Octreotide as medical therapy of idiopatic chylothorax in 3 cats after surgery

Abstract

Idiopathic chylothorax is a rare disease that affects cats. Different therapeutic options, both surgical and medical, have been described without a clear standard protocol and positive outcome. The use of Octreotide in cats has been described previously (for the medical therapy of hyperinsulinemia in cats affected by insulinomas, gastrinomas, acromegaly and acute pancreatitis) but its usefulness as definitive treatment to cure chylothorax is unclear. This preliminary data describe the clinical features of three cats treated with Octreotide after a partial surgical resolution of idiopathic chylothorax. Three cats presenting a moderate amount of chylous effusion 1 week after surgical closure of thoracic duct with transdiaphragmatic approach were selected for our study. The Octreotide started 7 days after surgery at the dose of 20ug/kg/sc/tid (dose proposed in literature 10-20ug/kg/sc/tid for maximum 2-3 weeks). Standard clinical, radiographic and ultrasonographic evaluations were performed twice a month and together blood cell count, serum biochemistry, cytological, chemical-physical evaluation of thoracic effusion were performed at each control. Clinical, imaging and laboratory abnormalities were reported. The Octreotide administration was interrupted 1 month later by the end of the pleural collection and each patient was re-evaluated 1 year after surgery. Cat one: (DSH, 5 years old, neutered male) presented pleural effusion from day one to day 146 of therapy. Octreotide was interrupted at day 176. Cat two: (DSH, 6 years old, neutered male) presented pleural effusion from day one to day 143 of therapy. Octreotide was interrupted at day 173. Both cats were discharged without clinical symptoms and they were rechecked 6 months later without any clinical problems, except the diffuse pleural thickening observed at the ultrasonographic examination. Cat three: (DSH, 9 years old, neutered male) presented pleural effusion from day one to day 182 of octreotide therapy. At day 182 the cat was euthanised according to the owners due to respiratory insufficiency. Necropsy confirmed a severe constrictive pleuririts. In all the subjects thoracentesis were performed during controls if necessary. No adverse effects were observed even considering that this drug was used for 6 months therapy. In our experience on three cats the use of Octreotide turned out useful and safe as complementary therapy of the idiopathic chylothorax.