While some people have been happy with using daily Lupron rather than
the depot form others had the adrenal disease suddenly markedly worsen,
and I DO mean markedly. How often that happens is not documented but
the mechanism is well known and covered later in this post. How often
that might happen and be confused with a different and usually more
serious form of growth being present also is not known.

Also in this post is why fur regrowth happens better with melatonin
even though melatonin does not provide as good control as some other
approaches, and is best used along with those meds since it uses a
different mechanism.

When the FHL was in its very early years both Mike Janke and I heard
from a series of such people, some in private letters, and their
letters were heartbreaking. At first he and I both figured those people
were facing carcinoma or lymphoma located in an adrenal which took off,
but some had necropsies with pathology done later.

Mike then contacted one of the research pharmacologists who MOST
STUDIED Lupron. Here is that person's expert info:

http://www.miamiferret.org/24hr_lupron.htm

As one of the people Mike put in charge of his site files at his death
I think it should be okay for me to copy the whole article but I
suspect that the others lack time to reply so I will just copy some
portions:

QUOTED MATERIAL from Mike Janke:

 ...I then contacted John Hines, who wrote, "Adrenal Disease and the
Therapeutic Effect of Lupron." Since John studied the topic of Lupron
usage, has a Ph.D. in Pharmacology and is a ferret lover, I felt I
wouldn't find anyone more knowledgeable on the subject and definitely
one with the credentials to offer an expert opinion.

First a brief layman's description (mine) of how Lupron works so some
of John's comments might make a little more sense. Lupron desensitizes
the pituitary gland and causes it to stop producing two hormones, LH
(luteinizing hormone) and FSH (follicle-stimulating hormone). These two
hormones (the primary problem is LH) stimulate the adrenal glands into
producing sex hormones which cause the adrenal disease symptoms we see.
This is an extremely basic explanation. There are many more details in
John's paper.

My main question to John was, can 24 hour Lupron be effective in
ferrets for adrenal disease treatment if used as a monthly dose? John's
comments on the topic were as follows:

"... if the Lupron is of the type that all enters the bloodstream in 24
hrs., (24 hr. Lupron) what you get is a few hours of high pituitary
activity followed by only several HOURS of inactivity (desensitized).
Then the 24 hr. Lupron is gone shortly thereafter, and the pituitary
RE-sensitizes and LH release to the natural GnRH resumes probably in a
day or so. If the ferret is only getting the 24hr. shot once a month,
it's useless. In fact, the use of the 24 hr. Lupron probably makes the
adrenal disease worse because you don't get much therapeutic effect,
but you are still getting that initial high pituitary activity when the
Lupron is first administered. This initial burst of pituitary activity
is of little consequence when it is followed by cessation of pituitary
activity. But, with the 24 hr. Lupron, you get only the initial burst
of pituitary high activity -- followed by normal pituitary activity.
It's like adding a splash of gasoline to a fire."

We had several discussions, particularly about the claim that the 24
hour Lupron works for a month or more because of "the way it attaches
to the adrenal receptors" to which John responded:

"I did notice in your earlier correspondence that the vet and
pharmacist had described their Lupron as binding to 'adrenal
receptors'. I can see how a drug that binds to the pituitary and
impacts on the adrenals could be misconstrued as binding to the
adrenals by the average person; however, if the pharmacist or vet
actually said to her that "Lupron binds to adrenals", then that
immediately is cause for concern as it demonstrates a fundamental
ignorance about how the drug works."

"[pharmacist's name omitted] doesn't understand how Lupron works. He
seems to know what its ultimate effect is, just not the mechanism.
That's a shame, because he should know better than anyone. Leuprolide
binds to receptors on the pituitary. The word "attach" could be
misleading -- to some people it might imply a permanent joining of the
leuprolide to the GnRH receptor, which is not the case. Leuprolide
tightly associates ("binds") with the GnRH receptor, but it is a
reversible process. It can dissociate ("unbind") as well."

...The important message I want to get across is, ask questions, know
what you are getting and what you are treating your ferret with. This
applies to ANY treatment, not just one for adrenal disease.

 ...If 24 hour Lupron is something you want to try for whatever reason,
this probably won't change your mind. Just be aware that you may see
no results and in fact, may make matters worse.

END QUOTES

There is a parallel situation with deslorelin. There is a horse 24
hour type that should be avoided with ferrets and there have already
been some people speaking of marked worsening after trying that med.
Deslorelin is in the same class of meds as Lupron and has the same
method of action so that just plain makes sense. If using deslorelin,
please, take the quoted expert info above into account and remember
that the Suprelorin Implant, being longer acting has excellent reasons
to be favored. There is even less of a chance of the time without
coverage, and the very temporary spiking than happens with Lupron
specifically because it is longer acting. In the U.S. that med is sold
directly to vets by Virbac U.S.

Because these drug use a different mechanism than melatonin you safely
CAN use melatonin along with it, with Ferretonin being the longer
acting form of that.

Fur regrowth is NOT a good indicator of how well any adrenal treatment
approach is working; it has some correlation to partial control but
often an adrenal growth can be increasing in size while fur regrows,
whereas some who have control do not always regrow fur or may regrow
sparse fur after as long as many months or even years (from personal
experience that includes even successful and complete surgical removal
of both adrenals, with Fludrocort or Precorten as well as Prednisolone
or other similar steroid needed to avoid Addisons, with her having had
many years of life afterward followed by necropsy and pathology to
teach vets who were new to ferrets).

Melatonin works very well -- very, very well -- to regrow fur because
it also works directly on the skin and follicles themselves. Sadly, it
does not control adrenal disease as well as meds in the same class as
Suprelorin Implants and Lupron Depots, but it safely can and should be
used in conjunction with them for increased control.

On that topic of fur growing:
http://jhc.sagepub.com/content/44/4/377.long
http://www.ncbi.nlm.nih.gov/pubmed/8601697
http://www.biolreprod.org/content/53/6/1251.long
http://www.ncbi.nlm.nih.gov/pubmed/7673877

Implant capsules do NOT need to be removed after used up.

Sukie (not a vet)  Ferrets make the world a game.

Recommended ferret health links:
http://pets.groups.yahoo.com/group/ferrethealth/
http://ferrethealth.org/archive/
http://www.miamiferret.org/
http://www.ferrethealth.msu.edu/
http://www.ferretcongress.org/
http://www.trifl.org/index.shtml
http://homepage.mac.com/sukie/sukiesferretlinks.html
all ferret topics:
http://listserv.ferretmailinglist.org/archives/ferret-search.html

"All hail the procrastinators for they shall rule the world tomorrow."
(2010, Steve Crandall)

A nation is as free as the least within it.

[Posted in FML 7726]