Hepatocutaneous Syndrome in Cats

Other names for this condition include superficial necrolytic dermatitis (SND), necrolytic migratory erythema (NME), and glucagonoma syndrome. It is more commonly found in dogs than it is in cats.

When a cat develops hepatocutaneous syndrome, it has developed a lesion on its liver. This condition is chronic and usually progresses to the cat’s eventual death. This syndrome is rare, developing as the result of diabetes, neuroendocrine or pancreatic tumors, and a degenerative, vacuolar hepatopathy (VH) that on its own is also fatal. Hepatocutaneous syndrome can also develop secondary to endogenous steroidogenic hormone release or after chronic phenobarbital therapy. This condition makes itself visible with crusting and ulcer-like lesions on the cat’s ears, footpads, around its eyes, and on any limb pressure points. Once the skin lesions are visible, the liver lesions have already developed.

Cats will present with several symptoms as this disease develops:

• Crusting and ulcerative lesions on several areas of the cat’s body
• Thickened footpads
• Difficulty walking from the thickened footpads
• Odorous lesions 
• Weight loss
• Loss of interest in food
• Lethargy
• Mild anemia
• Depression
• Physical weakness
• Urinates excessively
• Excessive appetite (seen more in cats with Cushing’s Disease or diabetes)
• Excessive thirst

Causes of hepatocutaneous syndrome can include:

• Abnormality in liver or pancreas (such as a tumor)
• Endocrine disorders (Cushing’s disease, diabetes mellitus, hypothyroidism)
• Metabolic changes
• Phenobarbital
• Abnormally low plasma amino acid concentrations (glutamine, proline, alanine, threonine, arginine and citrulline)
• Development of hyperglucagonemia after development of a glucagon-secreting tumor of the pancreas

After carrying out a full physical, vets run several diagnostic tests, such as an ultrasound, so they can look for nodules on the liver (these will take on a “swiss cheese” pattern). X-rays are also helpful in diagnosing this syndrome. 

Blood work is also ordered, allowing the vet to look for high blood sugar, lowered plasma amino acid concentrations and higher-than-normal TSBA concentrations. Serum profiles are studied, allowing the vet to find elevated liver enzymes, high cholesterol, high triglycerides and high serum glucose. They may also find a normocytic normochromic anemia, a form of anemia characterized by red blood cells that appear to be of average size, with normal hemoglobin content. This condition is betrayed by a reduced delivery of oxygen to the cat’s body tissues. It’s a symptom of several illnesses, rather than an illness of its own.

The vet requests a urinalysis for the cat, looking for diabetes, ketonuria (excessive ketones in the urine) and proteinuria (excessive proteins in the cat’s urine).

When the vet diagnoses hepatocutaneous syndrome in the cat, they will begin working to correct deficiencies in the cat’s amino acids. Second on the vet’s list is to provide care and relief for the lesions and VH. While corticosteroids are normally prescribed for the treatment of skin issues, in this syndrome, they should not be prescribed, because of their tendency to make the cat’s condition worse.

The cat will receive intravenous amino acids. The cat can receive up to four cycles of this treatment before they lose their effectiveness.  A diet with high levels of protein will also be prescribed for the cat. Egg yolks, which are high in proteins, may benefit the cat.

If the hepatocutaneous syndrome develops as a result of diabetes, it’s vital to control the symptoms of diabetes. However, if the cat has developed insulin resistance, it may suggest that counter-regulatory hormones such as glucagon and glucocorticoids have become involved in this illness.

If the cat has either fungal or bacterial infections, the vet prescribes anti-fungal and antibiotic medications to treat these conditions.

The skin lesions can also be treated with water-soluble vitamins, essential fatty acid supplements, niacinamide, and zinc methionine. The cat may also be given ursodeoxycholic acid twice a day in its food, along with antioxidants such as SAMe and vitamin E. The thickened and painful footpads can be treated with foot soaks and topical creams to soften the skin. Topical anti-yeast sprays to treat any secondary yeast infections in the skin can also be helpful.

Hepatocutaneous syndrome in cats will worsen over time and ultimately be fatal. Because so many conditions and substances can affect the liver, causing the development of this syndrome, the vet has to play detective, finding out exactly what is making the cat sick. Even corticosteroids being given for another condition can make the cat sick, making it necessary to stop giving the cat this medicine.

In the end, the vet and cat owner will work together to help the cat feel healthier, making it comfortable and improving its quality of life. If neoplasia (the development of a new, abnormal tissue growth) develops, then the cat’s true prognosis becomes even more guarded. 

While the cat is at home, the pet owner should do everything they can to make it comfortable, providing tasty foods high in protein and giving the cat sufficient water, companionship, and love.