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Equine Medicine > Endocrine Diseases, Pt. 2 > Flashcards

Endocrine Diseases, Pt. 2 Flashcards

1
Q

Equine Metabolic Syndrome vs. Pituitary Pars Intermedia Dysfunction:

A
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2
Q

What 3 criteria are seen in equine metabolic syndrome? What 2 things contribute to these criteria?

A
  1. obesity and/or regional adiposity
  2. insulin dysregulation
  3. clinical or subclinical laminitis

genetics and environment (diet, pasture)

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3
Q

What are some higher genetic risk breeds associated with equine metabolic disorder?

A

“British-derived” ponies and “Andalusian/Spanish/Portuguese” breed

  • ponies, miniatures
  • Analusians
  • Morgans
  • Paso Fino
  • Saddlebreds
  • Warmbloods
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4
Q

What are the most common changes in BCS indicative of adiposity of EMS?

A
  • generalized obesity
  • cresty neck
  • regional fat deposits
  • absence of ribs
  • creased topline

“easy keepers”

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5
Q

What kind of tissue is adipose tissue?

A

active endocrine organ that secretes adipokines and cytokines that contribute to adverse local and systemic effects —> more weight gain, laminitis

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6
Q

BCS and EMS:

A
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7
Q

What kinds of horses have naturally cresty necks?

A

STALLIONS - used to attract females

NOT SEEN IN MARES

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8
Q

What are the most common sites for regional adiposity associated with EMS?

A
  • crest of neck
  • withers
  • behind shoulder
  • over the ribs
  • along the back
  • tailhead
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9
Q

How is insulin affected by EMS? What 2 things does this result in?

A

hyperinsulinemia (resting and in response to carbohydrate challenge) - increased secretion or decreased clearance

  1. insulin resistance
  2. insulin dysregulation
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10
Q

What is insulin resistance? When is it considered compensated and uncompensated?

A

cells fail to respond to insulin

  • COMPENSATED = hyperinsulinemia + decreased insulin sensitivity
  • UNCOMPENSATED = hyperinsulinemia + hyperglycemia
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11
Q

How is insulin dysregulation diagnosed?

A
  • fasting hyperinsulinemia
  • postprandial hyperinsulinemia
  • insulin resistance
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12
Q

What are 5 possible causes of hyperinsulinemia in EMS? What does this lead to?

A
  1. PPID
  2. obesity
  3. lack of exercise
  4. genetics
  5. high non-structural carbohydrates

laminitis (founder)

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13
Q

What is laminitis? What clinical signs are associated with laminitis in cases of EMS?

A

separation of the sensitive laminae that connect the horses hoof to the coffin bone (3rd phalanx), resulting in it rotating away and sinking into the sole of the hoof

  • front feet situating in front of horse instead of straight underneath
  • narrow-based stance when all hooves are affected
  • increased digital pulse
  • increased temperature of hoof
  • recurrent abscesses
  • hoof rings
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14
Q

What are the 3 forms of EMS?

A
  1. obese
  2. lean
  3. EMS + PPID
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15
Q

What clinical signs are associated with the 3 forms of EMS? What other signs are seen?

A
  1. OBESE - weight loss resistance, laminitis, cresty neck, SQ adipose deposits
  2. LEAN - laminitis
  3. EMS + PPID - laminitis +/- signs of EMS

DM, metabolic derangements, hyperlipemia, infertility, pedunculated lipomas, preputial/mammary gland edema

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16
Q

What endocrine tests are used for diagnosing EMS?

A
  • RESTING insulin
  • DYNAMIC post-prandial (OST) and tissue sensitivity (ITT) tests
17
Q

When is resting insulin concentrations not able to be used to diagnose EMS?

A

winter exacerbation of insulin levels = no testing December-Februrary

18
Q

How are resting insulin concentration levels performed?

A
  • keep pasture/hay the same, but keep horse fasted from grain 4 hours before the test
  • collect baseline blood in EDTA and serum separator tubes
  • centrifuge in 4 hours
  • separate plasma/serum
  • plasma = insulin; serum = glucose
19
Q

How is the oral sugar test performed?

A
  • fast for 3-6 hours
  • feed horse corn syrup
  • collect blood at 60 and 90 minutes
  • centrifuge samples within 4 hours of collection
  • separate plasma/serum
  • plasma = insulin; serum = glucose
20
Q

How is the insulin tolerance test performed? What risk is associated? How is it avoided?

A
  • horse does not need to be fasted
  • collect baseline blood sample in serum separator
  • administer 0.1 U/kg of insulin IV
  • collect another sample of blood within 30 minutes
  • centrifuge samples within 4 hours
  • separate serum and measure glucose levels

hypoglycemia - feed meal immediately after last sample

21
Q

Diagnosing EMS, endocrine testing:

A
22
Q

What are some endocrine tests used to diagnose EMS?

A
  • insulin baseline
  • OST
  • leptin baseline (increased internal adiposity)
  • adiponectin (Europe)
  • triglycerides
23
Q

What aspects of the 3 criteria of EMS are managed for treatment?

A
  1. OBESITY/ADIPOSITY - BCS, weight
  2. INSULIN DYSREGULAYION - insulin status, leptin
  3. LAMINITIS - clinical, radiological
24
Q

How is diet altered to manage EMS?

A
  • STOP treats and grain
  • hay intake should be 1.5% of BW and can be soaked
  • put horse in a dry lot or allow in regular pasture in the morning or with a muzzle
25
Q

What should be encouraged to help horses with EMS to lose weight?

A

evaluate foot health first, then encourage regular exercise an walking on pasture

26
Q

What 3 medical treatments are available for EMS?

A
  1. Levothyroxine
  2. SGLT2 inhibitors - Velaglifozin, Canagliflozin, Ertugliflozin
  3. Metformin
27
Q

When is Levothyroxine recommended to treat EMS? What is its purpose? How should dose be altered?

A

if EMS is resistant to management changes

induces mild hyperthyroidism to increase metabolism

reduce once weight loss is achieved and progressively wean off

28
Q

What 3 side effects are noted with Levothyroxine?

A
  1. hyperexcitability
  2. increased appetite
  3. coprophagia
29
Q

When are sodium-glucose cotransporter 2 (SGLT2) inhibitors recommended to treat EMS? What is its mechanism of action?

A

if there is laminitis and severe insulin dysregulation and owners are able to afford (expensive!)

inhibits glucose reuptake from glomerular filtrate = lost in urine

30
Q

What SGLT2 inhibitors are available for EMS?

A
  • Velagliflozin (not available commercially)
  • Canagliflozin, Ertugliflozin (DM in humans, limited equine data)
31
Q

When is metformin recommended to treat EMS? What does it do?

A

if there is poor owner compliance with diet

given 30 min prior to feeding or turnout (up to 3x daily) to decrease glucose absorption from the intestine

32
Q

What are 5 other alternative treatments for EMS?

A
  1. omega fatty acids - flaxseed, fish oil, algae DHA (decreases inflammation)
  2. resveratrol
  3. cinammon
  4. chromium
  5. apple cider vinegar

(derived from human diet strategies to lose weight)

33
Q

How does EMS compare to PPID?

A

EMS = all ages, diagnosed by insulin and glucose levels

PPID = comorbidity > 10 y/o, diagnosed by TRH stimulation and ACTH concentration

(insulin dysregulation is exacerbated by PPID)

Equine Medicine (33 decks)

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