Top 5 Diseases of Domestic FerretsKvin Lertpiriyapong, DVM, PhD, DACLAMEast Carolina University

Ferrets are playful, curious, and relatively docile—characteristics that have made them increasingly popular as pets. Because of their curious nature, unique biology, and increased average lifespan due to improved care, ferrets are prone to specific diseases and conditions that can be debilitating.

1 Adrenal Gland Hyperplasia or Neoplasia Adrenal gland hyperplasia or neo-plasia most often affects middle-

aged ferrets, particularly those between 3

TOP 5 h EXOTIC ANIMAL MEDICINE h PEER REVIEWED

TOP 5 DISEASES OF DOMESTIC FERRETS 1. Adrenal Gland Hyperplasia

or Neoplasia

2. Pancreatic Islet β-cell Tumor

3. Foreign Bodies

4. Dental Disease

5. Diarrhea

February 2017 cliniciansbrief.com 119

and 4 years of age.1,2 Affected ferrets fre-quently display symmetrical hair loss (Figure 1, next page), which usually begins on the back and/or tail. Spayed ferrets can have vulvar enlargement. Male ferrets can develop prostatomegaly and secondary dysuria, stranguria, anu-ria, and/or urinary obstruction. Male and female ferrets may display increased sex-ual behavior or aggression. The cause is unclear; early spaying and neutering, increased period of exposure to light, and genetics have been suggested.1-3

Clinical signs can be used to make a pre-sumptive diagnosis, which can be con-firmed with an adrenal panel (available at University of Tennessee Veterinary Medical Center [utmedicalcenter.org]).

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Ferrets with adrenal disease commonly have elevated concentrations of estradiol, andro-stenedione, and/or 17-hydroxyprogesterone.1,4 Other diagnostic tests (eg, abdominal ultraso-nography) may be used adjunctively.1

Surgical resection of adrenal glands and phar-macologic treatments are common approaches for treating hyperadrenocorticism.1 For ferrets that are good surgical candidates, surgery not only alleviates the clinical issue but also enables evaluation for other abdominal dis-eases (eg, insulinoma). Among pharmacologic options, deslorelin acetate implants have proven effective3,5 and are relatively conve-nient, which can improve owner compliance. Based on recent studies showing that ferrets medically treated with deslorelin had longer relapse times as compared with those treated surgically, deslorelin acetate implants have been recommended as a first-line treatment.2,3,5

2 Pancreatic Islet β-cell Tumor Also known as insulinomas, pancre-atic β-cell tumors commonly affect aging ferrets with disease onset

typically occurring around 4 years of age (range, 2-7 years).2 Insulinomas are relatively less aggressive and have a better prognosis in ferrets as compared with dogs.2

Affected ferrets can be clinically normal. Clini-cal signs can include irritability, mental dull-ness, weight loss, ptyalism, vomiting, pawing at the mouth, ataxia, hindlimb weakness, and, in severe cases, generalized seizures or death.

Presumptive diagnosis can be made based on a fasting blood glucose level of <70 mg/dL in the presence of clinical signs and resolution of signs with glucose treatment.2,6 Ferrets should be closely monitored during fasting to prevent severe hypoglycemia. Abdominal radiography and ultrasonography are usually unhelpful; most insulinomas are only a few millimeters in size and are difficult to detect.2,6 Definitive diagnosis can be made only by histologic examination of surgical biopsy specimens.2,6

Insulinoma treatment, focused on managing hypoglycemia, begins with dietary manage-ment (ie, reduction of sugar and carbohydrates, frequent high-protein meals) with the addition of antihypoglycemic agents (eg, glucocorticoids with or without diazoxide) as needed.2,6 When combined with medical management, surgical excision—the treatment of choice—is associ-ated with longer survival times as compared with medical management alone.2,6

Regardless of treatment, insulinoma is pro-gressive. Lifelong evaluations and adjustment of medical therapy will be required. Any dis-ease (eg, anorexia, diarrhea) that affects nutrient absorption can exacerbate a well-controlled ferret with insulinoma.

3 Foreign BodiesThe frequent occurrence of foreign body GI tract obstruction in ferrets has been attributed to the animal’s

curious nature and propensity to gnaw and chew on objects. Foreign objects reportedly found in affected ferrets include rubbery toys, sponges, pencil erasers, leather straps, hairballs, and wine cork pieces.7 Preventive measures include restricting access to these d FIGURE 1 Alopecia typical of adrenal disease

objects and cage confinement when direct supervision is not possible.

Obstruction can occur along any part of the GI tract. Presumptive diagnosis often can be made based on a history of anorexia, abnor-mal abdominal palpation, and diagnostic imaging findings. Some affected ferrets will display dehydration, vomiting, nausea, and diarrhea. Severely ill animals may be in shock. CBC and serum chemistry profile results are variable, although in some cases elevated lev-els of aspartate aminotransferase and alanine aminotransferase—with or without hypopro-teinemia and hypoglycemia—have been reported.7

Surgery is the treatment of choice and is asso-ciated with a good prognosis, particularly in cases in which obstruction is identified early with minimal intestinal necrosis.7 Presurgi-cal supportive care should be provided.

4 Dental Disease Tooth fracture (Figure 2), dental calculus, and periodontal disease are common in ferrets.8,9 Tooth

resorption, dental caries, stomatitis, and oral tumors are rare.8,9

Tooth fracture has been linked to cage con-finement, environmental trauma, and abuse.8 In a study, dental calculus accumulation was shown to be accelerated when ferrets were fed with moist canned cat food supplemented with sucrose and mineral salts, and use of dentifrices decreased calculus accumula-tion.9,10 Dentifrices and tartar-control treats are commercially available, and their use may limit dental calculus formation and associated periodontal diseases. Commer-cially available dentifrices and tartar-control treats may limit dental calculus formation.10 Immunosuppressed and older ferrets may be at increased risk for developing severe periodontal disease.9

Complicated tooth fracture can lead to pulpi-tis, pulp necrosis, and periapical infection, which can be detected by a combination of thorough oral and dental examination and full-mouth dental radiography. Other associ-ated clinical signs include face-wash strokes (ie, pawing at the mouth or face), headshakes, forelimb flails, ear grasps, tongue protrusion, and chin rubbing.8 Complicated fractures can be treated with endodontic treatment or extraction. Clinicians should consider ruling out potentially predisposing diseases (eg, dia-betes mellitus, immunosuppressive condi-tions). Although these are rare in ferrets, the author recommends considering these condi-tions and examining for them when appropri-ate; this recommendation is based on observation in humans.11

Treatment for periodontal disease in ferrets is similar to that in other species.

5 DiarrheaVarious causes of diarrhea in domestic ferrets have been implicated, includ-ing viral (eg, Aleutian disease virus,

ferret enteric or systemic coronavirus, rotavi-rus), bacterial, protozoal (eg, Eimeria spp, Isos-pora spp), and other parasitic infection (eg, intestinal worms).9,12,13 Diarrhea also can be caused by neoplastic or inflammatory bowel disease (eg, lymphoplasmacytic inflammation)

February 2017 cliniciansbrief.com 121

d FIGURE 2 Tooth fracture (arrow) in a ferret

TOP 5 h EXOTIC ANIMAL MEDICINE h PEER REVIEWED

or food sensitivity.1,9,13 In some cases, multiple underlying disease conditions may be involved, and stress can exacerbate the condition.9

Clinical severity of diarrhea can be highly variable, with disease ranging from only a change in fecal consistency to diarrhea with severe systemic disease. Diagnosis can be challenging because of the various etiologies, the presence of many potential pathogens in healthy ferrets, and poor understanding of the causes of many diseases.

Further diagnostics such as bacterial culture and susceptibility and specific pathogen test-ing, including fecal flotation and molecular methods (eg, polymerase chain reaction), can help rule out bacterial, viral, and parasitic involvement. Positive results may suggest

specific antibiotic or antiparasitic therapy. Depending on severity, treatment can also include fluid-deficit correction, nutritional support, and other supportive care.

Neoplasia and inflammatory bowel disease require GI biopsy. Neoplastic conditions may be treated surgically or with specific antineo-plastic therapeutic regimens. Inflammatory bowel disease treatment is largely aimed at reducing inflammation via anti-inflamma-tory therapy but can include other strategies (eg, dietary antigen exclusion).9

Conclusion Ferrets are likely to encounter one or more of these clinical problems in their lifetime. Knowledge of these common clinical problems should facilitate diagnosis and treatment. n

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References1. Fox JG, Muthupalani S, Kiupel M, Williams B. Neoplastic

diseases. In: Fox JG, Marini RP, eds. Biology and Diseases of the Ferret. 3rd ed. Ames, IA: John Wiley & Son, Inc; 2014: 587-626.

2. Chen S. Advanced diagnostic approaches and current medical management of insulinomas and adrenocortical disease in ferrets (Mustela putorius furo). Vet Clin North Am Exot Anim Pract. 2010;13(3):439-452.

3. Chen S, Michels D, Culpepper E. Nonsurgical management of hyperadrenocorticism in ferrets. Vet Clin North Am Exot Anim Pract. 2014;17(1):35-49.

4. Rosenthal KL, Peterson ME. Evaluation of plasma androgen and estrogen concentrations in ferrets with hyperadreno-corticism. J Am Vet Med Assoc. 1996;209(6):1097-1102.

5. Wagner RA, Finkler MR, Facteau KA, Trigg TE. The treatment of adrenal cortical disease in ferrets with 4.7-mg deslorelin acetate implants. J Exotic Pet Med. 2009;18(2):146-152.

6. Miller CL, Marini RP, Fox JG. Diseases of the endocrine system. In: Fox JG, Marini RP, eds. Biology and Diseases of the Ferret. 3rd ed. Ames, IA: John Wiley & Son, Inc; 2014:377-399.

7. Mullen HS, Scavelli TD, Quesenberry KE, Hillyer E.

Gastrointestinal foreign body in ferrets: 25 cases (1986-1990). J Am Anim Hosp Assoc. 1992;28:13-19.

8. Eroshin VV, Reiter AM, Rosenthal K, et al. Oral examination results in rescued ferrets: clinical findings. J Vet Dent. 2011;28(1):8-15.

9. Maurer KJ, Fox JG. Diseases of the gastrointestinal system. In: Fox JG, Marini RP, eds. Biology and Diseases of the Ferret. 3rd ed. Ames, IA: John Wiley & Son, Inc; 2014:363-376.

10. Mann PH, Harper DS, Regnier S. Reduction of calculus accumulation in domestic ferrets with two dentrifrices containing pyrophosphate. J Dent Res. 1990;69(2):451-453.

11. Lamster IB, Pagan M. Periodontal disease and the metabolic syndrome. Int Dent J. November 2016. doi:10.1111/idj.12264

12. Kiupel M, Perpinan D. Viral diseases of ferrets. In: Fox JG, Marini RP, eds. Biology and Diseases of the Ferret. 3rd ed. Ames, IA: John Wiley & Son, Inc; 2014:439-502.

13. Sledge DG, Bolin SR, Lim A, et al. Outbreaks of severe enteric disease associated with Eimeria furonis infection in ferrets (Mustela putorius furo) of 3 densely populated groups. J Am Vet Med Assoc. 2011;239(12):1554-1588.

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The Norbrook logos and Loxicom are registered trademarks of Norbrook Laboratories Limited. Metacam is a registered trademark of Boehringer Ingelheim Vetmedica, Inc. 0117-497-I01A

Observe label directions. Do not use Loxicom Oral Suspension in cats. Acute renal failure and death have been associated with the use of meloxicam in cats. As with any medication, side effects may occur. These are usually mild, but may be serious. The most common side effects reported in field studies were vomiting, soft stool/diarrhea and decreased appetite. If side effects occur, discontinue treatment immediately and consult a veterinarian. Dogs should be evaluated for pre-existing medical conditions prior to treatment and monitored during therapy. See product labeling for full product information.

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