Message Number: YG2807 | New FHL Archives Search
Date: 2001-04-21 07:45:00 UTC
Subject: Re: Follow up Mackenzie's insulinoma surgery

--- In Ferret-Health-list@y..., "Bruce Williams, DVM" <williams@e...>
> --- In Ferret-Health-list@y..., macdoodle99@y... wrote:
> > Hi, I thought I would just post a quick note to follow up on my
> > ferret Mackenzie's insulinoma surgery. The path came back as
> > metastatic islet cell carcinoma. Someone recently posted about
> their
> > ferret also having this and apparently it is rare, but here is
> > another one. In this case, actually the "pancreatic mass" turned
> out
> > to be hyperplasia--so not the original tumor. But the liver
> > and the mass on the intestines was the metastatic carcinoma.
> > Regardless of whether the original tumor was removed or not, the
> > prognosis I believe is the same since my vet could not excise the
> two
> > metastatic lesions, but debulked them.
> >
> > Mackenzie had a normal exam and lab work including glucose about
> > weeks prior to symptoms. 4 weeks after symptoms started she
> > underwent surgery and had the three tumors and lots of other bad
> > stuff. This definitely is a very aggressive carcinoma.
> >
> > She continues to grind her teeth. Which I now feel is unrelated
> > hypoglycemia as her blood sugars have remained in the 100's
> (although
> > falling). I believe it is abdominal pain. Which would mean that
> she
> > may never have even been symptomatic from her blood sugars in the
> > 4o's. Her only symptoms really were anorexia and teeth grinding,
> > which persist despite normal blood sugars.
> >
> Once again, I'm going o be a cynic about the pathologic diagnosis.
> You say that the pancreatic lesion was not an islet cell neoplasm,
> but hyperplasia, and that MacKenzie has no evidence of
> hyperglycemia.
> Your description of the widespread tumors does indicate a
> which may be an adenocarcinoma of some other origin.
> This may seem like a small issue, but when we try to get prognostic
> information on various neoplasms, such as the extremely rare
> metastatic islet cell tumor, we need to be extremely sure that the
> diagnosis is valid.
> > And now that leaves me just trying to figure out how miserable is
> > she? And when do I end her suffering? Aside from the teeth
> grinding
> > and weakness just after surgery, she is eating and is so healthy
> > appearing. Unlike my other pets who were old and fragile and
> clearly
> > declining when I euthanized them, Mackenzie is a picture of good
> > health. It is so difficult and heart breaking.
> >
> Have you treated her for a gastric ulcer - this is not uncommon
> surgery and can easily explain the teeth grinding....
> With kindest regards,
> Bruce H. Williams, DVM, DACVP
> Join the Ferret Health List at

Dear Dr. Williams,

Regarding the comment about hyperglycemia: Well, her blood sugar
after surgery was 143 and then 130 the following day and then 100 the
next day. I don't know whether you consider that hyperglycemic or
not, but this was a ferret who had a blood sugar of 46 on diagnosis
and was started on pediapred with a subsequent blood sugar of 47.
One week later, after empirically boosting the pediapred to 1.5 cc
three times a day, her blood sugar was 49, at which point she went to
surgery for refractory hypoglcemia.

Regarding the ulcers: This time she presented with anorexia and
teeth grinding. She had gastric ulcers 5 years prior at age 2 with
all the classic sign: anorexia, lip smacking, teeth grinding, and
black tarry stools. She couldn't even drink water without it causing
teeth grinding. She lost half her body weight. She required SQ
fluids for a while. She was treated with a 6 week course of amox and
flagyl and with carafate for about a year (because shortly after
stopping the carafate the teeth grinding would return, although
within about a week of starting treatment with the 3 meds all
symptoms disappeared.) So when she presented this time, we
empirically started carafate (didn't think we would need to treat for
the helicobacter again.) After two weeks, no effect. That's when we
pursued other diagnoses and came up with insulinoma. But throughout
this whole thing, she has been on the carafate, actually at higher
doses than she was treated with when she did have ulcers. She also
did get a full course of amoxicillin for a possible oral ulcer.

As for the hyperplasia in the pancreatic mass: I think my vet thinks
he did not find the primary tumor. I believe that the primary
tumor's size does not always indicate probability of metastasis but
it does seem a bit odd that the mets would be so much bigger than the
primary. Also, we did no imaging prior to the surgery, so my vet
operated based on what he could see and feel.

Regarding comment on prognosis: Her symptoms have never responded to
treatment. Given her refractory hypoglycemia before surgery, and the
rapidity with which this thing has progressed over 4 weeks when she
was normal two months ago, I really feel this seems to be consistent
with a metastatic islet cell carcinoma. I think her symptoms reflect
abdominal pain due to the tumors (but I don't know because I seem to
get a wide variety of opinions on her teeth grinding and what it
means in this case). I feel her elevated blood sugars now are due to
decreased tumor burden after debulking them in surgery with a
resultant decrease in insulin production. And I expect that this
tumor will grow back very quickly and that we will shortly be seeing
low blood sugars again. I read your post in response to another
person whose ferret was diagnosed with metastatic islet cell
carcinoma. You imply a tumor that grows and spreads rapidly. I
think Mackenzie's case is very consistent with that.

However, if it would benefit you and anyone else on this list, I can
probably get you the pathology slides or the actual report.

Thank you very much for your response.