Hi Dr. Williams.  I just wanted to make a couple comments about your post
about Lupron; provide some quotes from Cathy Johnson-Delaney, DVM, about
Lupron (she recommends it and has used it to treat her own ferret); and also
correct an error in my yesterday's post.  First, the correction:
 
>I just might add that Lysodren [should read LUPRON] isn't usually used
>alone (though I have to dig out where Cathy advises to try it alone - I
>think it's where no abnormal adrenal tissue could be found via exploratory;
>which makes sense because the Lysodren targets and kills adrenal tissue,
>and if nothing abnormal can be found...well, you get the drift).
 
Dr. Williams; your scientific information about Lupron appears contradictory
to Cathy's (quoted below); but is very technical and probably difficult for
the average FML'er, at least for me, to follow.  The conclusions are clear,
though; you say there is no indication Lupron should work in treating
adrenal disease; and Cathy says there is, and it does.  (Incidentally, one
of the reasons I started the Ferret Adrenal/Insulinoma Mailing List is that
there are so many differing opinions among vets on treating adrenal disease
that facing it as a fuzzy parent is very scary and confusing.)
 
Cathy Johnson-Delaney, DVM, is recommending Lupron as, mainly, an adjunct to
Lysodren, for reasons I'll let her own words explain below.  Cathy is a
highly respected, active vet who travels to and presents at many
veterinarian conferences.  I also know her personally and know she adores
otters and ferrets (house otters she jokingly calls them).  Her home is
adorned with lovely otter sculptures and paintings that she's collected
since childhood.  She is also a mom of two fuzzies, and has also treated her
own beloved ferret, the late Robbie, with Lupron as adjunct to Lysodren (see
her words below), and I know she would study carefully before giving him
anything.  When Robbie died, of insulinoma -- with no indication upon
necropsy that Lysodren or Lupron treatment brought him harm, but showing a
shrunken right adrenal tumor and normal prostatic tissue thanks to the
chemical treatments -- Cathy was absolutely devastated.
 
Cathy has also come up with a safer protocol for administering Lysodren than
the one generally used, and this in itself could save many fuzzies' lives.
 
So, I have reason to respect her and her opinions.  I also respect you very
much and appreciate all you've done for fuzzies, but, with all due respect,
note that, though you have a vet degree and are a ferret parent, on a daily
basis you are a pathologist examining tissues, not a vet treating diseases.
(I also humbly note that the scientific knowledge you possess is light years
beyond mine!)
 
>there is no indications that it would treat adrenal-associated
>endocrinopathy in the ferret.  This is very new ground, it may not work,
>and it certainly should not be thought as a cure for AAE.
 
In looking at treatments for adrenal disease, Cathy is looking for what will
provide the longest, best quality of life.  From all the relapses from
surgery I have read about, and reactions to Lysodren or lack of response,
there doesn't seem to be a cure for adrenal disease at this point.  And
Cathy has certainly never called Lupron a cure, nor have I.
 
Yes, Lupron is a relatively new treatment for fuzzy adrenal disease.  Yes,
in the ideal circumstance and situation, surgery is great, and some ferret's
recover from adrenal disease.  But new treatments are needed for adrenal
fuzzies who, for various reasons, can't be treated surgically.  Commenly the
disease recurs after surgery, or the symptoms don't abate at all, or no
abnormal tissue is found; or the growth found can't be removed.  There is
Lysodren, but that doesn't always work.  Other treatments must be tried.
What is there for ferrets who can't have adrenal surgery -whether because of
age, financial limitations, or the tumor's size and placement - and who fail
on Lysodren alone?  Or for ferrets with prostate problems who need relief,
faster relief than Lysodren may provide?  It isn't easy to unblock a urinary
tract in fuzzies -- I have one who died, and know others who lost their
lives as well.
 
In any case, I wanted to offer some excerpts from Cathy's writings about
Lupron, which shows she's done her research, too.  And, as I hold her in
high regard, I feel confident in sharing her experiences and theories.
 
I'm glad that Lupron has finally reached the "FML" light of day!
 
Sincerely,
Lynn Mc.
 
P.S.  Here are a couple excerpts from Dr. Williams's post that Cathy's info
apparently contradicts:
 
>As far as using it in ferrets with cystic prostatic disease - Lupron does
>not lessen the effects of estrogen, so the cysts will continue to get bigger
>as long as teh estrogen levels stay high.
 
>As far as alleviating hair loss -- once again, because Lupron is not an
>estrogen blocker, it will not alleviate the damage that the ongoing high
>levels of estrogen are doing to the hair follicle cells which produce and
>give nutrition to the hair.  So the hair continues to fall out.
 
>Perhaps the most imporant point of all - Lupron does not do anything to
>shrink or kill tumor cells.
 
NOTE: The key here is "anything".  Cathy indicates that it can, alone, help,
but she recommends it most often as adjunct to Lysodren.
 
>However, by looking at the normal actions of Lupron in the body, there is
>no logical reason why it should work, and in male ferrets with dysuria, you
>may actually worsen the problem.
>Bruce Williams, DVM
>Diplomate, ACVP
 
From Cathy Johnson-Delaney, DVM, Seattle, Washington, in an ACD article that
was done for VetRap (Seattle King Co Vet Med Assoc), published several
months ago:
 
"...Leuprolide acetate4 may be an extremely useful adjunct therapy along
with the lysodren.  Administered at 100mcg/kg IM every 3 weeks, it
suppresses sex steroidogenesis.  It inhibits the growth of hormone-dependent
tumors and tissues.  Effects include reduction in size of the prostate or
vulva, and hair growth through follicle reactivation.  Use of this drug in
ferrets is just being tried, but based on initial uses, it seems very
successful."
 
From Cathy's correspondence with me, including info about treating her own
fuzzy, Robbie:
 
"...The Lupron Depot is a synthetic GNRH agonist that blocks sex
steroidogenesis.  It is leuprolide acetate, utilized primarily for
endometriosis and as palliative treatment to shrink prostate tissue with
many kinds of prostate cancer.  Although theoretically it primarily acts to
interrupt the feedback system from the pituitary to the adrenal/auxillary
endocrine tissue, it essentially acts to block estradiol receptors.  It is
for this ability that we decided to try it in my ferret, whose prostate had
totally occluded his pelvic canal, making urination and defecation almost
impossible (and painful).  He had his left adrenal totally removed in April
of 95, along with one large insulinoma.  In Aug of 96 he plugged.  He
started Lupron in September.  I am happy to say he is now 5 days past 2
years from surgery (the right adrenal was determined to be too much of a
surgery risk to even try).  He is 13 months on lysodren (varying from 100 -
250 mg/week), and is 8 months on Lupron (100 mcg injection IM every 3
weeks).  He will be six years and nine months on May 4, and is growing hair
where none has grown for 2 years.  He plays, has no problem
urinating/defecating, climbs, and runs (he didn't do that for most of the
time post surgery til when he started Lupron and I upped his lysodren)..."
 
"...If you have elevated estradiol, somewhere, something is going wrong.  If
the biopsy comes back normal adrenal, and you do have elevated sex steroids,
I think I'd opt for the Lupron to begin with and hold on the mitotane.
Monitor bloodwork and symptoms.  There may be extraadrenal tissue hiding
somewhere in the abdomen.  Robbie had an extra 1/2 cm wedge of spleen in a
piece of mesentery.  Had anyone done a splenectomy, a chunk of spleen would
have been left, that was active.  The classic model of this is in primates
(humans) with endometriosis.  There can be endometrial tissue a lot of
places in the abdomen other than the lining of the uterus.  A hysterectomy
may not stop the problem.  That is what Lupron was first designed for.  It
blocks the pituitary stimulation of all that endometrial tissue and of the
ovaries that can't be found/removed...."
 
"...I do think, as I've said all along, that surgery is only one part of
dealing with adrenal tumors.  Debulking is fine, but it doesn't stop the
pituitary-adrenal feedback loop which is busy stimulating the remaining
tissue to churn out sex steroids, and although you get some drop in steroid
production because of the tissue removal, there is still production going on
with the detrimental side effects (bone marrow depression, electrolyte
changes if cortisol is involved, which it is a little, prostatic changes
which puts pressure on the urinary system, etc etc ).  Chemotherapeutic
agents work on destroying remaining tissue (which is why I believe the pulse
dose works - it gives the body a chance to clear the necrotic cells so
toxins don't build up enabling you to use the drug longer at a more
effective level) and on blocking that feedback which is stimulating the
remaining tissue.  The neoplastic tissue will churn out the steroids on its
own, but it seems conclusive that the pituitary stimuli encourages it and
probably does have some effects.  That is why the Lupron works - cuts into
the feedback, as well as acts to block estradiol receptors.  I really think
we need to look at the whole picture: no one part is curative on its own..."
 
So there you have it... Thank you for listening!
 
Lynn Mc. and the gang of seven, including one very furry adrenal fuzzy
(five months on Lyosdren due to a huge, inoperable adrenal tumor, and trying
his wings on Lupron, to have the best shot at survival his momma can give...)
[Posted in FML issue 2209]