What are the medical and surgical treatment options for adrenal gland disease in ferrets?

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Adrenal gland disease in ferrets is managed with either surgical adrenalectomy or medical suppression of sex steroid production, with the choice driven by surgical candidacy, concurrent disease, and owner preference. Surgical adrenalectomy is the treatment of choice for ferrets with adrenocortical tumors. Adrenalectomy of the diseased gland alleviates clinical signs in most ferrets and carries a good long-term prognosis, though recurrence of disease after surgery is possible.2 Surgery combined with hormonal suppression is an option for ferrets with certain adrenal tumors.2 Medical management is preferred when ferrets are geriatric, have concurrent disease, or surgery is declined for economic reasons. Available medical options manage clinical signs but do not cure the underlying adrenal disease — the gland may continue to enlarge despite treatment.3 Gonadotropin-releasing hormone (GnRH) agonists do not reduce tumor size or halt tumor growth, but do suppress clinical signs of adrenal disease.2 Medical management of adrenal tumors has a greater disease-free period compared to adrenalectomy.4 GnRH agonist therapy is the primary medical modality. Deslorelin acetate, a depot GnRH agonist, is administered as a subcutaneous implant; one ferret in the literature was managed with serial deslorelin implants, with the last placed 7 months prior to disease progression.6 Leuprolide acetate (depot suspension, 30-day formulation) is administered at 0.35 mg/kg IM every 30 days; fur regrowth was confirmed after 2 months of treatment in a ferret with hyperestrogenism.7 Secondary complications of adrenal disease require targeted management. Prostatic enlargement causing urinary obstruction and nonregenerative anemia from hyperestrogenism are both addressed within the medical management framework.3 Bone marrow suppression may occur in severe cases of hyperandrogenism.6 Clinical signs that should prompt evaluation and treatment include bilateral symmetrical truncal alopecia, vulvar enlar