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Articles 2020-24 > Endocrino > Flashcards

Endocrino Flashcards

1
Q

What dosage of pergolide mesylate can be used in donkeys?
What is the new hypothesis of absoption?

A

Pergolide mesylate administration to donkeys at 2 μg/kg bwt orally q24h (same as horses) → well-tolerated, with plasma concentrations similar to or higher than concentrations achieved in horses dosed similarly.
This study provides the first report of oral transmucosal abs° in equids.

Pharmacokinetic properties of pergolide mesylate following single and multiple-dose administration in donkeys (Equus asinus)
evj 2023

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2
Q

Which months have the lowest and highest TRH-stimulated ACTH concentrations?

A

TRH-stimulated ACTH concentrations were lowest in February-May and highest in August-October.

Evaluation of seasonal influences on adrenocorticotropic hormone response to the thyrotropin-releasing hormone stimulation test and its accuracy for diagnosis of pituitary pars intermedia dysfunction
Vet J 2023

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3
Q

What is the clinical implications of imprecise sampling time for 10- and 30-min TRH stimulation tests ? Which protocol to prefer ?

A

10-min protocol : In one report, sampling 1 min early or late resulted in deviation of the ACTH concentration by ≥10% in 75% of horses and led to an erroneous diagnosis of PPID status in 21% horses.
30-min protocol : The gradient of the ACTH response curve to TRH administration is flatter at this time, resulting in less minute-to-minute variation.
⇒ Imprecision of >1 min is likely to be more impactful for the 10-min protocol.

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4
Q

What are the potential bone sequelae observed in horses with PPID?

A

Bone mineral density of lumbar vertebrae (nonweight bearing bones) can be decreased with PPID (L3, L4, L5) and could increase risk of developing pathological fractures. Not observed in weight bearing bones (third metacarpus or metatarsus)

Lumbar vertebral bone density is decreased in horses with pituitary pars intermedia dysfunction
evj 2024

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5
Q

What is the relationship between cortisol, ATCH and insulin in aged horses (> 15y) ?

A

There was no association between ACTH and cortisol.
Positive linear correlation between ACTH and post-OGT insulin in the autumn. In autumn, high ACTH was associated with ID, when no clinical signs of PPID were present.

Association between insulin dysregulation and adrenocorticotropic hormone in aged horses and ponies with no clinical signs of pituitary pars intermedia dysfunction
evj 2023

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6
Q

How to interpret ACTH dosage tests in PPID ?

A

The combination of clinical signs and age informs the index of clinical suspicion prior to diagnostic testing.
Both pre-test probability of disease and season of testing have strong influence on the ability to diagnose PPID using basal ACTH or ACTH after TRH stimulation.
Thus, it should be remembered that the risk of an FP result increases in situations where there is a low pre-test probability.

BEVA primary care clinical guidelines: Diagnosis and management of equine pituitary pars intermedia dysfunction
evj 2024

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7
Q

Does plasma ACTH dosage (basal and TRH-stimulation test) rather sensitive or specific?

A

The specificity of the test outweighs its sensitivity, indicating that low concentrations are more useful to rule out the disease than are high concentrations to confirm the disease.

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8
Q

What is the effect of breed on plasma ACTH in equids ?

A

Breed differences in basal ACTH concentrations have been reported. Some pony breeds, donkeys, and Arabians have higher basal ACTH concentrations than horses, particularly in autumn.
Breed and time of year should be considered when interpreting plasma ACTH concentrations in equids suspected for PPID.

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9
Q

Which breeds are predisposed to PPID ?

A

There is no evidence supporting a breed predisposition to PPID. Breed or type is of limited use for estimating pre-test probability.

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10
Q

What is the effect of age on plasma ACTH in equids ?

A

Association between increasing horse age and increased ACTH concentrations in healthy horses and ponies.

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11
Q

What is the prevalence of PPID in horses ?

A

The prevalence of PPID in equids aged ≥15 years is between 21% and 27%.
Odds of PPID increases by 18% in horses/ponies for every year > 15 years of age

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12
Q

What are the clinical signs associated with high clinical suspicion of PPID ?

A
  • Generalised or regional hypertrichosis
  • Delayed / incomplete hair coat shedding
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13
Q

What are the clinical signs associated with moderate clinical suspicion of PPID ?

A
  • Hyperhydrosis
  • Abnormal fat distribution / regional adiposity
  • Epiaxial muscle atrophy
  • Laminitis
  • Weight loss
  • Recurrent opportunistic infections
  • Behavioural changes / docility / lethargy
  • PUPD
  • Pot-bellied appearance
  • Bulging supra-orbital fat
  • Lordosis
  • Infertility
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14
Q

What is the effect of geographical location on plasma ACTH in equids ?

A

Significant effect of latitude on ACTH concentration has been reported in both northern and southern hemispheres, reflecting differences in photoperiod.
Latitude-specific reference intervals are required when interpreting ACTH concentrations for PPID diagnosis.

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15
Q

What factors influence ACTH concentration in healthy horses?

A
  • Age
  • Geographical location
  • Season
  • Breed
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16
Q

What factors are associated with pre-test probability of PPID ?

A
  • Age
  • Clinical signs
17
Q

How accurate is the basal ATCH assay in diagnosing PPID?

A

Basal ACTH concentration in aged horses showing specific clinical signs of PPID will have a high PPV based on a high pre-test probability.
Basal ACTH concentrations in young horses showing few or non-specific signs of PPID will have a lower PPV, based on a low pre-test probability.

18
Q

How accurate is the TRH stimulation test in diagnosing PPID?

A

Where basal ACTH results fall in the equivocal zone, the TRH stimulation test can be used for further evaluation. It has increased accuracy in the diagnosis of PPID, particularly in subclinical cases.

19
Q

What is the repeatability of TRH-stimulation test in mature horses ?

A

Good repeatability in non-autumn months when performed at intervals of 2–4 week. However, during the autumn, more variation should be expected.
Smaller response of ACTH to TRH stimulation when repeated within 1 day.
⇒ TRH simulation tests for PPID should not be performed at intervals shorter than 24 h.

20
Q

How does the feeding affect basal ACTH or ACTH response (10 min) to TRH administration for diagnosing PPID ?

A

Conflicting results
There may be some effect of diet and/or feeding vs fasting on basal plasma ACTH concentrations, and fasting may also be relevant to TRH stimulation tests.
For repeated sampling of the same individual, it is prudent to test under similar dietary conditions.

21
Q

What factors could influence basal ACTH concentration or ACTH response (10 and 30 min) to TRH administration for diagnosing PPID?

A
  • Diet
  • Critical illness
  • Breed
  • Transport or acute stress
  • Mild to moderate pain
  • Concurrent OST testing
  • Coat color ? (Grey horses may have higher basal ACTH than non-grey horses in autumn.)
22
Q

How does BCS affect basal ACTH concentration or ACTH response (10 and 30 min) to TRH administration for diagnosing PPID?

A

BCS may not impact testing for PPID

23
Q

What are the effects of pergolide on ACTH tests in PPID horses ?

A

Pergolide treatment lowers basal ACTH concentrations and improves the ACTH response to TRH stimulation in most animals.

24
Q

What are the effects of pergolide on clinical signs of PPID horses ?

A

Pergolide improves most clinical signs associated with PPID in most animals except laminitis

25
Q

Does PPID have a clinical impact on mares’ reproductive performance?

A

The reproductive performance of the high ACTH group was significantly lower than the other groups.

Relationship between endogenous plasma adrenocorticotropic hormone concentration and reproductive performance in Thoroughbred broodmares
JVIM 2021

26
Q

Does Chasteberry or cyproheptadine help in PPID horses ?

A

Chasteberry may improve some clinical signs of PPID but there is no proven effect on ACTH and there is no benefit to adding chasteberry to pergolide therapy.
Combination of cyproheptadine with pergolide is not superior to pergolide alone.

Articles 2020-24 (8 decks)

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