Adrenal Disease
Adrenocortical disease (ACD), also referred to as just "adrenal" in ferrets is the #1 ferret disease in middle-aged and older ferrets. This disease is extremely common in ferrets that have been neutered at a very young age (all mass bred "mill" ferrets). Below you will find information on this disease, treatment options, and some personal stories. This information will be updated when new information is available.
The above image is of T. Whitehawk's boy Leoben who was diagnosed with Adrenal Disease in February 2019 at age 5 years.
Leoben's tail fur had thinned out dramatically, and he became underweight despite a good appetite. He also began drinking water a LOT more frequently, and also peeing a LOT more frequently. He often dribbled urine all around in streaks, and purposefully began peeing "on" items like slippers (while on his human's feet); he was behaving like he was "in season" (or rut), but, he is neutered. He also began displaying random acts of aggression with one of his bonded female friends.
Leoben was implanted with the Suprelorin F (deslorelin acetate) implant, which has worked wonderfully to manage his symptoms.
~*~
The images below are pics of T. Whitehawks's boy Apollo (age 6 years) who was also diagnosed with Adrenal Disease.
Top three pics are from BEFORE he received the Suprelorin F implant (January 2020).
The BOTTOM pic is after the implant (taken about 4 months after the implant). ALL of his fur grew back in thick and soft.
Symptoms of Adrenal Disease may include:
Hair loss (alopecia),
Swollen vulva (in females). Left untreated may cause UTI
Inability / straining to urinate (in males). Left untreated can cause sepsis and/ or death because th eprostate enlarges preventing the bladder from emptying normally.
Abnormal aggression, and/ or sexual aggression
Lethargy
General Weight loss. Muscle weakness/ wasting (atrophy).
*NOTE: Ferrets do NOT need to have ALL of these symptoms to have adrenal disease (theses are just most common).
Adrenal Disease
By Mary Wesker
Adrenal disease is VERY common in ferrets. Most will develop it, but symptoms usually don’t begin to show until around age 4-6, though seeing signs sooner has happened, much like Insulinoma. They can have it and its possible you wouldn’t know because symptoms are slow to show up. Here are our links about Adrenal disease, symptoms to look for, and treatment options.
“Adrenal Disease is one of the most common ferret conditions seen in clinical practice. The disease is a result of a tumor or hyperplasia (overgrowth) affecting one or both adrenal glands. Although this condition can occur at any age, it is most common in ferrets over three years old. There are many theories as to the cause of this condition (genetic, environmental, diet, early reproductive sterilization); however, the underlying etiology is still unknown.
Increasing evidence points both to early neuter and abnormal/artificial light cycles. In the case of neuter, the sterilization procedure removes the source of sex hormones (estrogens and testosterone), which in turn removes the natural inhibition of the continuous stimulation from the pituitary gland on the adrenal glands, which subsequently produce an excess of the sex hormones. In the ferret, the length of daylight regulates sex hormone production via the pineal gland in the brain. Abnormal light cycles result in a similar constant stimulation as sterilization. Due to the perpetual stimulation from the pituitary gland in the ferret’s brain, the affected adrenal gland produces an excess of sex steroid hormones: estrogen, testosterone, and their precursors. Chronic high levels of these hormones causes the myriad of clinical signs present with this disease. This chronic debilitating disease can greatly affect the ferret’s quality of life. Although the growth of the diseased adrenal is usually benign (adenoma or hyperplasia), malignancy (carcinoma) is present in about 25% of the cases."
Diagnosing Adrenal
By Tara Whitehawk
—The University of Tennessee is currently the only place that does adrenal gland disease blood testing for ferrets. Your vet draws the sample and sends it to them. The major drawback is that this test can give false negatives (it costs about $160 for the test).
—Because this test is expensive and not 100% accurate - many vets who are well versed in ferret disease and medicine will recommend implanting them with the Suprelorin F (deslorelin acetate) implant, or trying monthly Lupron shots without forcing you to have the above test done.
—The Suprelorin F implant is a very fast and simple procedure (very similar to getting a microchip placed). In most cases sedation is not needed however, this will depend on your ferret's vet and their comfort level/ experience doing the procedure.
LINKS:
LATEST UPDATES ON FERRET ADRENAL DISEASE (18 March 2019 / VetFolio]
Note on the DES implant as a preventative: You’ll notice both the FDA and the company that makes the implant only recommend it for treatment of the disease, NOT as a preventative. That’s because there’s no available research on it’s effectiveness as a preventative, and thus, they can’t legally say its a preventative without proving it is.
From an AFA article on Adrenal: "...Although many of these drugs can effectively block and/or inhibit the production of the adrenal source hormones and alleviate clinical signs, most do not decrease the size of the adrenal tumor or hyperplasia, nor arrest the advancement of the underlying disease process once it has begun. The veterinarian, in concert with a well-informed client must weigh the benefits and risks of both medical and surgical approaches to management of AD." - This is as of 2013 so it is possible there are other studies we have not become aware of or that are in progress.
Adrenal & Light
By Holly
Ferrets need approx. 14 hours of total darkness (or as close as possible) a day. The reason they need complete darkness while they sleep isn't because it helps them sleep better. It's because when they are asleep and in complete darkness, their body kicks into gear to produce melatonin.
Melatonin helps regulate the reproductive organs. When ferrets get less melatonin (less darkness), their body creates more hormones and kicks into "breeding" season (spring & summer - when there is more light and less darkness to produce melatonin)
BUT most ferrets are neutered/spayed. It can't breed. So all these hormones being created are being made by the adrenal gland instead, and putting extra stress on the adrenal gland.
So basically, the more darkness they get, the less stress their adrenal gland will get.
When you notice your fuzzies zonked out in the middle of the floor in the sunlight or where the lights are on, you can throw a blanket over them (or move them to their dark snuggle spot) and that's plenty good. This is why a lot of people get cage covers as well, especially for the summer hours when the sun is up extra early and extra late in the day 😊
https://weaselwords.com/ferret-articles/ferret-light-sensitivity-study/ - a study in light exposure
Additional Reading/ Resources:
LATEST UPDATES ON FERRET ADRENAL DISEASE (18 March 2019 / VetFolio]
Adrenal Disease Tumors in Your Ferret [Ron Hines DVM PhD / Vetspace]
Adrenal Disease Complex in Ferrets [AZ Exotic Animal Hospital]
Adrenal Disease in Ferrets [Holistic Ferret Forum]
NEWS
September 2023:
Study to evaluate a hormone therapy for prevention of adrenal disease in ferrets:
If you live near the University of Georgia and have any healthy young ferrets, you may be able to have your ferret(s) screened to take part of the "Study to evaluate a hormone therapy for prevention of adrenal disease in ferrets". Please visit the link for more information. Essentially this is a scientific study to see if the deslorelin acetate implant can actually prevent adrenal disease if given before onset of the disease.
https://vet.uga.edu/.../study-to-evaluate-a-hormone.../
DES, Lupron, Melatonin, etc
GnRH Super-Agonists: “Until recently, no drug was specifically approved for use in ferrets in the United States. Within the last year one product, Suprelorin® (Deslorelin acetate-Virbac) has been approved and has become available to veterinarians in the US without special import restrictions. Until this product became generally available a number of other medications were used to manage AD. The best known of these is Lupron® (Leuprolide acetate-Tap).
Below is information on the treatments most commonly used today:
Lupron: decreases the levels of both estrogen and testosterone through tonic stimulation of the pituitary gland resulting in down regulation of FSH and LH secretion. It is available as an injectable drug in several forms (short acting daily, 1-month depot, 3-month depot, 4-month depot). One protocol includes using a high dose of Lupron 4-month depot®. In those cases of AD which respond to this type of drug the protocol is highly effective in reversing all of the clinical signs of the disease for four to seven months. The dose is 2 mg/ferret subcutaneously; repeat when clinical signs recur. Other clinicians have suggested using lower dosages in the range of 100 ug to 200 ug/ferret. Do not use the short-acting daily form as it is ineffective and may even aggravate the condition. The drug comes in the form of a powder and diluents which are mixed together prior to administration. Many veterinarians will reconstitute and divide the stock bottle into separate aliquots and freeze the doses for use at a later time. No hard data exists regarding the stability of the product when frozen and the manufacturer (Tap) strongly counsels against freezing for later use. Some compounding pharmacies will separate the dry powder of the 4-month depot formulation into vials containing individual dosages based on the veterinarian’s request allowing one to mix only the amount to be given at any one time and avoiding the complications relating to freezing and storage of reconstituted material. A small number of ferrets develop subcutaneous reactions to the injection approximately two to four weeks after administration. A biopsy of the site may reveal inflammation consistent with injection site panniculitis. It is best to leave the swelling alone; it resolves on its own in four to six weeks. Surgical removal of the site also removes the depot drug. Anti-inflammatory medication may provide comfort and help speed resolution.
Suprelorin F (deslorelin acetate implant made specifically for ferrets): In 2012, Virbac Corp. purchased the import and distribution rights for Suprelorin ®, Deslorelin acetate from Peptec, Australia. Currently a 4.7 mg implant can be purchased individually or in lots of five implants. Research studies performed on adult ferrets with clinical AD have demonstrated significant decreases in clinical signs and hormonal concentrations related to AD. Vulvar swelling, puritis, sexual behaviors and aggression disappeared or decreased within 14 days of implant, with hair regrowth evident by 4-6 weeks. Plasma concentrations of steroid hormones decreased within 2 months (estradiol 32%, 17-OH progesterone 91%, androstenedione 93%). Response persisted for an average of 19 months, (range 8.5-26 months). Adrenal sizes varied, with some cases showing shrinkage, a greater proportion showing progressive increase in size. In some cases progression of adrenal tumors did not seem affected by implant. Results of these studies suggest that Deslorelin implants are best used in ferrets with AD which do not have evidence of adrenal malignancy at time of implant. Further, evaluation of adrenal size at time of implant and monitoring of size during treatment is recommended with cases having smaller glands (<1cm) followed by sequential abdominal ultrasound at yearly intervals. Those with larger glands (>1cm) would benefit from more frequent monitoring (2-3 yearly) and surgical intervention if signs of neoplastic transformation becomes evident.
Melatonin: Available in both oral and slow-release implant forms, melatonin inhibits the release of GnRH, thereby suppressing formation of LH and FSH. Ferret sexual activity is highly seasonal and relatively dominant during periods of long darkness (winter). Ferrets normally release their own melatonin during the dark phase of the day; consequently, melatonin plays a role in the normal seasonal drop in hormone production in non-neutered ferrets.
Oral Melatonin Oral dosing regimens of 0.5 to 1 mg per ferret daily have been used. In a limited number of published clinical studies, oral melatonin therapy resulted in consistent improvement in clinical signs including hair regrowth, reduction in vulvar or prostatic size. Hormone studies revealed interesting results with concentrations of estradiol, 17-hydroxyprogersterone (17-HP), and dihydroepiandrosterone (DHEA) decreasing over the first four months but then rising above pretreatment levels by 8 – 12 months. Further, concentrations of another steroid intermediate, androstenedione gradually increased above initial levels in every ferret at each time point throughout the one year study and adrenal tumor growth as measured by ultrasound measurement was not affected by the treatment. It is speculated that improvement in clinical signs is a result of decreases in serum prolactin levels rather than suppression of adrenal steroid production. Additionally, the report indicated that mean width of abnormally large adrenal glands was significantly increased after the 12-month treatment period and 6 of 10 treated ferrets had recurrence of clinical signs at the 8-month evaluation. Based on these findings, the use of oral melatonin as the sole long-term medical therapy for ferrets with AD cannot be recommended.
Melatonin Implant (Ferretonin® Melatek) A 5.4 mg implant (similar in size and shape to a microchip) comes in a prepackaged single dose, sterilized syringe (implant device) with needle and releases melatonin for three months. Unfortunately, few large-scale and long-term studies using a melatonin implant in ferrets with AD have been published. In one article, 70 pet ferrets with clinical signs of AD were implanted and monitored over the next 3-4 months. Clinical response was excellent with 69 of 70 showing resolution of signs including swollen vulvas, alopecia, and itchiness. Several developed large external fat pads in the cervical region which could be confused by clinicians as enlarged lymph nodes and evidence of lymphoma. Hormone levels were monitored in only one ferret, a neutered male. While levels of 17-HP and androstenedione decreased, estradiol levels increased over the four month study period. In another study, two female ferrets with AD were used to compare a melatonin implant with monthly Lupron® depot (100ug). Hormone levels were monitored and demonstrated slightly lower levels in the ferret with the implant. Though these findings are promising, clearly a study using a much larger number of ferrets is needed to arrive at statistically significant results and evaluation of long-term efficacy.
Vaccination (not yet available) Research is underway aimed at developing a safe and effective vaccine directed against either GnRH or FSH/LH. One GnRH vaccine (GonaCon®/AdjuVac patent pending) induces production of antibodies against endogenous GnRH. Antigen-antibody complexes are formed within the hypophysis. Due to large molecular size, these complexes cannot diffuse through pituitary stalk capillaries into the pituitary gland effectively suppressing LH and FSH production. Studies have demonstrated both response of clinical AD and a protective effect on young ferrets (1-3 years of age) significantly reducing development of AD compared to control animals.”