Exocrine pancreatic insufficiency (EPI) is a maldigestion syndrome caused by insufficient synthesis and secretion of pancreatic enzymes. This enzyme deficiency leads to the clinical signs of EPI, such as passing of fatty, undigested feces, increased appetite, and a poor haircoat.2,3 The diagnostic test of choice for EPI in domestic cats is the feline serum trypsin-like immunoreactivity (fTLI). An fTLI of <8 µg/L is diagnostic for EPI.1 This case series describes four captive tigers (Panthera tigris) from a sanctuary that presented with clinical signs consistent with EPI. Traditional diagnostic tests did not identify an alternate differential diagnosis. Serum fTLI for the diseased tigers were 0.5, 1.2, 1, and 0.9 µg/L (median 0.95 µg/L). Serum from 10 clinically healthy tigers from the same facility were also analyzed to establish some reference values for fTLI, along with serum folate and cobalamin concentrations. Mean fTLI in the healthy tigers was 3.1 µg/L (range 1.9–4.5 µg/L). A Wilcoxon-rank test revealed diseased tigers had significantly lower serum fTLI concentrations than healthy tigers (p=0.0058). Serum folate was significantly greater in the diseased tigers compared to the healthy tigers (p=0.0058). Serum cobalamin concentrations were below the level of detection (<150 ng/L) in all tigers, both diseased and healthy. All four diseased tigers had improved fecal quality and gained weight with pancreatic enzyme supplementation (PancreaTabs Plus, Henry Schein, Lexington, KY, USA; 8 tablets PO per feeding). These cases demonstrate that tigers with clinical signs consistent with EPI and a decreased serum fTLI concentration may have a good clinical response to pancreatic enzyme therapy.
The authors thank the Texas A&M Gastrointestinal Laboratory, Debbie Chaffins, Mary Lynn Haven, and the dedicated staff of Tiger Haven for their assistance in this project.
1. Steiner JM. Exocrine pancreatic insufficiency. In: Cote E, ed. Clinical Veterinary Advisor. 3rd ed. St. Louis, MO: Elsevier; 2015:338–339.
2. Thompson KA, Parnell NK, Hohenhaus AE, Moore GE, Rondeau MP. Feline exocrine pancreatic insufficiency: 16 cases (1992–2007). J Feline Med Surg. 2009;11:935–940.
3. Xenoulis PG, Zoran DL, Fosgate GT, Suchodolski JS, Steiner JM. Feline exocrine pancreatic insufficiency: a retrospective study of 150 cases. J Vet Intern Med. 2016:30;1790–1797.