Vacuolar Hepatopathy in Cats

Glycogen issues are more common in older cats who have adrenal gland problems, or who are taking steroid medication. Lipid over storage is found more in kittens or young cats. Vacuolar hepatopathy is a rare condition in cats, but should be treated by a veterinarian as the issue can be completely resolved.

Vacuolar hepatopathy is a reversible condition that occurs when the small cavities in liver cells accumulate too much glycogen (the stored form of glucose) or, in rare cases, lipids (fats or oils). This usually follows another primary liver disorder. Because it is often paired with another condition, it would be wise to monitor any cat currently experiencing liver disorders to gauge if vacuolar hepatopathy is also present.

As this is a disorder of the liver, most symptoms are common to other liver problems. If your cat is experiencing any of these liver related symptoms, veterinary care is advised. Symptoms include:

• Enlarged adrenal glands
• Enlarged liver
• Liver failure
• Lethargy
• Panting
• Polyuria (frequent urination)
• Polydipsia (increased thirst)
• Polyphagia (increased food intake)
• Abdominal distention 
• Bruising
• Hair loss

Most cases of vacuolar hepatopathy are related to issues with the cat's storage process of carbohydrates within the liver. These are often caused by medication but can also be genetic. All known possible causes are as follows:

• Steroid medication overuse
• Overproduction of steroids within the body due to genetic predisposition
• Hypothyroidism (not enough hormone production)
• Atypical Adrenal Hyperplasia (a genetic metabolic disorder affecting the development of sex organs)
• Hyperadrenocorticism (overproduction of cortisol) 
• Diabetes
• Dental disease
• Pancreatitis
• Cancer
• Inflammatory Bowel Disease 
• Chronic infections
• Juvenile Hepatic Lipidosis (fatty liver disease)

It is important to note that lipid vacuolar hepatopathy origins are often unknown.

Despite the matching symptoms of other liver disease, vacuolar hepatopathy, if suspected, can be easily diagnosed by running a few different tests.  Your veterinarian will want a full medical history on your cat.

Sampling of the liver may be needed for evaluation, but in some instances a less invasive option is available. FNA (fine needle aspiration) or an ultrasound-guided Tru-Cut biopsy are both safer options that may collect enough information to make a correct diagnosis. It must be noted that these tests can miss infiltrated lesions. A general anesthetic is needed for a full biopsy, while a sedative is needed for the less invasive options.

Your vet may choose to run a blood test for ALP (alkaline phosphatase) to see if the enzyme level is too high. They may also run tests to see if sex hormones are increased in the cat. A cortisol test may be run if the cat suffers from hyperadrenocorticism. If the issue is lipid based, tests can be run to monitor fat levels. If chronic infection is the underlying issue, bacterial culture tests will be run.

Treatments will vary greatly depending on the underlying cause of the vacuolar hepatopathy. If the underlying condition is treatable, the issue can be rectified.

Diet Change 

In cases of glycogen accumulation, calories can be heavily restricted to alleviate the condition. In lipid cases, restrictions of fat may be applied.

Surgery 

If adrenal or pituitary gland masses are present, surgery may be required for removal. Pituitary gland surgery is very high risk so radiation may be suggested to treat these types of masses instead.

Medications 

Many liver and endocrine disorders can be treated with various medications. These include melatonin, Trilostane, Lysodren, Ketoconazole, immunosuppressive drugs (such as chemotherapy) or anti-inflammatory drugs. Duration of time needed on medication varies depending on underlying condition.

Antibiotics 

To treat chronic infections or dental disease, antibiotics may be prescribed. The type needed will depend on the identity of the bacteria present. General time needed on antibiotics ranges from 2-4 weeks.

Hormone Treatments 

Various hormones may be supplemented in cases where the body is deficient at producing them. Treatment of this nature may be ongoing. 

While the condition of vacuolar hepatopathy itself is reversible, often treatments of the underlying causes have a long duration. Many tests may be needed periodically to determine the state of the liver or gland issues. If an enlarged liver was the original cause of the issue, physical exams, X-rays and bloodwork will be needed to evaluate size and enzyme levels. If the issue had to do with adrenal glands, an ACTH (adrenocorticotropic hormone) stimulation test may be needed to see if the glands are working properly.  If cancer was the cause, tests and ultrasounds will be needed to see if is in remission. Steroid use should be limited and dosages lessened.

If your cat has undergone surgery, keep it comfortable and limit activity in the recovery period. If any infections develop or if the cat’s condition deteriorates, immediately bring it to a veterinary clinic or animal hospital. While the underlying problems may need constant watch, the symptoms should decrease or stop completely if proper treatment is applied.