Hypofractionated radiation therapy for treatment of an adrenal mass in a ferret

Background: Ferret hyperadrenocorticism is the most common endocrine disease among domesticated ferrets. Current therapies include adrenalectomy and gonadotropin-releasing hormone analogs. Radiation therapy was used as an alternative noninvasive local therapy option. Case presentation: A 5-year-old male castrated ferret originally presented for pollakiuria. An abdominal ultrasound evaluation revealed an enlarged right adrenal gland with heterogenous parenchyma. Hypofractionated radiation therapy for treatment of the right adrenal mass was planned and performed using a small animal irradiator system. The prescribed radiation protocol was 30 Gray administered in 5 weekly fractions. The volume of the irradiated adrenal mass was serially quantified via the weekly cone beam CT. The adrenal mass volume decreased by 88% over the 10-month period. The ferret was euthanized 10 months postradiation therapy due to progressive co-morbidities, and the body was submitted for necropsy examination. No evidence of adrenal tissue or neoplastic tissue was found on histopathology of the irradiated right adrenal mass at the time of death. Evidence of systemic mycobacteriosis was discovered on necropsy. Conclusion and case relevance: Based on histopathologic evaluation, a complete response was achieved with hypofractionated radiation therapy of the right adrenal mass. Additional studies are needed to evaluate the safety and efficacy of this novel therapeutic approach.     

Gall bladder rupture associated with cholecystitis in a domestic ferret (Mustela putorius)

A six‐year‐old neutered female albino ferret was presented with an acute episode of lethargy and anorexia. Clinical examination revealed marked cranial abdominal pain. A severe neutrophilic leukocytosis was present. Abdominal ultrasound was consistent with a diffuse peritonitis and severe bile duct inflammation. Cytology of the abdominal effusion revealed bile peritonitis. An exploratory laparotomy was performed and the gall bladder appeared inflamed with multiple perforations. A cholecystectomy was performed. The ferret recovered without complication. Bacteriological culture of the bile and gall bladder yielded a pure growth of Pseudomonas aeruginosa. Histopathological analysis of the gall bladder and liver was consistent with a marked cholecystitis and cholangiohepatitis. On the basis of sensitivity testing, the ferret was treated with marbofloxacin for one month. No complications or reoccurrence were seen up to 1 year after the diagnosis. To the author's knowledge, this is the first report of bile peritonitis secondary to gall bladder rupture in a ferret.     

IMAGING DIAGNOSIS—RADIOGRAPHY AND ULTRASONOGRAPHY OF BILATERAL CONGENITAL URETEROVESICAL JUNCTION STENOSIS CAUSING HYDRONEPHROSIS AND HYDROURETER IN A FERRET (MUSTELA PUTORIUS FURO)

An 8‐month‐old neutered male ferret was presented for vaccination and preventive treatment for adrenal gland disease. Abdominal ultrasound revealed severe bilateral hydronephrosis and hydroureter. Excretory urography and negative contrast cystography showed bilateral ureterovesical junction stenosis. Positive retrograde cystography demonstrated right ureteral reflux. A subcutaneous ureteral bypass was placed in the left kidney; however, it had to be removed 3 months later due to an obstruction and persistent urinary tract infection. Bilateral ureteroneocystotomy was performed. Although congenital strictures are uncommon in veterinary patients, they should be included in the differential diagnosis in ferrets presenting with hydronephrosis and hydroureter of undetermined cause.     

Luteinizing hormone-dependent Cushing's syndrome in a pet ferret (Mustela putorius furo)

Hyperadrenocorticism in ferrets is associated with increased circulating concentrations of adrenal androgens, whereas plasma concentrations of cortisol and ACTH are usually not affected. Here, we report on a 5-year-old castrated male pet ferret (Mustela putorius furo) in which the major presenting signs were polyuria and polyphagia. Routine biochemistry values were within their reference ranges. The urinary corticoid:creatinine ratio (UCCR) was increased and the plasma ACTH concentration was suppressed. Abdominal ultrasonography revealed an enlarged right adrenal gland and atrophy of the left adrenal gland. Administration of hCG resulted in an increase of plasma cortisol and androstenedione concentrations. Based on these findings LH/hCG-dependent hypercortisolism and hyperandrogenism were suspected and treatment was started with a depot GnRH-agonist implant containing 9.4mg deslorelin. Within 3 weeks after placement of the implant all clinical signs had disappeared. Three months later the endocrine parameters had normalized, while abdominal ultrasonography revealed that the right adrenal gland had diminished in size and the left adrenal gland was considered of normal size. No recurrences of clinical signs were seen within 2 years after placement of the deslorelin implant. At that time urinary corticoid and plasma hormone concentrations were within their reference ranges, and no further change in the size of the adrenal glands was seen. In conclusion, this is the first confirmed case of LH-dependent hypercortisolism in a ferret that was treated successfully with a depot GnRH-agonist.     

Chronic pancreatitis with secondary diabetes mellitus treated by use of insulin in an adult California sea lion

CASE DESCRIPTION: A 21-year-old neutered male captive California sea lion developed chronic polyuria; polydipsia; polyphagia; accelerated development of existing cataracts; and frequent episodes of gastrointestinal upset including anorexia, signs of abdominal discomfort, diarrhea, and vomiting. CLINICAL FINDINGS: Chronic hypercholesterolemia, hypertriglyceridemia, hyperglycemia, and glucosuria were identified. During episodes of gastrointestinal abnormalities, transient hyperbilirubinemia and increased serum J-glutamyltransferase activities developed. Clinical findings strongly suggested chronic pancreatitis with secondary diabetes mellitus and intermittent cholestasis. Multiple diagnostic tests, including abdominal ultrasonography, serial hematologic and serum biochemical analyses, fecal examinations, urinalyses and bacteriologic culture of urine, measurement of serum fructosamine and insulin concentrations, and evaluation of thyroid and adrenal function, did not reveal any specific parasitic, endocrine, hepatic, or neoplastic etiologies. TREATMENT AND OUTCOME: For 1.5 years, the sea lion received once-daily administration of glargine insulin, gastrointestinal protectants, and a strict high-protein, low-fat diet. Daily monitoring of glucose regulation was achieved by training the sea lion to submit to blood and urine sampling. Glucose regulation ranged from fair to good, and clinical signs of diabetes mellitus lessened. Episodes of gastrointestinal upset still occurred, although the frequency and severity decreased. Ultimately, a severe episode developed, associated with diabetic ketoacidosis and sepsis, and the sea lion died. Severe fibrosing pancreatitis with exocrine and endocrine atrophy and abscesses arising from ectatic pancreatic ducts were found. Peripancreatic fibrosis caused stricture of the common bile duct, resulting in gallbladder distension without cholecystitis. CLINICAL RELEVANCE: Diabetes mellitus can occur secondary to chronic pancreatitis in California sea lions and insulin therapy should be considered.     

ADRENAL NEOPLASIA IN SEVEN FERRETS

Medical records from 7 ferrets presented to the VMTH with histologically confirmed adrenal neoplasia were reviewed. Three neutered female ferrets had adrenal cortical adenoma; four ferrets (2 neutered females, 2 neutered males) had adrenal cortical carcinoma. Ultrasound identified unilateral enlargement or abnormal shape of the adrenal gland in all ferrets. Only 1 ferret had adrenomegaly on abdominal radiographs. Adrenomegaly was identified in 1 ferret by magnetic resonance imaging (MRI). All ferrets were treated by adrenalectomy followed by a tapered dose of prednisone. Surgical complications were limited to fatal hemorrhage from the caudal vena cava in 1 ferret. Remission of clinical signs occurred in all 6 ferrets which survived surgery. The time of follow up varied from 3 to 16 months. The 3 ferrets with adrenal adenomas were still alive 3 to 7 months after surgery. AH 3 ferrets with adrenal carcinoma developed metastasis and were euthanized from 2 to 16 months after surgery.     

MULTIFOCAL EMBRYONAL TUMOR IN THE CENTRAL NERVOUS SYSTEM OF A FERRET (MUSTELA PUTORIUS FURO)

A 3-year-old, intact female ferret (Mustela putorius furo) was presented with right head tilt and circling. The animal was diagnosed with a chronic otitis media-interna by computed tomography (CT) and a myringotomy was performed. One week later the animal was clinically recovered. Thirteen days after the otitis diagnosis, the ferret was presented with hemiparesis of the hind limbs. Thoracic and lumbar radiographs showed mild congenital alterations in the vertebras and the myelography test revealed spinal cord dilation at the level of L3-L4. The CT and the MRI revealed an intraspinal lesion at the level of L2-L4. The animal was diagnosed with an intramedullary vascular lesion, and was treated with intravenous fluid therapy, meloxicam, marbofloxacin, amoxicillin/clavulanic acid, and gabapentin. Nest rest was recommended. The coagulation tests were within normal limits. Four months after de intramedullary lesion diagnosis, the animal was presented with apathy, depression and anorexia. Unfortunately, the ferret died at the same day. Post-mortem evaluation of morphology and immunophenotype of lesions resulted in the diagnosis of a multifocal embryonal tumor (ET) in the brain and spinal cord of a ferret.     

Survey of copper and zinc concentrations in commercially available dry ferret diets

BackgroundTo survey macronutrients and two micronutrients (copper and zinc) in commercial ferret diets to investigate dietary factors that may influence copper-associated hepatopathy in ferrets.MethodsProximate analysis and copper and zinc concentrations of 12 commercially available dry adult maintenance ferret diets. Medians were calculated on a dry matter and metabolizable energy basis and compared to the Association of American Feed Control Officials (AAFCO) nutrient profiles for cats and the National Research Council (NRC) recommendations for mink.ResultsCalculated metabolizable energy of diets ranged from 3830 to 4305 kcal/kg dry matter (DM). Crude protein ranged from 89.1 to 151.4 g/1000 kcal, nitrogen-free extract ranged from 13.9 to 124.7 g/1000 kcal, and crude fat ranged from 29.6 to 52.4 g/1000 kcal. The median copper concentration was 9.0 mg/1000 kcal and 37.8mg/kg DM, 7 times the AAFCO minimum for cats and 6.3 times the recommendation for mink. Median zinc concentration was 64.2 mg/1000 kcal and 243.1mg/kg DM, 3.4 times the AAFCO minimum for cats and 3.7 times the NRC recommendation for mink. The median zinc to copper ratio was 6.7.Conclusions and Clinical RelevanceThere is considerable variation in micro- and macronutrient composition among tested commercial ferret diets. High copper concentrations in ferret diets may contribute to copper-associated hepatopathy in ferrets.     

USE OF A GASTROSTOMY AND JEJUNOSTOMY TUBE FOR MANAGEMENT OF GASTRIC DISTENTION FOLLOWING PYLORIC OUTFLOW OBSTRUCTION IN A FERRET (MUSTELA PUTORIUS FURO)

An 8-month-old spayed female ferret (Mustela putorius furo) was presented for evaluation of persistent, severe gastric distention following gastrotomy to retrieve several foreign bodies. A structural cause of gastric outflow obstruction was not identified ultrasonographically or surgically. A 14 Fr gastrostomy and an 8 Fr jejunostomy tube were used to facilitate medical management of severe gastric stasis and to allow enteral nutrition. The ferret tolerated the feeding tubes well and recovered completely following intensive medical therapy. This report describes successful management of idiopathic gastric distention using gastric and jejunal feeding tubes in a ferret. Feeding tubes and supplemental nutrition plans should be considered for management of ferrets with compatible disease processes.     

Circumcaval ureter in two ferrets

BackgroundCircumcaval ureter is an anomaly in the development of the caudal vena cava, rarely reported in ferrets.Materials and methodsInclusion criteria for ferrets were circumcaval ureter confirmed on surgery or post-mortem examination. Data collection of ferrets with circumcaval ureters presented between January 2014 and January 2021 included signalment, medical history, clinical signs, laboratory diagnostics, diagnostic imaging results, treatments, and clinical outcomes.ResultsTwo ferrets met the inclusion criteria. One presented following diarrhea, and one was found on routine examination that revealed a right nephromegaly. Abdominal ultrasound revealed severe unilateral hydronephrosis associated with hydroureter in both ferrets. No obvious cause of obstruction was identified. Biochemical results were unremarkable in both patients. Hydronephrosis was investigated through CT scans, revealing Type 1 circumcaval ureter in both ferrets. Section and relocation of the right ureter by uretero-vesical anastomosis was performed in one ferret. This ferret died 48 hours later following a nephrectomy performed due to persistent hydronephrosis. The second cas underwent right nephrectomy andd ureter resection due to severe hydronephrosis and stenosis of the circuncaval segment. This ferret has remained healthy on followup with no abnormalities found in biochemistries or ultrasound examination.Conclusion and case relevanceFindings suggest that circumcaval ureter should be suspected in ferrets with unilateral hydronephrosis and associated hydroureter without any identified cause of obstruction on abdominal ultrasonography. It should be confirmed with CT scan and/or urography and treated surgically.     

Two unusual tumours in a ferret (Mustela putorius furo)

This case report describes the clinical history, diagnosis and treatment of a ferret with a tumour of the right adrenal gland and insulinomas of the pancreas. Histopathology of both lesions confirmed the diagnoses. Clinical signs of the adrenal gland tumour were a swollen vulva, overgrooming, sexual activity and pruritus. The clinical signs suggesting insulinomas were collapse of the ferret, disorientation and ptyalism. A low blood glucose level assisted the diagnosis of insulinomas. This is believed to be the first reported case of concurrent insulinomas and adrenal gland tumour in a ferret in the United Kingdom.     

Ante mortem diagnosis of pancreatitis in four cats

The ante mortem detection of pancreatitis in four cats is reported. Clinical findings included vomiting, lethargy and constipation in all the cats, diabetes mellitus in two cats and severe jaundice and a vitamin K responsive coagulopathy in one cat. Serum amylase was normal in all the cats and serum lipase was elevated in one azotaemic cat. Ultrasonography revealed predominantly hypoechoic masses in the right cranial quandrant of the abdomen of each cat. The anatomical location of these masses was consistent with the pancreas. Gross examination supported these ultrasonographic observations. The pancreatic lesions were characterised histologically as acute necrotising pancreatitis, acute necrotising pancreatitis with abscessation, chronic active pancreatitis with cystic dilatation of the pancreatic duct causing bile duct obstruction and chronic active pancreatitis with nodular hyperplasia. This report indicates that pancreatitis is a clinically significant disease in cats that may be diagnosed ante mortem.     

Systemic Infection Due to Candida parapsilosis in a Domestic Ferret (Mustela putorius furo)

An 18-month-old castrated male ferret (Mustela putorius furo) was presented to the veterinary hospital for acute collapse but died despite initiation of emergency treatment. The body was submitted for a complete postmortem examination. The pathologist determined the ferret was suffering from severe necrotizing encephalitis, necrogranulomatous mediastinal lymphadenitis, and ulcerative dermatitis attributable to systemic Candida parapsilosis. This is the first report of systemic Candida parapsilosis in a ferret.     

Extramural Ectopic Ureter in a Domestic Ferret (Mustela putorius furo)

Ectopic ureter is the most common cause of congenital urinary incontinence in the dog and cat. The occurrence of ectopic ureter in the dog has been estimated to be 0.016%. A 6-month-old ferret was evaluated for urinary incontinence and urine scalding around the perineal and inguinal areas. Ultrasonography showed a nondistended urinary bladder that contained a possible intraluminal blood clot. Excretory urography revealed a left ectopic ureter. The ferret was initially treated with oral amoxicillin-clavulanate and topical silver sulfadiazine ointment for the perineal and inguinal dermatitis associated with the incontinence. Because of the potential for complications and additional surgery with ureteral transplantation, a left nephroureterectomy was performed. Surgical recovery was uneventful and the incontinence improved, although a small amount of incontinence-associated dermatitis was still present 24 days after discharge. Phenylpropanolamine therapy was initiated to address a suspected dysfunction of the urethral sphincter. Urinary incontinence improved with the phenylpropanolamine therapy; however, a small amount of incontinence persisted throughout the 3 months in which the ferret was evaluated. To the authors' knowledge, this is the first report of an ectopic ureter in a domestic ferret.     

Equine multisystemic eosinophilic epitheliotropic disease: A case report and review of literature

CASE HISTORY: A 2-year-old Standardbred gelding presented with a history of fever over 1 week, anorexia and skin lesions on all four legs. The lesions were associated with severe pruritus and oedema, and there was no response to therapy.

CLINICAL FINDINGS: The horse was in poor body condition, was lethargic and severely pruritic. Skin lesions consisted of diffuse alopecia and crusting of the distal extremities. Initially it was slightly febrile, but subsequently its temperature increased up to 40°C. Ten days after admission it developed profuse watery diarrhoea and the skin lesions progressed. Skin biopsies revealed superficial and deep perivascular dermatitis with lymphoplasmacytic and eosinophilic predominance. Based on the poor prognosis the horse was subject to euthanasia.

PATHOLOGICAL FINDINGS: The most notable lesions included ulcerative gastritis, typhlitis and colitis with prominent oedema of the intestines, marked subcutaneous oedema and severe thickening of the large bile ducts. Histopathology showed marked eosinophilic and lymphoplasmacytic infiltration of various tissues including the skin, gastrointestinal tract, mesenteric lymph nodes, large bile ducts, pancreatic duct and kidney. Immunohistochemistry revealed a clear predominance of CD3-positive cells in the lymphocytic infiltrations.

DIAGNOSIS: Based on the clinical findings and histopathology a diagnosis of multisystemic eosinophilic epitheliotropic disease (MEED) was made.

CLINICAL RELEVANCE: Multisystemic eosinophilic epitheliotropic disease is rare in horses, and usually chronic. In the current case the horse showed an apparently acute onset with high fever and rapid clinical deterioration. A diagnosis of MEED should be considered in horses presenting with weight loss and skin lesions with or without fever. A final diagnosis is based on histological results of biopsy specimens from affected organs.     

An unusual presentation of canine distemper virus infection in a domestic ferret (Mustela putorius furo)

A 4.5-year-old, male castrated ferret was examined with a 27-day history of severe pruritus, generalized erythema and scaling. Skin scrapings and a trichogram were negative for mites and dermatophyte organisms. A fungal culture of hair samples was negative. The ferret was treated presumptively for scabies and secondary bacterial and yeast infection with selamectin, enrofloxacin, fluconazole, diphenhydramine and a miconazole–chlorhexidine shampoo. The ferret showed mild improvement in clinical signs over the subsequent 3 weeks, but was inappetent and required supportive feeding and subcutaneous fluids by the owner. The ferret was then examined on an emergency basis at the end of 3 weeks (53 days following initial signs of illness) for severe blood loss from a haematoma over the interscapular region, hypotension and shock. The owners elected euthanasia due to a poor prognosis and deteriorating condition. On post-mortem examination intraepithelial canine distemper viral inclusions were identified systemically, and abundant canine distemper virus antigen was identified with immunohistochemical staining. It is important to note the prolonged course of disease along with the absence of respiratory and neurological signs because this differs from the classic presentation of canine distemper virus infection in ferrets. Canine distemper virus should remain a clinical suspicion for ferrets with skin lesions that do not respond to appropriate therapy, even in animals that were previously vaccinated.     

Distichiasis in a ferret (Mustela putorius furo)

A 4‐year‐old intact male ferret was presented to the Ophthalmology Service of the Department of Clinical Sciences of Companion Animals of Utrecht University with chronic blepharospasm, epiphora, and conjunctivitis of the right eye. Examination of the eye revealed mild conjunctivitis and three hairs protruding from the openings of meibomian glands in the upper eyelid, providing the clinical diagnosis of distichiasis. The distichia were removed by transconjunctival unipolar electrocautery. Recovery was uneventful, but the original signs recurred 10 weeks after surgery. Ophthalmic examination revealed another distichia at a different location in the same eyelid and it was removed by full‐thickness wedge excision. Histopathological examination failed to reveal the exact origin of the distichia. To our knowledge, this is the first reported case of distichiasis in a ferret.     

Definition of diabetes mellitus

The nomenclature of human diabetes mellitus (DM) has been revised, and this classification has been accepted throughout the medical world and literature. The major categories of diabetes are: insulin-dependent DM, type I or IDDM; noninsulin-dependent DM, type II or NIDDM; secondary DM or type S; impaired glucose tolerance, IGT; gestational diabetes; and previous abnormality of glucose tolerance, PrevAGT. A review of the literature has shown that over half of the documented diabetic dogs, with a single medical diagnosis, appear to be type I, IDDM, with a substantial proportion being type S, and the remainder being type II, NIDDM. Obesity is frequently associated with IGT and NIDDM. Diabetic cats most commonly have pancreatic islet destruction associated with pancreatic amyloidosis; they are insulin deficient, IDDM. The commonest causes of secondary diabetes in dogs are pancreatic damage, hyperadrenocorticism and hypersomatotropism secondary to persistent progesterone influence. Progestogen therapy is the most frequently reported cause of secondary diabetes in cats. Diabetes in horses is type S, usually secondary to a functional pituitary tumor but occasionally following chronic pancreatitis. The blood glucose ranges for normal, IGT and diabetic animals, and the normal serum insulin values of various species is tabulated.