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Equine I > Endocrine disease > Flashcards

Endocrine disease Flashcards

1
Q

What does PPID stand for?

A

Pituitary pars intermedia dysfunction

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2
Q

PPID - what is it?

A

Slowly progressive, degenerative disease of the hypothalamic dopaminergic neurons

Loss of dopaminergic control of the pars intermedia melanotropes causes hyperplasia and formation of adenoma of the PI

POMC -> loss of peptides abnormally elevated

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3
Q

PPID - chances of disease

A

Age related neuro-degeneration, advancing age is the only known risk factor

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4
Q

Clinical signs of PPID

A

Varies and changes over time if untreated

Hypertrichosis (pathognomic)

Coat retention/patchy shedding and coat colour changes (suggestive)

Chronic laminitis may be a feature

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5
Q

Early clinical findings in PPID

A

Regional hypertrichosis/delayed shedding (strongly suggestive)

Loss of topline muscle, change in attitude/lethargy, decreased performance, abnormal sweating (suggestive)

Infertility, tendon or ligament laxity, desmitis/tendonitis, regional adiposity, laminitis (possible comorbidities)

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6
Q

Advanced clinical findings of PPID

A

Generalised hypertrichosis (strongly suggestive)

Abnormal sweating, topline muscle atrophy, altered mentation, exercise intolerance, rounded abdomen, PU/PD, recurrent infection (suggestive)

Recurrent corneal ulcers, infertility, increased mammary gland secretions, tendon/ligament laxity, desmitis/tendonitis, regional adiposity, laminitis (possible comorbidities)

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7
Q

Which horses should be tested for PPID?

A

Don’t just test without justification

PPID could be a contributing factor for many disorders

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8
Q

Simple tests for PPID

A

ACTH ***

a MSH
b endorphin
cortisol
glucose
insulin
urine cortisol:creatinine

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9
Q

Dynamic tests for PPID

A

TRH stim test (ACTH) **
Overnight dexamethasone suppression test

ACTH stim test
combined ODST/TRH
domperidone stim test
8hr cortisol difference
TRH stim test (cortisol)

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10
Q

Basal ACTH concentration

A

Variation with time of year

Variation with individuals

Labs have ‘seasonally adjusted reference intervals’

Increase in autumn in normal horses and ponies AND those with PPID

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11
Q

How to interpret basal ACTH

A

Interpret with context (clin signs, age)

Up to 25% with PPID have a grey zone result - positive diagnosis justified if strong clinical suspicion

Up to 30% of non-PPID horses fall in grey zone for other reasons so ignore if nothing else to support diagnosis

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12
Q

When not to test basal ACTH

A

Pain - severe pain for at least 24hrs (elevates ACTH - false positive)

Travelled in past 12hrs (elevated due to stress)

Testing in laminitic horses only a problem if severe pain

If negative results after these situations that is still helpful.

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13
Q

Treatment for PPID

A

Pergolide (Prascend) - only licensed medicine

Replace dopaminergic control of the pars intermedia

Good response in the majority of cases

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14
Q

Negative effects of pergolide

A

Sometimes transient inappetance - stop and restart at a lower dose after a week or two

Can be more fatal in shetlands or donkeys - can cause hyperlipaemia (can be fatal)

Reduces milk production (not often an issue)

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15
Q

What to expect after pergolide treatment for PPID

A

Normalised in 37%
>50% inprovement in 38%
<50% improvement in 25%

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16
Q

Monitoring PPID

A

Checking insulin (risk of laminitis) and clinical improvement

If ACTH conc is still a bit high but doing well otherwise don’t chase numerical ACTH conc with increasing pergolide dose - instead split the dose into BID

17
Q

Management for PPID cases

A

Low starch and sugar feeding

Regular foog trimming to keep feet balanced

Make sure dentistry problems are detected and treated early - enamel points, loose molars

Parasite control

18
Q

What % of laminitis cases have underlying endocrinopathy?

A

90%

19
Q

What is EMS characterised by?

A

Insulin dysregulation

Obesity (generalised or regional)

Increased (high) risk of laminits

Altered adipokines

Dyslipidaemia

20
Q

Breeds overepresented in EMS studies

A

Native ponies
PRE (spanish/portuguese horses)
Morgan horses
Warmbloods (arabs, thoroughbreds)
Paso finos
Saddlebreds
Miniature horses

BUT can happen in any breed

21
Q

How to recognise adiposity

A

Generalised obesity

Regional fat deposits
- rump
- cresty neck
- sheath/mammary gland
- intra-abdominal

22
Q

Signs of subclinical laminitis

A

Divergent rings (growth ring wider at heel than toes)

Footsore after trimming

‘Doesn’t like hard ground’

Flat soles
Dropped soles
Widening white line

23
Q

How long do divergent growth rings on hooves take to appear?

A

> 3 months

24
Q

How to diagnose insulin dysregulation

A

Simple unfasted resting basal samples:
- glucose
- insulin
- triglycerides

Post feeding samples (corn syrup) - take sample 45-60 mins later

25
Q

Adiponectin

A

Associated not with the anount of fat but with the negative consequences of body fat present.

Adipokines are peptides produced by adipose tissue that act locally and systemically.

26
Q

What does low adiponectin correspond to?

A

Metabolic obesity and insulin dysregulation - increased risk of laminitis

27
Q

EMS management recommendations

A

If only a few regional fat deposits then tight calorie control not as relevant.

Do not recommend exercise until laminitis has resolved and foot capsule is stable.

28
Q

Diet for PPID

A

Make sure starcha nd sugar component of diet is ALWAYS <10%

Fibre and oil doesn’t impact insulin dysregulation and laminitis even if making them overweight

Cannot be <1% BWT as DM intake per day

29
Q

What does soaking foarge do?

A

Takes out some water osluble sugars

Longer its soaked for, the more sugars taken up

In summer the warmth can make it foul

In winter the wet hay can be very unappetising

Try low starch/sugar haylage instead

30
Q

Medicines used for PPID

A

Metformin

Levothyroxine

Gliflozins (velag, cannag, ertug)

31
Q

What is the MoA of the gliflozins?

A

SGLT2 inhibitors

32
Q

DOes metformin help PPID?

A

First pass effect in liver

Really safe but likely makes little difference

Impairs glucose absorption in horses

Reduces insulin response to glucose ingestion

Cannot replace diet and management changes

May aid weight loss and protect against diet-induced hyperinsulinaemia

33
Q

Levothyroxine

A

Speeds up metabolism

When on it they become hyperthyroid as they weren’t hypothyroid in the first place

Makes them restless and hungry

34
Q

Indications for high dose levothyroxine

A

For cases with weight loss resistance (no response in a minimum of 30 days) or for accelerated management of obesity in acute laminitis cases.

Gradually reduce dose and discontinue treatment after weight loss achieved or after 3-6 months of therapy

35
Q

Indications for glifozin use

A

When horses are severely affected by laminitis and severe insulin dysregulation that is not responding to other measures.

Horses with marked hypertriglyceridaemia should not be treated with these drugs.

36
Q

What do gliflozins do?

A

Spill glucose from the kidneys

Massively lowers insulin in most patients

Risk of TGs elevation is high and sometimes to a clinically important/life threatening level

Some adverse events/idiosyncratic events of liver disease reported

Equine I (21 decks)

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