What is Pandora syndrome?
Pandora syndrome is a condition that affects multiple organ systems, including the urinary tract. The term is often used synonymously with Feline Idiopathic Cystitis (FIC); however, FIC is only one component of Pandora syndrome (see handout “Feline Idiopathic Cystitis” for more information on this condition).
What causes Pandora syndrome?
Pandora syndrome is believed to be caused by chronic stimulation of the central stress response system (CSRS), also known as the hypothalamic-pituitary-adrenocortical axis – an area of the brain that responds to stressful situations.
For example, if an animal senses a threat (stressor), the CSRS releases hormones and other signals to prepare the animal to either fight or run away. These hormones increase the heart rate, increase blood sugar, and increase blood flow to the muscles – a normal stress response that is very effective in the short term. Once the animal is safe, their body systems return to normal.
If the stressor is chronic or occurs frequently, the CSRS can become overworked, causing problems in the endocrine system, the immune system, and the autonomic nervous system. These changes cause abnormal inflammatory responses in various organs, including the respiratory tract, gastrointestinal tract, urinary tract, and skin.
"Exposure to chronic stressors early in life may increase the likelihood that a cat will develop Pandora syndrome."
Exposure to chronic stressors early in life may increase the likelihood that a cat will develop Pandora syndrome. Examples of chronic stressors include abuse, chronic disease, malnutrition, and early separation of a kitten from their mother. Severe stressors can trigger the disease at any stage of life.
What are the clinical signs of Pandora syndrome?
Cats will show the urinary signs seen with FIC, including difficulty urinating, frequent urination, straining to urinate, and bloody urine. They will also show other signs of disease, including:
- chronic upper respiratory disease (sneezing, nasal and/or eye discharge)
- asthma (coughing, difficulty breathing)
- gastrointestinal disease (vomiting, diarrhea, regurgitation, hairballs)
- diabetes mellitus (increased drinking, urination, weight loss)
- hypertrophic cardiomyopathy (difficulty breathing, sudden death)
- skin disease (chin acne, overgrooming)
- anxiety (hiding, aggression, inappropriate urination or defecation)
- abnormal eating behaviors (overeating or picky eaters)
How is Pandora syndrome diagnosed?
Several criteria are used to diagnose Pandora syndrome.
- Affected cats tend to have flare-ups during or after a stressful event like a change in their routine or an illness.
- A thorough history may reveal signs of disease other than urinary disease, such as evidence of anxiety or conflict between pets in the home. It may also reveal early life stressors such as an unstable home life or being bottle-raised.
- Other causes of the cat’s clinical signs are ruled out by lab testing such as bloodwork and urinalysis.
- Affected cats have a positive response to treatment for Pandora syndrome.
How is Pandora syndrome treated?
No single treatment will help every patient. Treatment may include diet and medication; however, multimodal environmental modification (MEMO) appears to play the biggest role in reducing or eliminating clinical signs in most affected cats.
MEMO is designed to reduce stressors (or the perception of threats) as much as possible. This environmental modification includes providing cats with adequate space, safe areas to relax or hide, areas to climb and scratch, comfortable bedding in areas where they feel safe, protected locations to eat (away from other cats), and enrichment that includes social interaction with their owners, toys, and food puzzles.
Given the prevalence of urinary conditions in cats with Pandora syndrome, litter boxes are an important factor in stress reduction. Considerations include:
- box type (large, open)
- placement (quiet, private, accessible)
- number (one litter box per cat, plus one – in different locations)
- hygiene (scooped daily, washed weekly)
- litter type
Ohio State Veterinary College’s “Indoor Pet Initiative” and the Feline Veterinary Medical Association (FelineVMA) provide excellent detailed resources on how to reduce stressors for cats.
Depending on your cat’s urinalysis, your veterinarian may recommend a change in diet to one designed to reduce irritation in the bladder and/or increase water consumption. Your veterinarian may recommend a diet containing supplements believed to lower anxiety. Any transition should be slow to reduce stress. New diets should not be mixed with old diets, but instead, offered in different containers.
"Certain medications may be used to treat your cat’s specific clinical signs."
Certain medications may be used to treat your cat’s specific clinical signs. Follow your veterinarian’s recommendation for their use and ask for advice on how they can be given with as little stress as possible.
What is the prognosis?
Pandora syndrome cannot be cured; it must be managed throughout the cat’s life. Managing this condition can be frustrating, as clinical signs may still occur despite treatment, although with reduced intensity and frequency. With awareness and dedication from their owners, cats with Pandora syndrome can still live happy lives.
