Evenhuis Janny, Epstein Steven E, Della-Maggiore Ann, Reagan Krystle L
William R Pritchard Veterinary Medical Teaching Hospital, University of California Davis, Davis, CA, USA.
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA.
JFMS Open Rep. 2021 Feb 27;7(1):2055116921990294. doi: 10.1177/2055116921990294. eCollection 2021 Jan-Jun.
A 9-month-old intact female domestic mediumhair cat presented with a 5-month history of obtundation, lethargy, hypernatremia (181 mmol/l; reference interval [RI] 151-158 mmol/l), hyperchloremia (142 mmol/l; RI 117-126 mmol/l), azotemia (blood urea nitrogen 51 mg/dl; RI 18-33 mg/dl), creatinine 3.0 mg/dl (RI 1.1-2.2 mg/dl), hyperphosphatemia (8.3 mg/dl; RI 3.2-6.3 mg/dl) and total hypercalcemia (11.4 mg/dl; RI 9-10.9 mg/dl), with concurrent polyuria with adipsia. Neurologic evaluation revealed proprioceptive deficits, and this finding paired with a history of focal seizure-like activity despite improving sodium concentrations suggested a cerebrothalamic lesion. For this reason, and historical and biochemical findings consistent with adipsic diabetes insipidus (DI), MRI of the brain was performed, which revealed a lesion of the hypophyseal fossa consistent with a pituitary cyst. Given the patient's age and the timeline of clinical signs, a congenital pituitary cyst was strongly suspected. The patient was managed initially with intravenous fluids to correct the hypernatremia, then managed for more than 4 years with topical ocular desmopressin acetate administration and free water administered through a feeding tube. This cat's clinical diagnosis included a congenital pituitary cyst with subsequent central DI and primary adipsia.
The clinical presentations of primary adipsia or central DI are both rare in cats. This is the first report to describe these conditions occurring in a cat owing to a congenital pituitary cyst and describes successful long-term management of this condition.
一只9个月大未绝育的雌性家猫，表现出5个月的意识模糊、嗜睡、高钠血症（181 mmol/L；参考区间[RI] 151 - 158 mmol/L）、高氯血症（142 mmol/L；RI 117 - 126 mmol/L）、氮质血症（血尿素氮51 mg/dl；RI 18 - 33 mg/dl）、肌酐3.0 mg/dl（RI 1.1 - 2.2 mg/dl）、高磷血症（8.3 mg/dl；RI 3.2 - 6.3 mg/dl）以及总血钙过高（11.4 mg/dl；RI 9 - 10.9 mg/dl），同时伴有烦渴性多尿。神经学评估显示本体感觉缺陷，尽管血钠浓度有所改善，但这一发现与局灶性癫痫样活动史相结合提示存在丘脑病变。鉴于此，以及与渴感减退性尿崩症（DI）相符的病史和生化检查结果，对脑部进行了磁共振成像（MRI）检查，结果显示垂体窝有一个与垂体囊肿相符的病变。考虑到患者的年龄和临床症状出现的时间线，强烈怀疑为先天性垂体囊肿。该患者最初通过静脉输液纠正高钠血症，随后4年多来一直通过局部应用醋酸去氨加压素滴眼液以及经饲管给予自由水进行治疗。这只猫的临床诊断包括先天性垂体囊肿继发中枢性尿崩症和原发性渴感减退。
原发性渴感减退或中枢性尿崩症在猫中均较为罕见。这是首例描述因先天性垂体囊肿导致这些病症发生在猫身上并成功进行长期治疗的报告。
