Ferret Medicine

Splenomegaly
– Clinical approach
– Ultrasound is most diagnostic!
– Fine needle aspiration biopsy
– Cytology
Managing large spleen
– In majority of cases:
DO NOTHING!!!
– Splenectomy may be beneficial in case the spleen
is very large.
– CBC & reticulocytes
Procedure is similar
– Hypersplenism may result in:
to that in other
– Anemia
– Leucopenia and/or
– Thrombocytopenia
companion mammals
Managing large spleen
– In majority of cases:
DO NOTHING!!!
– Splenectomy may be beneficial in case the spleen
is very large.
– However ……
– Erythrocytes produced in a spleen with extramedullary
hematopoiesis come into circulation!
– CBC & reticulocytres need to be know prior to surgery
– Adequate erythropoiesis needs to be ascertained by
taking a bone marrow sample
– In case of lymphoma => remove spleen
Insulinoma
Small tumour of the pancreatic •-cells
– Increased insulin production => hypoglycaemia
Symptoms:
– Ataxia of the hind legs
– Glazed look in the eyes
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– Salivation and pawing at the mouth
– Coma
Symptoms wax and
wane due to
fluctuations of plasma
glucose concentrations
– Chemotherapy may be necessary
Insulinoma
Diagnosis
– Symptoms
Insulinoma
Discrepancies with point-of-care (POC) measurements
– Intended for human diabetic patients
– are plasma calibrated
– A fasting blood glucose concentrations
– < 3.3 mmol/l (60 mg/dl)
– Calibration is found to be inaccurate for dogs and cats
– Different glucose values found when measured from
– Minimal fasting of 4 hours (6 h preferred)
– Venous plasma
– Prolong fast (in the clinic while monitoring patient) and measure again
POC
3.5 – 9.0 mmol/l
– Venous blood
• 75% of venous blood concentration
2.7 – 6.8 mmol/l
– Capillary blood
• 70% of venous blood concentration
2.5 – 6.3 mmol/l
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– When glucose is between 3.3 and 3.9 mmol/l (60 and 70 mg/dl)
Reference values
Official lab ….Gold standard
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Insulinoma
What is the sense of measuring insulin
when plasma insulin can be within reference range !?
Insulinoma treatment
– Emergency treatment
– Glucose 50% PO
– This can be absorbed through the mucous membranes
– Normal regulation of glucose
– High glucose => increase of insulin
– Low glucose => increase of glucagon
=> decreased insulin !!!
– With insulinoma
– Glucose 5% SC/IV
– High doses have been recommended (2 – 4 ml 50% glucose IV)
– This seems VERY high to me (1000 – 2000 mg / 0.8 dl / kg ferret)
– Glucose, however, is quickly taken up by cells
– Once the ferret is awake
– Low glucose due to increased insulin
– An insulin within the reference values is therefore still too HIGH
– Provide high protein diet
– For instance: Carnivore Care
Insulinoma treatment
– Pancreas anatomy
– Treatment options
– Surgery
– Medical
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Insulinoma surgery
Choice between surgery or medical is personal.
Body of
pancreas
Age of ferret, finances owner etc. play a role
– Prednisolon
– Diazoxide
– Octreotide
– (somatostatin analog)
– Doxorubicin
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No personal experience
Right lobe
of pancreas
Left lobe
of pancreas
– This form of chemotherapy may be useful in early stage of disease
Insulinoma surgery
– Size of tumour
– Usually very small
– but can be larger
– Primordial tumours may
be present
– Partial pancreatectomy is
therefore recommended
Insulinoma medical treatment
– Diazoxide (Proglycem®) 5 - 30 mg/kg, BID, PO
Do NOT remove too much pancreas
=> risk of Diabetes mellitus
– Inhibits insulin release
– Promotes glycogenolysis and gluconeogenesis
– Decreases cellular uptake of glucose
– Prednisolone
When tumour is located in body
=> resection is not possible
0.5 - 2 mg/kg, BID, PO
− Increased gluconeogenesis
− Inhibits uptake of glucose by peripheral tissues
− Preferred as emergency treatment
– Provide ad libitum a PROTEIN rich diet
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Insulinoma medical treatment
Insulinoma medical treatment
– Diazoxide (Proglycem®) 5 - 30 mg/kg, BID, PO
Preferred over prednisolon
=> Direct action on insulin
Start at 5 mg/kg BID
no real maximum dose
When vomiting occurs:
add prednisolon to protocol
Insulinoma
Prognosis
– Tumours are usually benign
–
– Prednisolone
Iatrogenic Cushing’s disease
has been seen with treatment
with prednisolon
Hyperadrenocorticism
– Very frequent occurring disease in ferrets
– First scientific report in 1987
– Symptom free period:
– Surgery: 12 – 22 months
– Medical: 6 – 18 months
Recurrence due to metastasisis or new tumours ?
Prevention
– Diet high in protein and low in carbohydrates????
Hyperadrenocorticism
Most important symptoms
Hyperadrenocorticism
Most important symptoms
– Symmetric alopecia (without major skin lesions)
– Symmetric alopecia (without major skin lesions)
– Swelling of the vulva in neutered jills
– Swelling of the vulva in neutered jills
– Return of sexual behaviour
– Stranguria due to prostate hypertrophy and cysts
– Pruritus of unknown origin
No sex predilection
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Hyperadrenocorticism
Hyperadrenocorticism
Diagnostic options
Diagnostic options
•
– Symptoms
MOST IMPORTANT
– Symptoms
– Abdominal palpation
– Abdominal palpation
– Hormone analysis
– Hormone analysis
– Androstenedione
• Oestradiol
– 17•-hydroxyprogesterone
• (DHEA)
• (not cortisol)
Adrenal disease
Intact female ferret
Androstenedione
67 (nmol/L)
58.3 (nmol/L)
17•-hydroxyprogesterone
167 (pmol/L)
165.5 (pmol/L)
Oestradiol
3.2 (nmol/L)
7.7 (nmol/L)
Ultrasound of adrenal glands
– Androstenedione
• Estradiol
– 17•-hydroxyprogesterone
• (DHEA)
• (not cortisol)
– Ultrasound
Ultrasound of left adrenal tumor
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Anatomical landmarks to aid in
identifying the left adrenal
gland
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3
– cranial pole of the left kidney
– aorta = 1
– coeliac artery = 2
– cranial mesenteric artery = 3
Aorta with A. mesenterica cranialis en A. coeliaca
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