From:
Bruce Williams, DVM
Date: 2001-03-08 21:32:00 UTC
Subject: Re: adrenal disease/insulinoma
--- In Ferret-Health-list@y..., Sheila Sykes <lobodelrio2000@y...>
wrote:
> Hello all,
>
> Follwoing are some very specific questions about
> Lupron and their dosages. I am hoping some vets on
> this listserve will be able to help. It is fairly
> urgent in nature.
>
> We just returned from our vet and talked to
> Professional Arts Pharmacy in the U.S. about getting
> Lupron. We would like to order Lupron within the next
> days or so for our 7 year old male ferret who has
> adrenal disease and insulinoma (being treated with
> Prednisone since April 2000) and a large abdominal
> tumor of unknown source (for the last 6 months). Our
> ferret can not be operated on at this time because of
> his poor condition. We live in Germany where adrenal
> disease in ferrets is virtually not known about. Our
> vet knows nothing of Lupron, but will administer it in
> the way that is suggested by our internet sources
> (which are primarily postings from Dr. Weiss). We
> will choose a one-month depot to start with. Dr.
> Weiss is suggesting that 500/mcg for the one-month
> depot is the most effective dose he has found so far.
> He states in a posting under Ferret health care titled
> "Lupron Demystified": "There are lower dosages
> recommended by some. Although I have not used lower
> dosages, I have heard of approximately 20 cases and
> seen several for a second opinion, where lower dosages
> did not reverse the symptoms". Besides for of Dr.
> Weiss's info and 2 other examples (one of which was
> yours Mike), recently received by the net, we have no
> other information on the effectiveness or use of lower
> dosages. Can any one else (esp. vets) supply us with
> more information on this? We feel much safer with
> lower dosages, but it seems they might not always be
> effective.
>
> It seems, from internet posting alone, that there are
> no significant side effects of Lupron when used for
> ferrets (although many-a frightening amount-are listed
> when it is used for humans-which make us worry). Does
> any one know more about Lupron side-effects? Can a
> ferret have major abdominal surgery (in our case to
> remove his large tumor-that is if he improves
> significantly on Lupron) while being on Lupron? Would
> surgery be more dangerous while a ferret is on Lupron
> (combined with prednisone-he now gets 3.12mg/day and
> weighs 1.5kg)?
>
Dear Sheila:
Honestly, I think the approach here is not appropriate if your intent
is to remove that tumor and give the ferret a shot at a cure.
Your ferret has definite adrenal disease and a large tumor in the
abdomen. In such cases, probably 90% of these large tumors are
adrenal tumors, and the larger the tumor, the more likely it is a
malignancy. With the concomitant insulinoma and a moderate daily
dose of prednisone, each day makes him less of a surgical candidate.
Lupron will not shrink the tumor, and it will continue to grow.
While Lupron may help the clinical signs - the animals will be less
lethargic and may even grow their hair back. But that tumor
continues to grow. If it is adrenal, it may metastasize or rupture.
If it is something else, well, who knows? Lupron in this situation is
a cosmetic stopgap measure.
To answer your question, Lupron will work at the lower dosage - the
higher depot dosage is more cost-effective in the long run, but that
requires a ferret to live for months to years on Lupron. Lupron will
not adversely affect the surgery.
But honestly, unless you are willing to concede this ferret to that
large tumor, Lupron is not the way to go - it is a cosmetic fix, and
likely that this ferret may not survive long enough to enjoy its
benefits.
My advice - give the ferret a shot at a cure - do the surgery. This
ferret is not yet a bad risk - no diagnosed heart disease, no
diagnosed kidney disease, and I am assuming regulated hypoglycemia.
And while you are in there, if the tumor is resectable, you can also
go hunting for insulinomas.
You may also want to discuss the possibility of vena caval ligation
with your vet, in case of a right-sided adrenal malignancy with
vascular invasion.
With kindest regards,
Bruce H. Williams, DVM, DACVP
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