Message Number: FHL8593 | New FHL Archives Search
From: Sukie Crandall
Date: 2009-04-03 18:56:57 UTC
Subject: [ferrethealth] Okay this is weird
To: fhl <>

At this point we think that the lab mixed up Whizbang's adrenal with
someone else's specimen.

Is it possible that the lab did not goof, and that she had an
insulinoma that had spread to the R adrenal? I know they don't
usually spread, but if they did would they behave like this for Lupron
and the TN Panel? I was honestly expecting an adrenal teratoma
because despite being rare they do behave this way from the bit i
could find on them.

Yes, we are trying to find out if the lab goofed, and I have inquiries
in with a few people to see if this really could be a explanation for
the combination of things encountered.

Whizbang, age 6 years, had one strong adrenal symptom (seriously large
and infected vulva) which nothing else explained despite careful
checking for other causes, consistently negative TN adrenal panels, and
her responses to Lupron were always to worsen and she would worsen
more for larger doses. Ultrasound showed a large right adrenal (Left
had come out cleanly in the past with hyperplasia.)

In the past she had one small pancreatic node (insulinoma on
pathology) and to be safest a segment of her pancreas was removed at
that time. That was at the same time as the left adrenal.

We'd been trying to avoid surgery because last time she developed a
seroma and her tissue let go, requiring an emergency 3 a.m. repair
surgery. Surgery could not be avoided but special stitches and
staples were used and so far are working fine.

This time the right adrenal came out cleanly -- that's it -- and
although there were some enlarged nodes they were left in so that she
would spend less time open. They have been the same size for years --
since her last surgery and between on ultrasound. (I didn't know the
sizes were the same at the last surgery till now.)

So, basically she lost a large right adrenal and nothing else from
what we were told on the day of surgery. She always had a negative TN
adrenal panel and always worsened with Lupron, but the right adrenal
was large and she had a swollen vulva with an infection that could not
be controlled.

Though very rare I was expecting an adrenal teratoma since it sounds
like those can act that way though there are some other rare possible
fits, too, but is it possible that the lab is correct, that she had an
insulinoma in the right adrenal producing that symptom set?

At this point I am more inclined to think there is a lab error.

Anyway, we are trying to figure it out. Perhaps it is a lab error,
but maybe on the rare times that an insulinoma spreads to an adrenal
it could provide negative TN Panels and worsening symptoms with Lupron.

Anything that behaves that way is rare, so the questions become:
what is it that is behaving like that,
is it malignant or not,
and what sort of prognosis is expected given the tissue type found?

Hopefully, we will get an actual answer, and if it remains confusing
then arrange to have the tissue checked at someplace like Michigan
State, though at this point we are assuming the lab screwed up and
that her tissue may even be lost which would be upsetting.

(Yes, she is on Prednisolone and Fludrocort now, and we are working on
getting the right balance for her.)

Sukie (not a vet)

Recommended ferret health links:

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