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==Introduction==

==Introduction==

Adrenal gland disease associated with '''adrenocortical hyperplasia, adenoma or adenocarcinoma''' occurs commonly in middle-aged ferrets in the USA and its incidence is increasing in Europe.

Adrenal gland disease associated with '''adrenocortical hyperplasia, adenoma or adenocarcinoma''' occurs commonly in middle-aged ferrets in the USA and its incidence is increasing in Europe.

Pituitary-dependent hyperadrenocorticism, which is the most common cause of hyperadrenocorticism in dogs, has not been recognised in ferrets.

Pituitary-dependent hyperadrenocorticism, which is the most common cause of [[hyperadrenocorticism]] in dogs, has not been recognised in ferrets.

In ferrets, adrenal disease is associated with '''elevation of sex hormone concentrations''', with elevations in oestradiol,androstenedione and 17-hydroxyprogesterone most commonly seen.

In ferrets, adrenal disease is associated with '''elevation of sex hormone concentrations''', most commonly oestradiol, androstenedione and 17-hydroxyprogesterone.

The practice of '''early neutering''', common in the USA (neutered as early as 6 weeks of age), has been shown to be strongly correlated with the development of the disease.

The practice of '''early neutering''', common in the USA (neutered as early as 6 weeks of age), has been shown to be strongly correlated with the development of the disease.

Since the adrenal glands and the gonads are in close proximity during early development, undifferentiated gonadal cells may migrate in the embryo with the adrenal gland cells. These undifferentiated cells may later become functional steroidogenic cells.

Since the adrenal glands and the gonads are in close proximity during early development, undifferentiated gonadal cells may migrate in the embryo with the adrenal gland cells. These undifferentiated cells may later become functional steroidogenic cells.

Surgical removal of the gonads is thought to reduce the appropriate negative feedback mechanism on the hypothalamic-pituitary axis. Thus, the functional gonadal cells secrete hormones in excess. Over time, the excess hormonal secretion and lack of negative feedback control is what is thought to lead to neoplastic transformation of these aberrant adrenal cells.

Surgical removal of the gonads is thought to reduce the appropriate negative feedback mechanism on the hypothalamic-pituitary axis. Thus, the functional gonadal cells secrete hormones in excess. Over time, the excess hormonal secretion and lack of negative feedback control is what is thought to lead to neoplastic transformation of these aberrant adrenal cells.

Other potential risk factors include '''genetics''', as most American ferrets are derived from a limited gene pool, and '''diet and husbandry''', whose roles have not yet been fully investigated.

Other potential risk factors include '''genetics''', as most American ferrets are derived from a limited gene pool, and '''diet and husbandry''', whose roles have not yet been fully investigated.

==Clinical signs==

==Clinical Signs==

'''Alopecia''': one of the most common clinical signs, presenting as bilaterally symmetrical alopecia, localised to the tail, dorsum or ventrum, or leading to complete baldness.

'''Alopecia''': one of the most common clinical signs, presenting as bilaterally symmetrical alopecia, localised to the tail, dorsum or ventrum, or leading to complete baldness.

Further investigation should include:

Further investigation should include:

'''Haematology and biochemistry''': in severe cases, pancytopenia may be present due to oestrogen toxicosis and mylosuppression. Aspartate aminotransferase (AST) levels are frequently elevated.

:'''Haematology and biochemistry''': in severe cases, pancytopenia may be present due to oestrogen toxicosis and myelosuppression. Aspartate aminotransferase (AST) levels are frequently elevated. The ACTH stimulation test and the Dexamethasone suppression test are useless in ferrets because, unlike in dogs, their disease is rarely associated with an increase in cortisol levels.

The ACTH stimulation test and the Dexamethasone suppression test are useless in ferrets because, unlike in dogs, their disease is rarely associated with an increase in cortisol levels.

 

:'''Sex hormone diagnostic panel''': A diagnostic test is available through the University of Tennessee which measures levels of estradiol, androstenedione and 17-hydroxyprogesterone, which are the most commonly elevated sex hormones in adrenal disease of ferrets. This diagnostic panel has consistently identified ferrets with adrenal disease.

'''Sex hormone diagnostic panel''': A diagnostic test is available through the University of Tennessee which measures levels of estradiol, androstenedione and 17-hydroxyprogesterone, which are the most commonly elevated sex hormones in adrenal disease of ferrets. This diagnostic panel has consistently identified ferrets with adrenal disease.

:'''Abdominal ultrasonography''': this can reveal enlarged adrenal glands and enables any concurrent abdominal problems ([[insulinoma]], splenic enlargement) to be identified. It has been found that only one adrenal gland was affected in 84% of diseased ferrets and that the '''left adrenal''' was most commonly affected.

'''Abdominal ultrasonography''': this can reveal enlarged adrenal glands and enables any concurrent abdominal problems (insulinoma, splenic enlargement) to be identified.

:'''Exploratory laparotomy''': direct visualisation of the adrenal glands is also an option and an incisional or excisional biopsy can then be performed.

It has been found that only one adrenal gland was affected in 84% of diseased ferrets and that the '''left adrenal''' was most commonly affected.

'''Exploratory laparotomy''': direct visualisation of the adrenal glands is also an option and an incisional or excisional biopsy can then be performed.

Differential diagnosis: [[Hyperoestrogenism - Ferret|hyperoestrogenism]]

==Treatment==

==Treatment==

There are '''medical''' options, which include:

There are '''medical''' options, which include:

 

:'''Leuprolide (GnRH analogue) and melatonin''' injections which may temporarily reduce the ferret's clinical signs and disease but will not cure the underlying condition. Repeat injections are often required, but this is an option for ferrets that are high-risk anaesthetic and surgery candidates.

'''Leuprolide (GnRH analogue) and melatonin''' injections which may temporarily reduce the ferret's clinical signs and disease but will not cure the underlying condition. Repeat injections are often required, but this is an option for ferrets that are high-risk anaesthetic and surgery candidates.

:'''Mitotane''' is used in dogs for the treatment of hyperadrenocorticism and has been used in ferrets. It is not currently recommended due to its unpredictable results and low margin of safety.

 

'''Mitotane''' is used in dogs for the treatment of hyperadrenocorticism and has been used in ferrets. It is not currently recommended due to its unpredictable results and low margin of safety.

Clinical signs should resolve shortly after appropriate treatment.

Clinical signs should resolve shortly after appropriate treatment.

==References==

==References==

Bielinska M, Kiiveri S, Parvianinen H, et al. (2006) '''Gonadectomy-induced adrenocortical neoplasia in the domestic ferret (Mustela putorius furo) and laboratory mouse.''' ''Vet Pathology'' 43:97-117.

Bielinska M, Kiiveri S, Parvianinen H, et al. (2006) '''Gonadectomy-induced adrenocortical neoplasia in the domestic ferret (''Mustela putorius furo'') and laboratory mouse.''' ''Vet Pathology'' 43:97-117.

Carpenter JW, Quesenberry KE. (2003) '''Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery''', 2 nd ed. ''W B Saunders, St. Louis'' pp. 83-87

Carpenter JW, Quesenberry KE. (2003) '''Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery''', 2 nd ed. ''W B Saunders, St. Louis'' pp. 83-87

Lewington, J. (2000) '''Ferret husbandry, medicine and surgery''' ''Elsevier Health Sciences''

Lewington, J. (2000) '''Ferret husbandry, medicine and surgery''' ''Elsevier Health Sciences''

[[Category:To Do - Helen]]

 

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[[Category:Expert Review - Exotics]]

[[Category:Ferret Diseases]]