Pouncer is a 15 year old m/n DSH who I scanned last spring (met check) prior to a cutaneous mast cell tumor removal.  At that time, his spleen was prominent and he had an odd, enlarged, nodular looking pancreas.  FNA of the spleen and pancreas at that point were normal.  He presented a few weeks ago for hematuria, and his owner noted that he had developed a crazy voracious appetite and apparently has joint pain.   Bloodwork including T4 is all within normal limits.  He appears normal otherwise, a pretty good sized guy but normal body weight despite his appetite.

Scan this time – spleen still borderline enlarged, kidneys are above normal in size, adrenals are bilaterally enlarged, pancreas is even bigger but still hypoechoic with the nodular appearance.  Urinary bladder is normal.  At this point, a couple of differentials were Cushing’s vs acromegaly (he is not diabetic but it’s still on the list).  Acromegaly cats can have enlarged kidneys, enlarged adrenals, arthropathy, no skin or haircoat changes, and larger males are over represented, so he met a number of criteria (should have looked at his heart, they can have cardiomegaly as well!).  I had them send off an IGF-1 test and it came back extremely elevated, consistent with acromegaly.  Last I heard the owners are going to consult with an oncologist. 

First case of acromegaly I’ve found via ultrasound!