Ferret Insulinoma

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Tumors of the pancreas (insulinoma) can cause excess secretion of insulin, thus lowering the blood glucose (sugar) level to a point that a ferret can become ill. Unfortunately, this is a relatively common problem in middle aged and older ferrets.

Graphic photos on this page.

The end of this page has a short video on surgery to remove nodules from the pancreas.


Symptoms

Some ferrets do not show any symptoms, while others exhibit lethargy and weakness. There might be a decrease in appetite and weight loss. These symptoms might even come and go over a period of months. Some ferrets will have increased salivation and even a glazed appearance to the eyes, and might even collapse or have seizures.

FerretInsulinoma-Waking

Some ferrets are very weak due to their low blood sugar

Diagnosis

Some ferrets are diagnosed as having an insulinoma when an abdominal surgery is being performed for other reasons (adrenal gland diseasespayliver disease). This is especially true for the ferrets that are not showing any symptoms of this disease. For those ferrets that are symptomatic of insulinoma, the diagnosis is made based on history, examination findings, and diagnostic tests.

Our laboratory has a special blood panel for ferrets that are exhibiting signs of insulinoma.The diagnosis of insulinoma is verified by a low blood glucose (sugar) level.

FerretInsulinoma-Glucometer

We use a special instrument to check the blood glucose level that only requires a few drops of blood. If you have ever tried to get blood from a ferret you would understand the importance of being able to do this test with only a few drops of blood

Medical Treatment

Medical therapy can be effective at controlling symptoms, although it can not cure the disease. Food should be fed frequently, and should consist of cat food or ferret food. Stay away from high sugar foods that can stimulate the pancreas to secrete excess amounts of insulin and set the stage for a hypoglycemic (low blood sugar) episode.

Prednisone (cortisone) can be effective at controlling symptoms for several months to several years. It comes in a liquid or pill form, and is usually given twice each day, depending on what your veterinarian determines. It helps raise the blood glucose level without stimulating excess secretion of insulin like foods high in sugar.

Other medications can be used if prednisone is not effective. These drugs are more expensive and have the potential to cause vomiting and appetite loss. Your veterinarian will let you know if they are indicated in your situation.

If your pet has an episode of hypoglycemia it should be given Karo syrup, Nutrical, honey or other foods high in glucose to temporarily raise the blood glucose level. After giving a high sugar food feed it its normal diet to minimize excess secretion of insulin in the long run.

If your pet has collapsed and is unable to swallow, rub a small amount of honey or syrup on its gums. Only use just enough to wet the gums and take care not to be bitten if your ferret is having a seizure. When it regains consciousness feed it its normal diet and bring it to the hospital for an exam and blood glucose check.

Ferrets that are not eating well are also commonly fed Hill’s A/D.

Surgical Treatment

The following area contains graphic pictures of an actual surgical procedure performed at the hospital.

Younger ferrets or those that have adrenal gland disease simultaneously are candidates for surgery. Tumor nodules that are found on the pancreas are removed, helping to prolong survival time. In some cases we perform a partial pancreatectomy. In spite of the fact that surgery is performed some of these ferrets will need medical management. Survival time is variable after surgery, ranging from months to years.

Several pecautions must be taken when this surgery is performed. Ferrets can easily become hypothermic due to the anesthesia and the fact that their abdomen will be open during the procedure. They can also become hypoglycemic due to the stress of the procedure. Special precautions are taken to help mitigate these problems.

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This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

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While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments.

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Our surgeon is ready to start before our patient is completely prepped. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

In ferret surgery pay particular attention to low body temperature (hypothermia) and low blood sugar (hypoglycemia). They are placed next to special hot water bottles throughout the procedure.

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We keep a close tab on body temperature, before, during, and after surgery

Our patients are carefully monitored to detect any abnormality before it becomes a problem. This early warning system is important in such a small animal that is ill and undergoing anesthesia and major surgery.

Surgery-Monitor

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

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Our surgeon and anesthetist work closely together

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In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters. We use a special stethoscope (called an esophageal stethoscope) that is passed down the esophagus and can give us a clear sound of the heart.

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Our patient is carefully clipped and scrubbed

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Our surgeon does the all important draping after the final cleanse of the abdomen

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 Under these drapes is a hot water blanket and also hot water bottles

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When our surgeon is comfortable everything is in order he makes his skin incision 

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There is a special location on the abdominal muscles called the linea alba.  You can see it as this white horizontal line between the muscles.

It is here that our surgeon cuts through the muscle and enters the abdominal cavity without cutting any abdominal muscles. This is a tendon that holds the abdominal muscles together, and is the area that has the best holding strength when we suture the area back together. If it did not have this strength, we would have an abdominal hernia.

FerretInsulinoma-LineaIncision

The scissors is used to make the cut through the linea alba into the abdomen

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 The pancreas is rapidly isolated and a insulinoma nodule is searched for visually and by palpation. Do you see the small nodule on the pancreas?

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The arrow will help you visualize the nodule

Many nodules are gently squeezed out

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This is a typical insulinoma nodule after removal from the pancreas

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This is the report we receive from our pathologist confirming the diagnosis

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Sometimes these tumors need to be cut out. These are hemoclips, metal sutures that stop the bleeding of small vessels buried in the fat around the area.

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On occasion we encounter a pancreas that has a large tumor

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The arrow points to the lower left edge of the tumor

After removal of any pancreatic tumors we check the rest of the abdominal organs for any problems. Ferrets are prone to many problems, and if we are doing surgery for a specific problem like insulinoma, we make sure to check the other internal organs.

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Our surgeon is carefully palpating the length of the intestines to feel for any abnormalities, especially foreign bodies and cancer.

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The spleen is assessed next in this patient. Even though it is large, it is not necessarily diseased. That nodule at the end is not significant.

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The liver is carefully assessed

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This one is cystic

A very important organ to check is the adrenal gland since adrenal gland disease is common in ferrets.

FerretInsulinoma-Kidney

This one is normal so it is difficult to visualize. It is the small pink circle of tissue that lies to the left of the dark brown kidney, which in this picture is surrounded by normal fat. Can you see it?

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The arrow helps identify it

After surgery our little patient is kept cozy warm, watched carefully for hypothermia and hypoglycemia, and monitored closely for pain.
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This one is a little groggy, but feeling no pain
This short video goes through the important points of surgery to remove nodules from the pancreas and also remove an adrenal tumor. Notice how we use the laser to make the initial incision.

Prognosis

Insulinomas are malignant tumors that will decrease a ferrets life span and compromise its quality of life. This is a serious disease that does not lend itself to a cure or long term control. Longevity after diagnosis varies from weeks to years, and depends on the duration of the problem prior to diagnosis. The sooner we make the diagnosis, the more that can be done to treat the problem and increase a ferret’s quality of life and lifespan.