
face, resources, events where we can

involve people who maybe aren't aware of
what we've been doing or even who we are

as an organization in some countries.

So this is really exciting for us.

It's like a massive acceleration of
our work, as a result of this grant.

Over the next three years, we're
actually targeting the UK, Portugal,

Greece, Cyprus, and Australia.

This doesn't mean the other countries
won't matter for the next three

years, you know, all our resources
are available to all countries.

But targeting five specific countries
enables us to do that deep dive to

find out what the issues are within
the country, what the challenges are,

and bring this all together to see if
we can create this suite of resources

and frameworks and training that will
have the widest relevance possible.

That's what we're trying to do.

Cat friendly homing is not an algorithm.

It's very much a way of thinking and a way
of working that has these core principles

as the foundations of everything.

This sector is full of people who
are incredibly resourceful, devoted

and passionate to their work.

And we want to reach out to
those people and get them excited

about the idea of evolution.

Because evolution, if you see it through
the lens of change, it feels daunting.

But if you see it through the
lens that we experience it, where

every time we learn something new,
we get hugely excited about it.

It's a lovely thing.

We're always looking for ways of
showing our love towards cats.

I think a really good way of showing
our love is, for our own evolution,

find out as much as we can so that
we know we can meet their needs.

What an exciting thing!

Nathalie Dowgray: Where
can we direct people?

Where can people find more information?

Vicky Halls: Well it's all there
on our website, we have a section

if they go to icatcare.org and
to Unowned Cat and they'll see

that's a tab on top of our website.

If they click on that, they'll see
a whole series of resources talking

about cat friendly homing model, humane
cat population management, loads of

resources from different organizations.

We also have a sign up for a newsletter.

We have a bi monthly newsletter that has
interviews, videos, articles, all sorts

of things every couple of months for those
people who really want to get a sense

of what's happening across the world.

And we encourage people
to get in touch with us.

My email is on the website.

If there's something you need with regards
to the care for unowned cats that's not

on there, let me know and I will make a
point of getting it on there if I can.

Nathalie Dowgray: Brilliant.

Now, that's a good point because
we're always open to creating new

appropriate resources for people.

As Vicky said, if you're interested in
following more, sign up to the newsletter.

Thank you for your time today, Vicky.

And now I'm speaking with Dr.

Chris Scudder on hypersomatotropism
induced diabetes in cats.

This is part of our JFMS
feline comorbidities series.

Thank you for your time today Chris.

I wanted to ask you why we now use the
term hyposomatotropism and not acromegaly

in cats, perhaps the way we used to?

Chris Scudder: You might see it
as a slight terminology quirk.

It stems from what each of the
different terms trying to describe,

acro meaning height or large and megaly
meaning, also large, so large height.

So it's almost a phenotypic
description of the condition.

People in human medicine initially
get recognized as having the

condition and they have demonstrable
phenotypic changes, which then results

in additional testings to try and
understand how that's come about.

In cats, what we've learned over time is
either cats do not have those demonstrable

phenotypic changes, or we're just less
akin to being able to identify them.

So there was some data published in
one study, which asked referring vets

if they thought that the cat that
they were testing had a suspicion for

excessive growth hormone of which only
a quarter of which had a suspicion.

When the three quarters had the
condition, but the phenotypic changes

weren't there to alert the veterinarian.

Hyposomatotropism is describing the
condition of excessive growth hormone.

And maybe that is the more common
presentation in terms of we're not

phenotypically identifying it, but we are
identifying the growth hormone change.

So it might be a better descriptor.

So that's why we're leaning more
to using that nowadays, although

I do fully appreciate it's
definitely more of a mouthful.

Nathalie Dowgray: Definitely, for
future questions, I'm going to say

HST rather than hypersomatotropism.

What sort of testing protocol
do you recommend if we've got

a newly diagnosed diabetic case
and we're concerned about HST?

Chris Scudder: The standard blood test of
choice is measuring IGF-1 or insulin like

growth factor 1 and there's a few reasons
why that's the diagnostic test of choice.

One being its half life is much
longer than that of growth hormone,

so its concentrations in the
circulation are a bit more stable

than that of growth hormone.

It's also stable after the sample
has been drawn, so it doesn't

need any special handling.

Two, it does seem to correlate
okay in patients that have

increased growth hormones.

And so if you have an increased
IGF-1, then your confidence that

that patient truly has excessive
growth hormone is reasonably high.

So again, its reliability is pretty good.

When are we measuring IGF-1?

I think that's going to in part be
dependent on clinical suspicion.

So you can measure IGF-1 even before
you start endogenous insulin, but then

their IGF - will increase after they
receive exogenous insulin and then they

may breach that threshold of increased
suspicion or underlying HST as the cause.

So you can definitely test them before
you even start exogenous insulin,

the downside is you may miss a few.

So if you are going to wait, then
the time to wait at the moment

seems to be about eight weeks will
be a reliable time point to wait.

While I think it's entirely reasonable
to see how patients do and to test

those that are doing things slightly
atypical with their diabetic response,

if you only test those that have
an atypical response to exogenous

insulins, I do think you'll miss some.

Not all of them are wacky diabetics
to control and some of them seem

to respond very beautifully to
routine doses and strategies of

diabetic management and insulins.

So if you've got an owner who's very
unlikely to ever want additional

treatments, then I think not
investigating and just managing that

diabetes, even if they're relatively
routine and never knowing if they

had underlying HST is acceptable.

But if you've got an owner who
may consider pursuing additional

investigations, additional more
targeted treatments, then I think

even if you do have a relatively
easy to control diabetic, I do think

there is merit in testing those.

Nathalie Dowgray: Brilliant.

One of the final questions I did just
want to ask about medical management,

obviously it suppresses the hormones,
but does it also have an impact

on the size of the pituitary mass,
or does the mass continue to grow?

Chris Scudder: That's something that we
looked at when we did the pasireotide

study in cats, pasireotide and other
treatments in the same family, like

octreotide, can successfully reducethe
pituitary tumour size of people with

acromegaly, and we're hoping whether or
not we would see the same effect in cats.

We didn't actually see much of a
change of size, and there was actually

one or two cats that went on to have
progressive pituitary enlargement

while receiving the medication as well.

In the feline HST setting,
then, pasireotide doesn't seem

to be shrinking the pituitary.

In terms of cabergoline, I'm not
aware of any data looking into that.

My understanding from human medicine
is it doesn't do too much for

growth hormone producing tumours.

There are other types of pituitary
tumours like prolactin producing tumours,

which are responsive to cabergoline
by reducing their pituitary size.

I don't believe the same happens with
the growth hormone producing tumours.

In cats, their pituitary
is either unchanged or they

continue to enlarge over time.

Nathalie Dowgray: So potentially,
with some of the longer term cases,

we may just need to keep an eye
out for any neurological changes?

Chris Scudder: Absolutely.

Nathalie Dowgray: What would your
top tips to those of us in practice

where we potentially suspect
HST as inducing the diabetes?

Chris Scudder: Most owners have
enough on their plate to try and

initially manage the diabetes
before considering too much else.

I would have a conversation with owners
after 2 or 3 months saying, now we're

getting on top of the diabetes or we're
not, there are other conditions which

can contribute or cause diabetes in cats.

One of which we can easily test for.

And at that time point, I would
suggest doing the IGF-1 testing.

And if that owner wanted to go
into the realms of learning about

additional treatment options,
I would discuss that with them.

And that may include wanting
to know the pituitary size.

So, if they're extremely polyphagic,
or they are ones with phenotypic

suspicion, then you might want to
do additional investigations to try

and determine whether or not that
IGF 1 truly represents HST or not.

If they didn't have those characteristics,
it would be reasonable to retest at a

later time point and see what that does
over time, probably another 3 months.

If they are borderline again, yyou
might entertain the idea of considering

pituitary imaging if the owners wanted
to know if that cat had HST, because

they might do something pituitary
specific on the back of that information.

That would be my general approach.

Nathalie Dowgray: No, brilliant.

That's really helpful.

And thank you so much for
your time today, Chris.

I think I've learned a lot, both reading
your article and talking with you as well.

Thank you for listening.

If you're an ISFM member, don't forget
you can access the full version of

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member benefits, including congress

recordings, monthly webinars, the
clinical club, the discussion forum, and

much, much more at portal.icatcare.org.

If you're looking for more
free CPD from ISFM in March, we

have two open access webinars.

The first is from Purina on 'How
to manage the CKD patient with

comorbidities.' And the second is from
IDEXX on 'Feline gunky-eyetis, when to

swab and when to test.' We'll be back
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