adrenal insulinomia

What can be done for my two female ferrets they both are adrenal and one is insulinomia as well , I would like to know if there is a method with out having to use drugs , it tears their lil tummies up

[Arnold L Goldman, D.V.M.]

Hi,

I.  Treatment options for ferret insulinomas can be medical, surgical, or both.

Medical therapy is designed to reduce low blood sugar episodes and will have no effect on tumor growth at all. Medical therapy alone results in the shortest "disease-free interval" and the shortest survival times. Corticosteroids inhibit glucose uptake at target cells and increase gluconse levels. Ferrets rarely show any adverse effects with their usage.

Diazoxide (Proglycem®) is usually added to prednisone therapy when patients become refractory. Diazoxide inhibits insulin release promotes elevated blood sugar, and decreases cellular use of glucose. Unlike corticosteroids, side effects such as vomiting and not eating can occur. Due to the side effects and the cost of the medication, Proglycem® therapy is best reserved for only the hard to control cases and the most involved owners. Not eating in an insulinoma patient can be fatal, so owners need to be vigilant in monitoring their pet's appetite when diazoxide is administered.

The third tier of medical therapy is use of Octreotide (Sandostatin) in weekly injections. It suppresses normal insulin secretion. This therapy has not received common usage in ferrets and in the few anecdotal reports, it has produced equivocal results.

Nutritional therapy is important regardless of the primary therapeutic regimen. Balanced ferret diets are high in protein and fat and low in fiber and digestible carbohydrates. Ferrets with insulinomas should NOT get treats with high carbohydrate content (e.g. raisins, corn syrup, hairball laxatives, or Nutrical®) unless they are in need of emergency blood sugar stabilization for a crisis. Most commercially available ferret treats contain significant amounts of carbohydrates. Insulinoma patients should receive high quality ferret foods that meet their carnivorous needs effectively without causing any carbohydrate related problems. Treats may be best limited to raw or lightly cooked organ meat like liver or raw meat. The occasional frozen mouse is a great treat. Fatty acid supplements are acceptable treats/supplements as well. Also  ferrets usually set their taste preferences by 4 months of age and can be resistant to dietary changes after that age.

Surgical therapy is designed to gain a definitive diagnosis while removing as much insulinoma tissue as possible. Surgical therapy carries a longer disease-free interval and survival than medical therapy alone.

After surgery, it is advisable to monitor the patient for 24 hours for low blood sugar and other post-operative problems. Unsupervised overnight recovery is not appropriate, because hypoglycemic crises can occur. If the patient is stable and active and eating, sending them home with a dedicated owner is acceptable as long as the owner is able to call someone for emergency care if needed.


II.  Adrenal gland disease in ferrets is treated by at least 1 of the 4 options below:

1.  Surgical therapy

2.  Medical therapy

3.  Benign neglect

4.  Euthanasia

The choice of therapy must be individualized to the specific ferret and owner. Surgical therapy can be curative but has significant associated expense and risk. Medical therapy has minimal risks but can be expensive and treatment failures and transient success followed by resurgent disease are common.

In cases of chronic disease, bone marrow suppression, profound anemia and urinary obstruction, if the owner is not able to afford or does not want to pursue aggressive therapy, euthanasia is a viable option.

In cases where hair loss is the only clinical sign and the quality of life is unaffected, benign neglect is a viable option. This is an easier choice in the female versus the male, since urinary obstruction is rare in the female.

Ultimately the choice of therapy should be based on a number of factors including:

Age of the ferret

Type of clinical sign(s) present

Sex of the ferret

Presence or absence of other conditions

Which adrenal gland appears to be affected (or both)

The number and type of prior abdominal surgical procedures

The experience and comfort level of the surgeon

The availability of proper equipment and supplies

The owner's desire for a cure

The owner's willingness and ability to invest financially and emotionally in medical or surgical therapy

The owner's willingness to risk intra-operative complications

The owner's willingness to risk post-operative complications

The discussion of each option is too complex for this venue. Do see a veterinarian that works with ferrets for guidance for your animals.

Good luck!

Dr G