Other factors include conditions of people keeping them as pets rather than as a working animal. In the past, ferrets wouldn't be neutered or speyed, and although it is recommeded that these proceedures are carried out, from my reading more recent research (2007) suggests that early neutering (before full adulthood ie. before 2 years old) and genetics are the main contributing factor to the development of adrenal disease. There has been recent scientific studies in the US that support this, but as yet, there is no clear evidence as to why this disease is on the increase or to other contributing factors. There is also some anecdotal evidence to suggest that artificial light outside the normal day/nightime cycle may be a contributing factor to developing adrenal.
The links below provide further reading on suggestions/research/background information as why Adrenal disease occurs along with symptoms and treatments.
Diagnosis/Blood Testing
Blood tests and a review of the ferrets medical history should be carried out as there are other medical conditions that can look like adrenal disease such as retained uterine tissue from an incomplete spay.
Blood tests are accurately tested by the University of Tennessee panel in the US which also accepts UK blood samples. Samples can also be sent to a UK lab for test but do ask for estradiol, androstenedione and 17-hydroxyprogesterone levels to be checked.
My experience in 2005 with Labs in the UK, even after requests from the vet to look for the above hormones, they may only look for 17-hydroxyprogesterone levels because they are looking for only Cushing's disease (even after explanations from the vet that in general ferrets suffer from Hyperadrenal disease and not Cushings disease). Please make sure your vet/lab realizes this. The UK test does test for 3 hormones but one of them is different to the Tennessee panel. Also blood counts to diagnose Adrenal in ferrets is different than results for dogs and cats.
The US blood test is sent off to:
The University of Tennessee to Dr. Jack Oliver, Clinical Endocrinologist, Adrenal Panel to joliver@utk.edu. If you contact this person they can give you the details.
This is one UK blood testing lab that samples can be sent to:
Greendale
Of 2007, they charge £57+VAT to test for adrenal and insulinoma
In 2005, I was charged £111 for blood test in the UK (London & Home Counties) for test £111 (Feb 2005) and waited 7 - 10 working days for results. However, the test came back inconclusive as the lab did not test for the full range of hormones!
However, from my experience, I would say that if your ferret is showing very typical signs of adrenal disease to skip the tests and just operate. These tests are not always right, but other than opening up the ferret they are the best method of diagnosis we have at the moment. Perhaps if more and more people are requesting these big three hormones tested for ferrets the UK labs will realise their serious mistakes.
X-rays and ultrasound may not be accurate enough to diagnose problems with the adrenal glands. However, with the advent of newer, more accurate ultrasound equipment and skilled technicians, ultrasound may now be accurate enough to diagnose and enlarged adrenal. See Casper's scan. (Nov. 06)
SURGERY
This is the best option for treatment and is the ONLY treatment which will stop/cure the disease. It is more costly initially for the actual surgery and associated tests. It could however, be quite risky for the ferret due to the inexperience of UK vets for this type of operation. The left adrenal is an easier and less risky operation than the right adrenal, which is situated right next to a main blood vessel - the vena cava. Inexperienced adrenal-operating vets may not want to touch the right adrenal gland if it is affected, or suggest putting the ferret down depending on what he sees. Experienced vets in the UK may attempt to operate out as much tissue as they can and continue with drug therapy.
If you decide surgery is the route you wish to go down, do try and find a ferret experienced vet. I was able to get several suggestions from accessing a UK ferret discussion list. It is quite expensive, in total with tests, surgery and post-op care, the bill comes to around £400. The vet may also wish to carry out a histology test on the affected tissue after surgery which cost us about £85.
How do you know which gland is affected?
From the blood test the vet doesn't usually know which, if not both, adrenal glands are affected unless there is a good ultrasound picture that shows enlargement (but this doesn't help if the affected gland didn't get enlarged), other than on the surgery table and the vet is looking at them. The vet needs to find the right side and check just incase. A lot of vets are afraid, with reason! of going near the right side because it is next to the vena cava. But sometimes the right side needs to come out (which is why it's good to have a really really capable surgeon). The removed organs need to be sent to a lab as well to see if there is a carcinoma (cancer). Some glands can look normal when removed, but lab results show that they might be in a pre-cancerous state and how far the disease has spread. Anyway, it's best for the vet to look at both. If both need to come out, they should, and in the same surgery. Ferrets can live without both adrenal glands, but they can then develop latrogenic Addison's disease (not enough hormones produced), so cortisol levels need to be checked within 3 days of surgery. Medication for Addison's disease includes Percorten and prednisone to get hormones back into their system.
DRUG TREATMENT
From reading I have found that drug treatment will only delay or mask the symptoms of the onset of the disease. Whilst, giving the ferret a better quality of life the disease is still developing. Again from reading, if left untreated in the States, a ferret may last for about a year (+/- 6 months), with drug treatment life span is not that much longer at about 1.5 years (+/- 6 months).
Drug treatment may be option if money is a consideration although drugs can work out expensive, or if your ferret isn't a surgical candidate. Although, it won't stop the onset of the disease, your ferret should hopefully feel a lot better as obvious symptoms disappear. You should also be cautious, as depending on how the disease is developing, some of these treatments may not work.
1. Lupron (luprolide acetate)
This may be still be used in the US, but has since been superceded by deslorelin in the UK..
This is the drug of choice to treat adrenal in the US. From research it seems this drug is available in the UK for medical use in humans, but I do not know if authorized by the VMD. In the UK, it's known as leuprolide acetate and I think it has a different brand name. If it is not authorised by the VMD, then technically it is illegal to use this drug in the UK. In order, to get the VMD to authorise this drug, your vet needs to fill in some paper work to say that there is no other viable way of treating ferrets for adrenal disease, pay a fee, wait and hope that they license it or just use it and turn a blind eye to the VMD if they are willing (2005).
Lupron is available from the States from:
Professional Arts Pharmacy
1101 North Rolling Road
Baltimore
Maryland, 21228<
Tel number: 001-800-832-9285
Fax number: 001-410-788-5686
Dosage suggestions (taken from the Ferret Mailing List):
From: AFERRETVET@cs.com
Date: Mon Sep 17, 2001 5:21pm
Subject: Re: [Ferret-Health-list] melatonin/Lupron
Hi Christina,
The recommended dose of Lupron is 100-500mcg/kg per month. Thus 300-1500mcg/kg of the 3 month version.
As you probably know the adrenal glands are typically either hyperplasia ("precancer"), adenomas ("benign"), or carcinomas ("malignant"). Carcinomas are likely to require the higher end of the dose, but hyperplasias and adenomas are likely to respond to the lower end of the dose.
You may want to use the 1000mcg (1mg) of the 4 month Lupron depot from Jayhawk Pharmacy (1-785-228-9700).
This will give you 250mcg per month, or 5 times as much Lupron for $100.
As for tumor response, again it likely depends on what type of tumor you have. Some carcinomas will continue to grow despite Lupron treatment.
Good luck with Bandit,
Jerry Murray, DVM
Experience from a vet in the UK suggests that this may not work depending on how the adrenal gland is affected. Results vary from using this drug - the UK experience has been that this is NOT a miracle cure. This is may cost more in the long run, and depending on what is affected may not work.
2. Vetoryl
This drug was sometimes used before deslorelin became available.
It has been suggested to use Vetoryl which is used in Cushings disease in dogs, there has been several cases where short term the ferret has responded well, and seems to work out quite cost effective. This seems to be a common drug with which to treat adrenal ferrets in the UK, but it is not necessarily recommended, there are some serious adverse side-effects and needs to administered daily. If large doses are required it can also work out expensive.
This is one persons experience of vetoryl:
"I did see a vet that wanted to put Oscar on Vetoryl. I looked into it and consulted other vets. Good thing I didn't go that way. Not only would the medicine have masked his growing carcinoma, but it could have also sent him into Addison's disease.
The problem with a lot of vets is that they are treating ferrets the same as cats and dogs. But ferrets have a unique system. Dogs and cats (dogs mostly) will get problems with their pituitary gland, which is important in all animals for hormones. However, ferrets are far far far more likely to get problems in their adrenal glands, which deals with specific types of hormones - the sex hormones (progesterone, estrogen, testosterone). It is the surplus of estrogen that causes alopecia (hair loss) and enlargement of the female vulva. Female ferrets are also far more likely to get adrenal problems. Anyway, by giving Vetoryl, this stops cortical and aldosterone production as well - which works in animals with pituitary tumors (aka Cushing's Disease), but chances are extremely slim that Willow has a pituitary tumor. It's almost certainly adrenal when it comes to ferrets. Therefore by administering Vetoryl you are taking a chance of sending her into Addison's disease which will medically need to be tested for constantly and controlled if she does get it. And that's a lot of extra money for you and stress for her, if she even survives. And it's not known if it actually will work well enough to keep the sex hormones in check. And there are hormones that aren't going haywire that you'll be stopping. If she does get Addison's disease, she'll need bidaily prednisone and monthly percorten. "
Another vet had this to say:
He has had experience of it causing problems leading to death with dogs (reports of death in humans too) and does not recommend it as a safe or very useful drug for treating ferrets with adrenal, as it also may act on a different part of internal structure. He was very strongly against using it.
As there is very little evidence of Vetoryl being used and only a few cases are known about, my vet spoke to the drug company and had this to say.
Have now heard from Arnolds, they say that Vetoryl CAN block the sex hormone production from the adrenals. Apparently of the two cases that they have on file, the owner of the one that has responded well is in regular contact with Arnolds regarding progress, and is pleased. The other case was dealt with by a Dutch vet at the university of Utrecht, and he felt that the fact that it did not respond was due to pre-cursors of the sex hormones which seemed to predominate in this animal. There is clearly no guarantee that Vetoryl will work because of the pre-cursor problem, but there does seem a reasonable chance, and in theory anyway it should be of help in some cases.
UPDATE Jan '07 - Have heard of more UK vets using vetoryl to treat adrenal disease with apparently good results in some ferrets. It takes longer for improvements to appear than using melatonin, and I haven't heard about the long term effects.
UPDATE March '08 - I heard of a UK owner who used vetoryl for 2.5 years to treat 3 of his adrenal ferret with good success. He did say that over time the dose had to be increased, fed daily and henced was working out quite expensive. Here's his story:
Damien (the ferret) did very well indeed. He lost his smell, became lively and became less amorous within about 2 days of starting on Vetoryl. Prior to Vetoryl he seemed to be have problems urinating. Kept standing in the appropriate position but nothing appeared. That resolved rapidly as well. He started to regrow fur at 3 weeks and became a normal healthy ferret again. We'd did have to increase (double) the dose a year later because his fur started getting poor again. He died of a severe chest infection that didn't respond to antibiotics.
Got another ferret (Bilbo whose nearly 8 years old) whose been on Vetoryl for 18 months now. Had fur loss one summer, fur returned in the winter and then he started going bald again so blood samples were done for adrenal disease. The results were positive so he was put on Vetoryl. He developed a balance problem about 6 months ago so the dose was reduced just in case but that didn't improve anything and instead he started to go downhill, so the dose was increased about 3 months ago and he's still ploughing on. He is bald and skinny now but the vet doesn't want to increase the dose because he's very happy and playful and is getting on and has other problem. The vet is thinking of adding pred in as a precaution against Addison's disease.
A third ferret followed exactly the same pattern as Bilbo. He wasn't tested for adrenal disease because the vet said there was no point, it was obvious that he had adrenal disease. He regained his fur very rapidly and seemed to be doing very well on a lower dose than Damien and Bilbo so the vet left him on the lower dose. Unfortunately even though his fur was fine his adrenals expanded rapidly after 6 months on Vetoryl and an exploratory indicated that his disease was malignant. He was not brought around after the op because he was begining to suffer.
Thanks to FunFuret for this information.
3. Melatonin/Ferretonin
See www.melatek.net
This is still a viable treatment, but has been superceded by deslorelin.
Ferrets with adrenocortical disease may benefit from treatment with melatonin. This may involve melatonin's effect on gonadotropin or prolactin secretion from the pituitary. Tumor growth is not affected by administration of melatonin. Melatonin may slow the disease but it is more of a cosmetic mask - however it will help urinary problems in males ferrets associated with adrenal disease. Melatek, a US company manufacturs ferret melatonin implants.
Benefits of Ferretonin Implants:
- Promotes fur regrowth in all ferrets
- Promotes weight gain and muscle growth
- Reduces stress on your ferret and returns the happy and playfullness for all ferrets
- Reduces dry itichy skin and fur loss
- Feduces musky odour and oily build up
- Redcues swollen vulva in females
- Reduces urination difficulties
- Reduces aggressive and bad sexual behaviour compatible with other adrenal drugs
- Assists in pre and post surgical prevention of adrenal disease to ensure a less stressful recovery
- Economical cost compared to other adrenal treatment drugs
Melatonin may arrest development of adrenal tumours, but the disease itself is still there. The ferret treated with Melatonin will have a better standard of life as the obvious outward signs will disappear, but could still die if the tumour grows aggressively.
Useful pre and post operatively to support the system. Available as long acting implant from above company. However, based on 1mg/kg, human capsules can be used. Melatonin is a prescription drug in the UK, but is available without prescription across the Internet. Implants are available only from the US company and require your vet to contact them.
There are no long term studies done of the effect of melatonin in adrenal ferrets. Short term the prospects look good, but there has been one report that says long term the adrenal symptoms return. You should also remember, Melatonin is only masking the disease.
UPDATE JAN 2008 UPDATE
In the UK a melatonin implant is manufactured for sheep called Regulin. I have a friend who recently had one of these implanted into her adrenal ferret and results so far look good. This would be a much cheaper option than importing Ferretonin from the US - and essentially it would be the same stuff.
UPDATED OCTOBER 2008 TO PRESENT
*** RECOMMENDED TREATMENT IN THE UK***
4. Deslorelin
It has been brought to notice that from 1 April 2008 that Deslorelin is to be licensed for use in the UK. The license is specifically for dogs and it is at your vets discretion to treat ferrets with deslorelin. Deslorelin has been used in Australia for treating adrenal ferrets with very good results. It is also going to be licensed in the US soon.
Deslorelin is an implant which lasts on average about 8 months (in dogs), although some research has shown that it may last between 9-24 months using a 9.4mg implant (in ferrets). More usually ferrets are implanted with a 3mg implant which may last between 12-18 months. The only way to be certain is apparently to see adrenal symptoms start to return and then put in a new one. The way in which it works is similiar to Lupron, but in trials is supposed to have better results. Again, this is NOT a cure for adrenal disease, however new evidence (Oct. 09) shows that adrenal gland size is reduced and physical appearance will improve. If the gland is not carcinogenic then deslorelin will work very well, however if the gland is cancerous then surgery is the best option.
There is evidence also that deslorelin may be used an effective alternate to surgical neutering, but not enough research has been carried out to understand the safety in the long term use. Deslorelin will also apparently reduce the male musky smell more efficiently than surgical neutering.
The licensing of deslorelin is an important development as this is the first specifically adrenal treatment that has been licensed for use in the UK with a good short term safety record. Deslorelin is now licensed and distributed for use in the UK (August 2008).
CASE STUDY: Tony Clarke from the Ferret Health Mailing list has kindly posted on his ferret, Sugar, experience and improvement of using deslorelin.
His ferret presented classic adrenal symptoms and he chose to treat her with Suprelorin 4.7mg available through Virbac SA. Sugar's experiences are as follows:
- Cost of implants x 2 is £56 (Sept 08) - vet charged £28 + VAT for injection of one. Injection of implant uses a very large needle and sedating the ferret is recommended.
- Day 5 - Hair coursened, skin turned very pink
- Day 10 - Vulva decreased by 50%
- Day 30 - Small imperceptible improvements made daily. Vulva decrease dramatically but still slightly swollen. Skin calmer, fur soft, growing in winter undercoat, more playful - becoming more like old self.
- Day 60 - Vulva is now 5-10% of its maximum size, the changes seem to
happen in a non linear way, nothing seems to happen for a week and then a big reduction in size almost overnight.
She seems to have almost finished shedding her summer coat, I am combing out less day by day, she was a bit skimpy in the fur department anyway but she had no bald patches. She has become livelier than she was prior to the implant and is now
enjoying a good wrestle everday with Suki. Her appetite seems to have improved but that may be just stoking up for the colder weather.
- A year on - Sugar is now on her second suprelorin (deslorelin acetate) implant, she was reimplanted at 12 months after the initial one. I did the second implant
at that time because although the implant may last longer than 12 months I
was worried that there would be a sudden relapse if I didn't notice the
return of symptoms soon enough.
Adrenal Disease treatment using Deslorelin
Clinical and endocrine responses to treatment with deslorelin acetate...Wagner 2005
Clinical Extract: a slow-release sub-cutaneaous 3-mg implant of deslorelin acetate. Plasma estradiol, androstenedione, and 17-hydroxyprogesterone concentrations were measured before and after treatment and at relapse of clinical signs; at that time, the adrenal glands were grossly or ultrasonographically measured and affected glands that were surgically removed were examined histologically.
RESULTS: Compared with findings before deslorelin treatment, vulvar swelling, pruritus, sexual behaviors, and aggression were significantly decreased or eliminated within 14 days of implantation; hair regrowth was evident 4 to 6 weeks after treatment. Within 1 month of treatment, plasma hormone concentrations significantly decreased and remained decreased until clinical relapse. Mean time to recurrence of clinical signs was 13.7 +/- 3.5 months (range, 8.5 to 20.5 months). In 5 ferrets, large palpable tumors developed within 2 months of clinical relapse; 3 of these ferrets were euthanatized because of adrenal gland tumor metastasis to the liver or tumor necrosis.
CONCLUSIONS AND CLINICAL RELEVANCE: In ferrets with ACD, a slow-release deslorelin implant appears promising as a treatment to temporarily eliminate clinical signs and decrease plasma steroid hormone concentrations. Deslorelin may not decrease adrenal tumor growth in some treated ferrets. Deslorelin implants may be useful in the long-term management of hormone-induced sequelae in ferrets with ACD and in treatment of animals that are considered at surgical or anesthetic risk.
Another thing you can do, which I have found so very helpful, is join the ferret health list (fhl).
