Research Communications of the 24th ECVIM-CA Congress

A six year old, de-sexed female British Shorthair cat presented with acute onset weakness and mental dullness. Upon initial presentation the cat was mildly hyperglycaemic (9.9 mmol/L; 3.3-6.7 mmol/L). Over the following 12 hours the cat developed central blindness, tremors, intermittent seizures and opisthotonus. Repeat blood sampling revealed a marked hypoglycaemia (0.8 mmol/L). An insulin level (performed on serum obtained while the cat was hypoglycaemic) was inappropriately elevated (10938 pmol/L; reference range 72 -583 pmol/L). An intravenous bolus of 5% glucose resulted in rapid resolution of all clinical signs and mild transient hyperglycaemia (12.5 mmol/L). Despite frequent feeding, the hypoglycaemia (2.0 mmol/L) recurred, so an intravenous glucose continuous rate infusion was commenced. An abdominal ultrasound was unremarkable, although three cranial mesenteric lymph nodes were noted to be prominent (3 mm in width). An exploratory laparotomy revealed a firm and erythematous left limb of the pancreas. The body and right limb of the pancreas appeared grossly normal. Following surgical resection of the left limb of the pancreas, the cat returned to a euglycaemic state after a brief rebound hyperglycaemia. Histopathology revealed pancreatic fibrosis with marked multifocal micronodular hyperplasia of exocrine and endocrine cells, mild lymphoplasmacytic inflammation and ductular ectasia. Synaptophysin immunohistochemistry confirmed nodular beta cell hyperplasia. Mild granulomatous lymphadenitis and hydropic change within hepatocytes was also noted. The cat recovered uneventfully without any further intervention. It gained weight and remained euglycaemic over the following six months.