From:
Bruce Williams, DVM
Date: 2001-06-15 22:11:00 UTC
Subject: Re: Removal of Adrenal Glands
--- In Ferret-Health-list@y..., cjbandit@a... wrote:
> Hi,
> Dr. Williams I have a ferret Bandit (whom I wrote to you in the
past about)-
> He is 5 years old and had both adrenal removed a year in a 1/2
ago. One
> adrenal was surgically removed and the other was frozen with
cryosurgery.
>
> I was told by the dr. who performed the surgery as long as I had
Bandits
> electrolytes checked regularly (sodium & potassium levels in
particular) and
> they we're in normal limits he would not need hormone
replacements.
That is essentially true, although you should also keep a close eye
on activity, appetite etc., which tends to go out the window before
you see marked electrolyte abnormalities.
Well,
> Bandit never has needed them and seemed fine up until he got ECE
from my new
> kit-it's been about 3 months post ECE and his stools are still bad
and he
> urinates frequently and he leaves urine on his belly (something
somewhat
> new). As you suggested I had a urinalysis done and the results
were
> negative. The Doctor said there was no blood in the urine and the
pH level
> was normal and the concentration was what it should be. He said
there was
> some protein in the urine but that was normal.
That is all correct.
>Bandit's been loosing hair on his tail and back paws and I can
> actually see little hairs fall off of him. It really looks as if
it's a
> seasonal shed-it's not shedding anywhere else and his coat is soft
and shiny.
> This vet agrees. But these are soon of the reasons I took him to
the vet.
I would not be soquick to ascribe it to a season shed, especially
when the hair loss is on the back feet, and he is having urinary
abnormalities...
> Question: What else do I need to ask him in terms of the results of
the
> urinalysis? What other types of things do you look for??
At this point, I would consider the possibility of recurrent adrenal
disease. I am not saying rush him back to surgery, but several of
these symptoms do fit. A UT panel is certainly one possibility here.
> He said a culture wasn't necessary.
I agree - with no obvious inflammation, bacterial cystitis does fade
from view in terms of ruleouts.
>
> Question: This Dr. seems to believe that maybe Bandit has Addison's
Disease
> since he doesn't have any adrenals. He also said that to check he
would need
> to take at least 3cc's of blood to check his cortisol levels and he
would
> have put him out for that, which he really doesn't want to do.
I don't think that assessing cortisol levels will identify Addison's
disease. It appears that this assessment is simply being made on one
feature of the clinical hsitroy, and is not supported by clinical
data or symptoms.
Bandit had
> bloodwork done about a month ago and everything came back
normal....This vet
> suggests I call the vet that did the operation and ask him exactly
what he
> did during the surgery. He also explained to me that when I had
Bandit's
> adrenals removed I should have had ran a pathology on the adrenals
to see if
> they we're cancerous. He could not believe that the vet who did
the
> operation wouldn't insist on this because Bandit could have
cancerous adrenal
> tumor left over-since he's not needing hormone replacements.
I have to agree. Gross inspection of enlarged adrenals is useless as
a replacement for pathology - some malignancies are not even large
enough to cause the gland to enlarge, and some benign tumors may
approach a centimeter in size. Metastasis is so rare with adrenal
tumors that it is of little benefit to use metastasis as criteria for
malignancy or not.
There is certainly a possibilty of incomplete removal and regrowth of
a malignant tumor, and it is something that I think we should be
strongly considering - not Addisons.
With kindest regards,
Bruce H. Williams, DVM, DACVP
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