From:
Bruce Williams, DVM
Date: 2001-03-18 21:31:00 UTC
Subject: RE: Intermittent adrenal disease
Dear Cathy:
> About 10 months after the obstruction her
> vulva swelled up and she lost almost all of her hair. She
has a small firm
> nodule on the top of her head that does not seem to bother
her except
> when I try to touch it.
>
> Her vulva has shrunk back to normal, she has a full coat but
now is
> suffering extreme weight loss. She falls over easily,
stares into space,
> mouth tics or twitching, won't eat, grinds teeth and has
diarrhea. Vet
> confirmed insulinoma with blood sugars consistantly 40-41.
She was
> diagnosed with clostridial diarrhea. She has been started
on pred.,
> amoxicillin, carafate and Hills AD diet. Trying to buff her
up for
> surgery. I thin the AD just a little with water and feed
her 6 times a
> day. She usually takes 5tsp per feeding followed by much
teeth grinding
> but no emesis. Stools are looking more normal but a little
soft. She gets
> the carafate b.i.d., amoxi. t.i.d., and pred. b.i.d. all for
three days now.
OK -
The adrenal is fairly easy - we occasionally see cases (I have
one in the house now) where there is a functional lesion in
the adrenal which is secreting estrogen, enough to cause
follicular atrophy which is recoverable during the hormonal
stimulation of the seasonal cycle. The effects of adrenal
disease vary based on how much estrogen is secreted, and how
long it is secreted for. Ferrets who recover from the
cosmetic effects of adrenal disease but recover will likely
during the next seasonal cycle not recover, as the neoplasm
will continue to grow and therefore secrete more estrogen, and
the secretion of estrogen has had longer to cause its effects.
Chances are, the hair loss will occur again, as will the
vulvar swelling, and this time surgery will probably be
needed.
The insulinoma, trances, twitching, etc is classic insulinoma,
and you seem to be on top of that.
The tooth grinding, weight loss, diarrhea, etc., is somewhat
of concern. My first thought in these cases is that of
gastric ulcers - ulcers commonly accompany systemic disease as
a result of stress - the insulinoma is enough to cause one.
Or, with the history of intestinal blockage, that would be a
likely ruleout here. Or even coronavirus infection (ECE) - or
a combination of several of these. But you mention Clostridial
diarrhea - a disease that is very uncommon in ferrets (if it
occurs). Although I don't know how this diagnosis was
reached, it is somewhat suspect (especially if based on a
fecal exam showing robust bacilli (which are omnipresent in
ferret stools and not indicative of intestinal contents.)
> I also am concerned about the nausea. Is that normal with
> insulinoma or is it part of the enteritis? Obstruction? How
long should I
> wait for surgery to give her the best chance?
Insulinoma does not result in vomiting - it is very likely to
be the result of the GI problem. It is very difficult to give
specific advice on this case, without knowing more about lab
work, etc., but I generally recommend not waiting too long if
an obstruction is in the realm of possibility. this is
something that you need to talk with your vet about - it will
be a thorough abdominal exploratory - with the possibility of
pancreatectomy, adrenalectomy, and possibility of gastrotomy
or enterotomy. The nodule on top of the head is likely a
small skin tumor, and may wait for another day.
With kindest regards,
Bruce H. Williams, DVM, DACVP
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