From:
Sukie Crandall
Date: 2010-06-08 22:22:32 UTC
Subject: [ferrethealth] Re: Does anyone have access to this article?
To: fhl <ferrethealth@yahoogroups.com>
Notes from the article with a few short quotes while most is in my own=20
words (though I am not sure how much of this also holds for these=20
conditions in ferrets):
Normally, hypoglycemia (low blood sugar) would cause first a decline=20
in insulin secretions and a rise in some other compounds=20
(counterregulatory hormones) that would result in an increase of sugar=20
in the blood: glucagon, epinephren, and norepinephrine, then=20
cortisol. From page 544 in the top paragraph on the third column they=20
write:
"In fact, insulin-
induced hypoglycemia is considered the
gold standard test for the diagnosis of
adrenal insuf=EF=AC=81ciency (AI)."
I think that what they are saying is that insulin that is ADDED -- not=20
produced by the body -- and does not result in the counterregulatory=20
hormone increases illustrates that the body is incapable of producing=20
those hormones and therefore there must be adrenal insufficiency.
That would mean that adrenal insufficiency combined with insulinoma (a=20
combination that one of our ferrets has, though the order of onset is=20
different for him) would be a big double whammy if i understand this=20
correctly. The hormonal responses appear so basic to higher life=20
forms that I suspect they are the same for ferrets as for us humans. =
It may also explain why some ferrets can have slowly worsening=20
insulinoma over a long period of time or hidden insulinoma if the=20
adrenals provide enough counterregulatory hormones at least for a while.
(The human needed surgery for a pancreatic carcinoma, afterward moving=20
into long-term but temporary hyperglycemia, high blood sugar, for=20
which he took insulin, and later his adrenal glands got past their=20
insufficiency on their own once long enough past the hypoglycemia, low=20
blood sugar, which began the medical intervention.)
They begin their general discussion with:
"In this paper, we report a patient with
a malignant insulinoma who was inciden-
tally found to have AI, which resolved
after resection of the tumor and resolu-
tion of his hypoglycemia. This =EF=AC=81nding is
very relevant because our patient, as most
insulinoma patients do, underwent tumor
resection and major surgery in the setting
of AI that can be potentially fatal if this
diagnosis is overlooked and if the patient
is not given stress doses of glucocorticoids
perioperatively."
Having this occur appears to be extremely rare, but if it has not yet=20
been done, it may be interesting to try to find out if many ferrets=20
ever have their adrenal glands become less productive perhaps in=20
response to the stress of producing large amounts of counterregulatory=20
hormones or maybe because the glucose swings that happen are no longer=20
large enough to garner appropriate responses when insulinoma has=20
existed for a while. At least keeping the possibility in mind might=20
help some ferrets. This may also explain why our ferret with both=20
problems needs about double the dose of Fludrocort that he needed=20
before insulinoma to not be woozy (Yes, his symptoms for AI are=20
similar to his symptoms for insulinoma early on.), and why the=20
Percorten that he instead used during a bad spell of diarrhea seemed=20
to last only about 2 and 1/2 weeks.
They also wrote:
"Several hypotheses have to be put forth
to explain this association. One is that AI
in patients with insulinoma is caused by
exhaustion of the counterregulatory mech-
anisms, whereby repetitive hypoglycemia
leads to lowering of the glucose level
threshold for which these hormones are
released. Another possibility is that the au-
tonomic nervous system is activated only
when hypoglycemia is induced acutely;
this is not the case in insulin producing
tumors because they develop slowly and
induce hypoglycemia over time."
http://www.ncbi.nlm.nih.gov/pubmed/20418760
> 1. Pancreas. 2010 May;39(4):544-6. Association between insulinoma
> and adrenal insufficiency: a case report and review of the
> literature. Tang HY, Garcia JM. PMID: 20418760 [PubMed - in process]
Sukie (not a vet)
Recommended ferret health links:
http://pets.groups.yahoo.com/group/ferrethealth/
http://ferrethealth.org/archive/
http://www.afip.org/ferrets/index.html
http://www.miamiferret.org/
http://www.ferrethealth.msu.edu/
http://www.ferretcongress.org/
http://www.trifl.org/index.shtml
http://homepage.mac.com/sukie/sukiesferretlinks.html
all ferret topics:
http://listserv.ferretmailinglist.org/archives/ferret-search.html
"All hail the procrastinators for they shall rule the world tomorrow."
(2010, Steve Crandall)
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