Pituitary Tumor & Use of LDN

Hello vets! Thank you for your time and answering questions. My kitty Kyo (Key-oh), age 13y 8m, has been diagnosed with a large (0.75" x 0.5" x 0.76") pituitary tumor (likely non-acromegaly - his IGF-1 was 3 points above normal). We have him on steroids and finished 3 rounds of SRT  on Thursday, August 11, 2023. He is doing much better so far (rarely pacing or yowling, sight seems improved, less zoning out, eating better again though still not purring). The only thing out of control is his diabetes due to steroids with numbers spiking in the low 300's and dropping to 60 (using Libre 2 sensor).  His internal specialist recently switched him from 1.5 iu of Prozinc 2x day to 3 units of Tuojeo once per day but even on Tuojeo his numbers are all over the place including dropping to 60 last night 3.5 hours after dosing him.  However, he's only been on the Tuojeo since Tuesday, August 22.  His internist is supposed to look at his graphs today and go over next steps and hopefully we'll be making some adjustments. However, my biggest question on this is that someone (non-vet) in another group mentioned Low-Dose Naltrexone (LDN) as an option to treat the tumor but Kyo's radiologist oncologist hasn't heard of that for this. I'm wondering if this woukd be something worth trying and if so, which of his vets should I talk to about it - regular vet, neurologist, internist? Here's a picture of the boy after his treatment finished in the graduation bandana the team signed and put on him.

Hello and thanks for your question- that's a very handsome chappy and a sensitively worded query, which shows me that you already understand that specialists are experts who know the case, so are ahead of me in their understanding of it.  It does sound extremely complex; at my level (think: GP, like the vetty version of your local doctor), I wouldn't advocate giving steroids to a diabetic.  However, in this case there are multiple diseases going on at once and they are trying to balance the benefits regarding one condition against disadvantages regarding another.  Treating multiple conditions is complex and requires a thorough knowledge; as these are experts, so I might assume that they have collaboratively decided that the benefit of the steroid outweighs the disavantage regarding the diabetes control, at this time. The treatment of the tumour may be, as your first port of call, the oncologist's speciality.  Perhaps if I were to double-check, then maybe I would approach the internal medic.  Do some internal medics know more than some oncologists about the treatment of some particular member of a particular species?  Of course it's possible. However, I would expect all three people to be discussing the case together and therefore working from the same page.  So it should be absolutely fine to speak to the one you feel most comfortable in approaching, and for them to help you to explain where the case is up to. Do you have any evidence to support what you heard?  Its worth mentioning to them where you heard about it, so that they can check the source if need be.  'Why not?' Is also a valid question.  'There isn't enough science supporting this yet' or 'We're absolutely sure that it wouldn't work because-' may be two different valid answers.

Another valid answer is, 'I'll check that for you,' because medicine changes fast, new ideas are had all the time and double checking your preconceived ideas is an important part of science.