From:
Bruce Williams, DVM
Date: 2001-03-13 17:30:00 UTC
Subject: Re: advice from USA vets please
--- In Ferret-Health-list@y..., Alison Skipper <skipper@b...> wrote:
> This is a request for advice from colleagues in the US. As most of
you
> will know, we hardly ever see adrenal disease in ferrets in the UK,
and
> so even those of us who are interested in ferrets have no practical
> experience of it. My colleague has seen (as a referral) a spayed
female
> ferret, aged about 4, which has been imported from the US. This
ferret
> was referred because of a mass in her neck, which the referring vet
(who
> is a very good vet generally) biopsied: she was confident that the
mass
> was a lymph node, but the histology report described it as adipose
> tissue.
> Apparently the ferret is polydipsic and polyuric, and lethargic.
She
> has a mildly enlarged vulva and marked bilaterally symmetrical
> alopecia. My colleague felt that her abdomen felt "wrong" - too
many
> enlarged things - but without experience of neoplastic ferret
abdomens
> he wasn't certain what he was feeling.
> He took blood. Since we use SI units, I won't quote the figures
one by
> one, but the haematology was normal except for a low lymphocyte
count;
> in the biochemistry, glucose was not checked (I don't know why -
maybe
> it clotted in the tube), urea was a little low, creatinine, albumin,
> globulins, ALT, ALP, potassium, calcium, CK, LDH and triglycerides
were
> all normal, GGT was high. The lab does a lot of exotics work.
> We are fairly sure that the ferret must have adrenal disease; the
> question is what we do about it, and what else she may have. I
have met
> neither ferret nor owner. The owner must love the ferret as she
will
> have paid upwards of $2000 to import her to the UK, having gone
through
> quarantine, but is now reluctant to undergo any further
intervention (eg
> radiography/ultrasound/further biopsy) or treatment. We are
reluctant
> to carry out an adrenalectomy when neither of us has seen or done
one
> before, the owner doesn't want us to anyway, and there are perhaps
other
> concomitant problems. I haven't yet established if we can get
Lupron in
> the UK. Rumour has it that ferret steroid hormone panels can be
> obtained, but I get the impression that some US vets think they
don't
> add all that much to the diagnosis.
> We would be very grateful for suggestions as to how we should handle
> this one. How confident can we be of the diagnosis on the evidence
so
> far, and what sort of prognosis can we suggest if treatment is
> impractical or refused?
American bloodline with swollen vulva and bilateral alopecia - sounds
vey good for adrenal, and in most cases, that would be enough to go
to surgery. The polydipsia and polyuria may be a red herring here,
but that glucose would sure be helpful. MOst adrenal cases are
estrogen only, and cortisol elevations are rarely seen.
If it helps to bring the ferret to the surgery table, you can suggest
going right to the surgery table at this time. I firmly believe in
the Univ. of Tennessee panel for borderline cases, but this doesn't
sound like one, so I'd be comfortable in going right to surgery.
Usually, enlarged adrenals, unless they are right-sided malignancies
don't usually jump out at you on palpation. A swollen spleen is the
most likely thing to cause the abdomen to feel stuffed. However, if
the owner does not want surgery or treatment, there is not much you
can do. Without knowing whatis going on in there, it is really
difficult to prognose the case. A hyperplastic adrenal may drag on
for years, but a malignancy may cause lights out in a couple of
months. However, you can certainly say that if ignoring the problem
does not directly result in demise of the animal, that it will
greatly impact on the quality of life.
The fatty mass in the neck in the area of the lymph node, is not
uncommon in my experience in both adrenal ferrets, and older ferrets -
they tend to put lots of fat around the lymph nodes for some reason,
and this mildly supports the adrenal theory.
It sounds like you may have one shot at either diagnosis and
treatment, if that, in this case. My suggestion is to combine them -
do a laparotomy and adrenalectomy. Surgery in the hands of a new
ferret surgeon is better than medical treatment, or no treatment, any
day!
With kindest regards,
Bruce H. Williams, DVM, DACVP
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