A 3 year old female Bearded Dragon (Pogona vitticeps) presented at a veterinary practice in 2012. She lived with another 2 Bearded Dragons, of approximately the same age. Husbandry was close to optimal with provision of visible and ultraviolet spectrum lighting, temperatures within the preferred optimal temperature zone (POTZ), a varied diet of insects and vegetables and a sensible supplementation with calcium and multivitamins twice weekly.

She was presented due to a sudden onset of lethargy, wobbliness, "puffy eyes" and a head tilt. She had also regurgitated prior to the consult and the evening before. The in-contacts reptiles showed no signs.

On clinical examination she was very quiet and lethargic with a good body condition score and weighed 670g. She presented pink mucous membranes with the normal slightly yellow colour in the mouth (typical of the wild type bearded dragons), normal coelomic palpation with no masses palpable nor pain elicited, and no signs of respiratory distress. She had normal pedal responses on all four limbs and presented what seemed to be blepharoedema with no abnormalities detected in the globes. Her movements were very ataxic on all four limbs and the righting reflex was certainly decreased.

There was no history of possible contact with toxins and both in contacts were absolutely normal, eating and drinking normally, passing faeces and urates also as normal.

A full blood test, including biochemistry and haematology were run whilst the bearded dragon was hospitalised with antibiotic cover (Ceftazidime 20mg/kg; Fortum® 100mg/ml; Glaxosmithkline) and intracoelomic fluidtherapy. The most alarming abnormality on biochemistry was the elevated glucose and the laboratory recommended measuring this parameter again. There was slightly elevated total calcium. Otherwise the biochemistry was unremarkable. Haematology showed a mild linfopenia and a possible mild haemoconcentration. Glucose levels were repeated the following day and continued to be extremely high (around 30mmol/l).

Radiographic views (latero-lateral (LL) and dorso-ventral (DV)) were taken. There were no abnormalities observed, there was not a fluid line on the LL. Ultrasound was performed in which no abnormalities were noted (liver structure, gallbladder, gastrointestinal tract, fat pads, stomach were all normal).

Subsequent glucose readings were taken and the levels did not seem to decrease at all, remaining around 30mmol/l.

Presumptive somatostatinoma. Diabetes mellitus is considered extremely uncommon in this specie. Although this presumptive diagnosis seemed the most likely, other differentials were considered, including diabetes mellitus, hepatic and pancreatic neoplasia, viral causes.

Although we did have the option to run insulin assays and to perform a further work up including biopsies through endoscopy or exploratory laparotomy, these diagnostic tests were declined by the owner. Another option was to trial insulin, which has not been validated in reptiles, and therefore the response would be unpredictable but the owner declined also.  

She was hospitalised to perform the diagnostic tests were performed and whilst awaiting the blood results. 5ml Hartmann’s (Aquapharm 11; Animalcare Ltd) intracoelomic fluidtherapy was administered every 12h. She also received antibiotic cover (Ceftazidime 20mg/kg IM; Fortum® 100mg/ml; Glaxosmithkline) and also analgesia (Meloxicam 0.2mg/kg IM; Metacam® 5mg/ml; Boehringer Ingelheim)

Humane euthanasia was decided and the owner declined a post mortem examination. She was induced with Isofluorane (Isoflo®; Abbott Laboratories) and then 3ml Pentobarbitone was administered via the intracardiac route.