26. PPID

Question 1

What does PPID stand for?

Answer 1

Pituitary Pars Intermedia Dysfunction

Question 2

What is PPID?

Answer 2

Slowly progressive age-related degenerative disease of the hypothalamic dopaminergic neuron hypothalamus

Question 3

What is HDN?

Answer 3

Hypodopaminergic neurons

Question 4

What is the pathophysiology of PPID?

Answer 4

Age degenerates he dopamine that usually down regulates POMC.

POMC increase ACTH leading to a Cushing’s like disease.

This is NOT Neoplastic

Takes place only in the pars intermedia

Question 5

What are the clincial signs of PPID?

Answer 5

Hypertrichosis - Hair coat change - color, guard hair, curly, delayed shedding
Muscle wasting (normal exercise)
Laminitis
Lethargy
Abnormal sweating
PU/PD
Tendon and ligament laxity
Regional adiposity
Recurrent infection
Infertility

Question 6

How do you test for PPID?

Answer 6

Baseline ACTH (Elevation indication)

TRH (Thyrotropin stimulating hormone (Elevation by a lot = indication (little is normal)

Question 7

What is key to remembering how to interpret your tests for PPID?

Answer 7

They are seasonal so need to look at right reference range

Question 8

How do you treat PPID?

Answer 8

Parasend or Pergolide (dopamine)

Question 9

What is the goal of treating PPID?

Answer 9

Correct the symptoms
-Lifelong treatment
-Refractory