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Ferret Adrenal Disease

By: Dr. Heidi Hoefer

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Diagnostic tests

  • There is no simple, single test to confirm adrenal disease and many cases are diagnosed based on symptoms alone. Diagnostic testing is important, however, to evaluate overall health of the ferret, to check for concurrent diseases, to determine if the tumor is growing, and to see if the adrenal condition has led to other complications like anemia.

  • Abdominal ultrasound (sonogram) is a relatively simple and safe test to evaluate the size of the adrenal glands and test for prostate enlargement. The image provided by the sonogram allows measurement of the adrenal glands to determine which gland is affected. Changes in the texture of the gland are sometimes good indicators of the possibility of malignancy, as can monitoring the glands over time for changes in size. It is important to know if the left or right gland is diseased, as surgery is more complicated if the right gland is involved. The normal adrenal gland in the ferret is about the size and shape of a lentil bean. Radiographs (X-ray's) are not as helpful because they cannot give detail on such small structures. The sonogram also allows evaluation of all the other abdominal organs which lets us know if there are other complications.

  • Complete blood count (CBC) and platelet count are essential to evaluate the activity of the bone marrow. The hormones produced by the tumor can suppress the production of blood cells from the bone marrow. This results in low red blood cells (anemia) and low platelet counts. Because platelets are essential for clotting in the body, ferrets with low counts develop bruises easily and are at a much higher risk of uncontrolled hemorrhaging. This is especially a concern if the ferret is to undergo surgical removal of the adrenal tumor. These individuals may require a blood transfusion before or after surgery. This test is very important, especially if the ferret has had symptoms for some time. Fortunately, bone marrow problems are not that common in ferrets with Adrenal Disease.

  • Most veterinarians will also run a plasma chemistry panel to assess overall health of the ferret. Many ferrets with Adrenal Disease also have other common diseases, such as insulinoma. Testing is especially recommended if the ferret will undergo surgery.

  • Plasma hormone testing can be performed to definitively diagnose the disease. However, this test does not differentiate which gland is affected (right or left), or indicate if the gland is malignant. In ferret showing the typical symptoms, the diagnosis is often based on ultrasound and/or symptoms alone.

    Therapy

    Because this condition is a hormone-producing tumor of the adrenal gland, the only definitive treatment is removal of the tumor or "adrenalectomy". In most cases, only one adrenal gland is abnormal. Both can be affected, however, so it is important that each gland is examined carefully during surgery. The right adrenal gland is adhered to the vena cava, the largest vein in the abdomen. Right adrenal tumors can actually wrap around this vein or grow into it making surgical removal very tricky on this side. An accomplished surgeon is recommended for this procedure. The left adrenal gland is easier to approach and remove.

    Medical therapy is used to block the actions of the adrenal hormones without actually affecting the tumor. While this type of therapy may reverse the symptoms of adrenal disease, it is does not stop the growth tumor. Therefore, if medical therapy is chosen, the gland should still be monitored for evidence of growth. Fortunately, most ferrets with Adrenal Disease have benign disease, and medical therapy alone is adequate. Medical treatment alone may also recommended for ferrets unable to withstand surgery because of age or other medical problems (heart disease, e.g.).

  • Surgical removal of the affected adrenal gland(s) is the only definitive treatment for this condition. Once the tumor is removed, the ferret should be considered "cured".

  • In some cases of bilateral adrenalectomy (removal of both adrenals) hormone supplements have to be given to make up for the total lack of adrenal function. Prednisone (Pediapred®) replaces the cortisol made by the adrenal gland and florinef helps with electrolyte maintenance.

  • Medical therapy to counteract the effects of excess hormone production is often very effective, especially in ferrets with benign disease. The most widely used of these drugs is Deslorelin (Suprelorin-F®). This is an implant that is injected under the skin, and typically lasts 8-12 months. A similar drug is leuprolide (Lupron®), an injection that has to be given every 1 to 4 months. These drug block the effects of excess hormone production. After administration, a swollen vulva will typically look normal within a week, hair will grow back within 6 weeks, and male ferrets will become less aggressive. The effect of these drugs on prostatic enlargement varies. A third treatment is a melatonin implant (Ferretonin®), which can also be effective for up to 3 months, especially in allowing regrowth of hair. None of these treatments, however, have any effect on the growth of the adrenal tumor, so monitoring for tumor growth is important if medical therapy is selected. Discuss these options carefully with your veterinarian.

  • Emergency therapy sometimes must be given to ferrets with urinary tract obstruction. Relieving the urinary obstruction ("unblocking") a ferret can be very difficult, due to the small size of the urethra. A small sterile tube is passed into the urethra, past the prostate, and into the bladder where the urine is then removed. Urinary catheterization is a temporary procedure necessary to save the ferret's life. Treatment of the underlying Adrenal Disease is also necessary to allow the prostate tissue to shrink so that the ferret can urinate.




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