Surgical outcomes for adrenal

[Sherry]

As usual, I was geeking out on the net regarding my favorite subject - adrenal disease . Anyway I ran into the following summarized abstract, which I thought was interesting:

Long-term outcome of domestic ferrets treated
surgically for hyperadrenocorticism

Surgery is the preferred
treatment for ferrets with
hyperadrenocorticism, but
little information is available
on prognosis of ferrets
that undergo surgery
or on factors associated
outcome. In a study of 130 ferrets with hyperadrenocorticism,
1- and 2-year survival rates after surgery were 98% and 88%,
respectively. Survival time was shorter for ferrets that underwent
partial adrenal gland resection with cryosurgery, but survival
time for ferrets that underwent complete adrenal gland
removal was not significantly different from time for ferrets that
underwent partial resection. Survival time was not associated
with histologic diagnosis or with which adrenal gland was affected
(right, left, or both).

here's the link (there's a cool graph for those who prefer pictures - like me )

avmajournals.avma.org/doi/pdf/10.2460/javma.232.9.1270


-jennifer

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #1 on Jun 1, 2010, 10:36pm »
So what they're saying is it doesn't matter whether they remove one or both the survival rate is about the same for the same length of time but if you remove both, isn't additional treatment required for the ferret to survive?? I've never had a ferret that had been treated by both adrenal glands removed. Loki Bear lived for about 4 or 5 years after his surgery and it wasn't adrenal that killed him (directly anyway) he suffered total renal failure. I gather that usually after the first adrenal surgery a second is usually necessary within a couple of years. I figure he did very well.
The problem is as I can see it, we keep coming up with ways to treat the di-sease (not a bad thing) because we have to deal with it, but what we really need to do is find ways to prevent it.
Have they come up with anything new regarding ways to prevent the di-sease? You're the pro on this one Jennifer.....is there anything out there? Some kind of solution because as I see it, it's not getting better it's getting worse. The ferrets are getting this dreaded di-sease younger and younger. The finger is starting to point to genetics. After all, it's in the ferret farms best interest to create a ferret that cannot live a long life. It's a matter of economics. A really ugly thought, but one just the same
ciao

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #2 on Jun 2, 2010, 8:01pm »
I'd really like to know what might/might not prevent it as well. I now have 3 of 9 with adrenal(yes, we sure Zeus is too- he's losing the fur on his paws).
I'm still really up in the air on surgery. Do I? Don't I? Will they redevelop it within a couple months of surgery necessitating a second, and resulting Addison's?
Or do I just stay the lupron route, and hope/pray for the best?

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #3 on Jun 2, 2010, 8:49pm »
I'm with you sherry, I have 2 out of 5 adrenal, one just started on lupron last month and the other I just caught "mating" a few days ago so I'm positive he adrenal too. Problem is I know one is 4 years old and the other at least 4, possibly older and most of the studies now seem that surgery doesn't usually help any longer than the hormones do, either it comes back or something else takes them. But my first adrenal had the surgery and went 3 years without reoccurance (died of insulinoma & lymphoma instead). Do I pay $510 per adrenalectomy and hope it doesn't come back in 4 months or spend $30 per monthly lupron for possibly years? I'm so torn, both ferrets are very healthy otherwise. I was dead set on surgery at first but it seems like it will come back and then it's lupron anyways. Has anyone's ferret made it 3+ years after diagnosis? We should do a poll on here.

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #4 on Jun 3, 2010, 6:45am »
I do have some things I want to post on this thread regarding some f the latest findings and theories....of course, "theory" is the operative word here.

I also need to respond to some of heather's comments here.

But here is some quick info.....my first two ferret were both Marshall's. Both ended up with no adrenals (bilateral).

Sabre:
classic symptoms - had first gland removed at the age of 3, second gland removed at 4. He lived for 4+ years after the first adrenal gland was removed. The "vena cava adrenal" was debulked , and a small bit of what may have been cancerous tissue remained because my vet felt this was a better option than cutting the vena cava. we used Lupron on a "as-needed basis". Did not die of adrenal disease, although it's possible that the remaining cancer had metasticized.

Schitzo:
very minor behavioral symptoms - diagnosed by the adrenal panel. Both glands were found to be bad and were removed at age 4. Debulked the "vena cava gland" with a tiny bit of cancer possibly remainig. Schitzo lived 2.5+ years after the surgery (also had insulinoma , died of late stage lymphoma in the bone, which ever showed up in lymph nodes and/or blood work. Schitty was never given lupron (no prostate issues)

Both were kibble fed babies. Both were on flourinef for the addison's issue. They were sweetest ferrets on the planet, and I thnik of them all the time.

More later -
-jennifer

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #5 on Jun 3, 2010, 3:06pm »
Here are my assumptions and thoughts on the abstract (not that I'm an expert - but that's what stinks about abstracts....you don't get the details.

Of interesting significance to me, the partial resection had both the BEST and WORST outcome depending upon the type of surgery use - outcome for the cryosurgery was clearly less successful with partial gland removal. I assume that the
non-cryosurgery method was traditional surgery - i.e. the knife.
BUT... it would definitley be worth finding out what type of surgery your fert vet uses. If she/he uses cryo, you may want to discuss the following before surgery:
1. Try to find some stats on cryo surgery involving complete gland removal. (This was not discussed in the study).
2. Discuss a "plan" with your vet before he performs the surgery to arrive at a preferred approach if one gland is bad and if both glands are bad.

My vet is a "knife guy". I had always wished he had done cryo because it has been touted as being "less destructive". Maybe I'm starting to like the knife better

Gotta run..I'm at work.....I'll add more comments later.
-jennifer

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #6 on Jun 3, 2010, 6:14pm »
I'll admit- one of my concerns is the cost! I'm looking at a $1000 per surgery. So if they need two- that's 2 grand per ferret that may/may not need it. As well as daily medication afterwards for the second? And they may/may not have the same/as long a life span as a ferret who's just on lupron? And with the lupron, no invasive techniques, necessitating surgical recovery, along with the risks that come from surgery in the first place.
Now, my ferret vet has a very good track record for adrenal surgery survival, but still...

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #7 on Jun 3, 2010, 6:22pm »
OK, I'm back....
When they talk about partial versus complete gland removal, my assumption is that "partial removal" can be done when only part of the gland appears to be affected. If the entire gland is affected , the entire thing comes out . SO the only time the vet would have a choice on partial gland removal would be if there good tissue remained in the in the portion of the gland that receives the blood supply.

I also find it interesting that, although my vet has been recognized as the first to perform successful resection of the vena cava, he stopped performing that surgery years ago because he said that recovery was very painful, ad the ferrets never did very well after that procedure had been performed. instead, he debulks that gland and will not remove diseased tissue if it necessitates cutting into the vena cava. He says that ferrets did better and lived longer with a little bit of adrenal cancer left behind. He flat out refuses to cut into the V.C. even if a client wants it done.

Gotta run again...will be back with more speculative stuff and info.

-jennifer

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #8 on Jun 4, 2010, 10:16am »
SherryLynne,
there is NO SHAME whatsoever as using cost as a factor to dtermine whether or not surgery is the "right" thing to do, especially in the case of an older ferret that has already lived a good life. MANY people chose to treat with melatonin only, and I feel there's nothing wrong with this at all. Many times you "invest" in the surgery only to have something else take them away before the untreated adrenal disease would have anyway. I beleive that quality of life is much more important than how long one lives.

Besides, so many ferts end up locked up in cages with not enrichment and entertainment all their lives. Anyone who provides a helathy, loving home with solid basic health care is doing a wonderful job as a ferret mom.

There's also a reality to the lifespan of a ferret....
Bob Church's preliminary stats from his New Zealand/Europe trip as follows:

Average age of ferrets:
US = 6
Feral ferrts = 7
Europe = 8

Per Bob, European ferrets that were housed as kibble-eating, spay/neuter pets were found to have life spans and disease similar to the american ferrets. He suggested that husbandry had more to do with life-span than the actual genetics, although this is still an unknown.

Anyway, I did find some more info that may be of interest...

avmajournals.avma.org/action/showMultipleAbstracts

The study is the same as the other one originally posted, although the abstract is different and includes the following statement: 130 ferrets were entered in the study (11 of 130 ferrets were admitted and underwent surgery twice).

what we do NOT know here is whether or not all ferrets who needed the second surgery actually got the surgery. At one time, the consensus among vets was that the "vena cava gland" was usually unaffected. SO either the disease is getting worse over time - or we've learned that the back side of the gland that's embedded in fat tissue can be diseased. you need to cut into the fat tissue to see the back side of the vena cava adrenal.

I need to post what I've done with Tomichi and where we are at with her. I'll do this in a separate thread. I'm going to post this and start another comment in this same thread (before I lose this one - LOL!!!)

-jennifer

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #9 on Jun 4, 2010, 10:46am »
There is another options that will prevent the need for a second surgery... some vets advocate taking both glands in the first surgery. If the "vena cava gland" is not yet diseased, it can be removed without resecting the vena cava, but this is still tricky.

www.animalemergencycenter.com/ima....AND_DISEASE.pdf

I'm of the opinion (and so is my vet) that "less is more". I would not be in favor of taking both glands, although the previous article alluded to the suggestion that partial resection of the gland s is better than total removal of one.
The abstract was very unclear about this to me.
It's also my understanding that hormone replacement therapy(HRT) will be required after complete bilateral adrenalectomies. (I had two, and both required the HRT 2x daily.


Here's info about requiring the hormone replacement therapy after SUBTOTAL bilateral surgery...

OBJECTIVE:To determine signalment, clinical signs, concurrent diseases, response to surgical treatment, and long-term outcome of ferrets with bilateral adrenal tumors or adrenal hyperplasia.
DESIGN: Retrospective study. ANIMALS: 56 ferrets with bilateral adrenal tumors or adrenal hyperplasia confirmed histologically following subtotal bilateral adrenalectomy. PROCEDURE: Medical records of all ferrets with bilateral adrenal tumors or hyperplasia examined between 1994 and 1997 were reviewed. Ferrets underwent a subtotal bilateral adrenalectomy or a unilateral adrenalectomy initially, followed by a unilateral subtotal adrenalectomy when tumors or hyperplasia later developed on the contralateral adrenal gland. A long-term follow-up of a minimum of 18 months after final adrenal gland surgery was obtained by examination of medical records and follow-up telephone conversations. RESULTS: Clinical signs of hyperadrenocorticism included bilaterally symmetric alopecia, return to male sexual behavior in castrated male ferrets, or swollen vulva in spayed female ferrets. Surgical treatment of bilateral adrenal disease by subtotal bilateral adrenalectomy (or unilateral adrenalectomy followed by contralateral unilateral subtotal adrenalectomy) was effective with a mortality rate of < 2%. Only 3 (5%) ferrets required glucocorticoid or mineralocorticoid replacement following subtotal bilateral adrenalectomy. Recurrence after bilateral adrenalectomy was 15% with a mean long-term follow-up period of 30 months. CONCLUSIONS AND CLINICAL RELEVANCE: Bilaterally symmetric alopecia, return to male sexual behavior in castrated male ferrets, or swollen vulva in spayed female ferrets are indicative of adrenal tumors or adrenal hyperplasia in ferrets. Surgical treatment of bilateral adrenal disease by subtotal bilateral adrenalectomy is effective, with a low rate of complications and postoperative recurrence rate.

link:http://www.ncbi.nlm.nih.gov/pubmed/10496136

Are you even more confused?
-jennifer

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #10 on Jun 4, 2010, 1:34pm »
In a circular method, what they're stating is that the removal of both is inevitable, it's just a matter of when....did I get that correct ???and that the surgery has a greater than 2% mortality rate going up to 5% when the second surgery is done. Maybe I love the double speak of the medical journals. It's like reading legalspeak....got any lawyers on board
ciao

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #11 on Jun 4, 2010, 5:14pm »
And their both as bad as the politicians for double- speak gobbledygook [image]
What I get from that is that they had done a second surgery where required based on return of symptoms, not that all the ones who'd had an initial unilateral surgery. Mortality rate was less than 2%, but what I find weird(if I'm reading it correctly) is that only 5% needed the HRT following a bilateral surgery??? First, I thought addison's was a given following a bilateral adrenalectomy. But if I understand that correctly, the adipose tissue(with embedded adrenal cells) were putting out enough of the needed hormone, that they didn't need the HRT at all.
And that yet another recurrence of adrenal disease was rated at 15% following the bilateral surgery, after being followed up for 30 months.
Leaves me to wonder how many more developed it again after that time frame.

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #12 on Jun 4, 2010, 9:38pm »
This is another instance where they are not taking 100% of the gland(s), which is what the subtotal procedure does. This explains the ability of the fert to go without the hrt.

when my boys were done, my vet left some of the vena cava gland with cancer - he said they did better than than those that had the resection of the V.C. But there may be more than just the resection of the VC ----> leaving some adrenal tissue appears to be a good thing. My kids went 2.5 and 4 years after adrenalecomy with some adrenal tissue left behind. I need to review all this later when I'm not tired.

Tomichi goes in Wednesday since the lupron is not working....te current approach is to leave good tissue where it belongs. I'm finalizing questions, etc. that I will email to my vet before Tomichi's "big day" I hate this so much - it literally makes me ill having to deal with he stress of making decisions based upon such limited knowledge....mypoor baby girl is doing awesome - some say no surgery is best fo the females, but the lupron is not controlling the situation.
-jennifer

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #13 on Jun 5, 2010, 12:06am »
The decisions regarding this horrible disease drive me crazy, because nothing is absolutely correct and nothing I do is going to make everything all right .
I will light a candle for your little girl, may things go well and she recovers and is around to drive you crazy for many years yet.
ciao

[Sherry]

Re: adrenal surgery types and outcomes
« Reply #14 on Jun 5, 2010, 7:11am »
Thanks Heather!

My vet spayed her. He also descented her since the poofing was still way outta control even after the spay....so my vet has ha her under anesthesia twice - she's extremey strong while under the knife and makes a strong recovery from anesthesia.

I'm more concerned with what's going on inside.

I will post a thread on Tomichi (AKA "Meach" - my alpha "fitch b**ch") This will include my my thoughts on late alter as well as prevention.

-jennifer