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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.

27
Q

What is the clinical efficacy of canagliflozin in ID horses ?
A- Canagliflozin decreased mean insulin concentration during OST, decreased body weight and increased triglyceride concentrations.
B- Canagliflozin decreased mean insulin concentration during OST and decreased body weight of horses, and did not impact triglyceride concentrations.
C- Canagliflozin decreased mean insulin concentration during OST and increased triglyceride concentrations, but did non decrease body weight of horses.
D- Canagliflozin was uneffective in decreasing hyperinsulinemia in ID horses.

A

A- Canagliflozin decreased mean insulin concentration during OST, decreased body weight and increased triglyceride concentrations.
Canagliflozin is a promising drug for treatment of ID horses that requires future studies.

Short-term effects of canagliflozin on glucose and insulin responses in insulin dysregulated horses: A randomized, placebo-controlled, double-blind, study
jvim 2023

28
Q

What is the clinical efficacy and side effects of ertugliflozin in HAL horses ?

A

After 30 days of treatment with ertugliflozin, there were:
- a reduction in insulin concentrations,
- lowering of insulin concentration in response to OST,
- improvement in modified Obel laminitis scores,
- increase in median serum triglyceride concentrations, but without any clinical signs of hyperlipaemia,
- 19% of PUPD during treatment.
Clinical efficacy observed by 4 days of TT.

Preliminary observations on the use of ertugliflozin in the management of hyperinsulinaemia and laminitis in 51 horses: A case series
eve 2023
Oral sugar test responses to ertugliflozin in ten horses with insulin dysregulation
eve 2024

29
Q

What is the more sensitive and specific test to diagnose ID in ponies between basal insulin concentration, OST and ITT ?
Is this test correlated with risk of laminitis ?

A

Basal insulin (BI) → Se 52% ; Spe 97% (low sensitivity)
OST → Se 84% ; Spe 60% (low specificity)
ITT → Se 85% ; Spe 88%
But only BI and the OST were associated with laminitis

Evaluation of field-testing protocols to diagnose insulin dysregulation in ponies using a Bayesian approach
vet J 2023

30
Q

Does continuous digital hypothermia effective in the treatment of hyperinsulinemic associated laminitis (HAL) ? What are the suspected mechasnisms ? (3 points)

A

Continuous digital hypothermia (CDH) prevents lamellar failure in the euglycemic hyperinsulinemic clamp (EHC) model of laminitis. These data add further support for the use of CDH as a first aid treatment for severe acute laminitis associated with hyperinsulinemia in horses.
Suspected mechanisms :
- decrease of pro-inflammatory cytokines and chemokines,
- decrease in lamellar glucose metabolism without affecting glucose concentration,
- decrease perfusion.

Effect of digital hypothermia on lamellar inflammatory signaling in the euglycemic hyperinsulinemic clamp laminitis model
jvim 2020
The effect of continuous digital hypothermia on lamellar energy metabolism and perfusion during laminitis development in two experimental models
evj 2020

31
Q

What is the mechanism of hyperinsulinemic associated laminitis during EHC model ?
A- Laminitis developed without evidence of lamellar hypoperfusion or energy stress. Therapies to improve perfusion are unlikely to affect the initial development of endocrinopathic laminitis.
B- Laminitis developed without evidence of lamellar hypoperfusion, but there was evidence of energy stress. Therapies to improve perfusion are unlikely to affect the initial development of endocrinopathic laminitis.
C- Laminitis developed with evidence of lamellar hypoperfusion, but no evidence of energy stress. Therapies to improve perfusion are likely to affect the initial development of endocrinopathic laminitis.
D- Laminitis developed with evidence of lamellar hypoperfusion and energy stress. Therapies to improve perfusion are likely to affect the initial development of endocrinopathic laminitis.

A

A- Laminitis developed without evidence of lamellar hypoperfusion or energy stress. Therapies to improve perfusion are unlikely to affect the initial development of endocrinopathic laminitis.

Lamellar energy metabolism and perfusion in the euglycaemic hyperinsulinaemic clamp model of equine laminitis
evj 2020

32
Q

What changes are observed during laminitis models?
A- Hypoaminoacidemia
B- Hyperaminoacidemia
C- No impact of insulin on plasma amino acid concentration
D- Nobody knows

A

Hypoaminoacidemia develops in EHC and PGI
laminitis models.
This finding may have relevance to laminitis because hypoaminoacidemia affects cell adhesion and cytoskeletal dynamics in human cells.

Plasma amino acid concentrations during experimental hyperinsulinemia in 2 laminitis models
jvim 2021

33
Q

What is the impact of intrasynovial triamcinolone treatment on the incidence of laminitis in a large population of sport horses ?

A

Intrasynovial triamcinolone acetonide administration does not increase the risk of laminitis in this study population.
A recent knowledge summary found “no conclusive evidence to support a causal association between therapeutic systemic corticosteroid administration and the development of laminitis in healthy adult horses/ponies”.

Intrasynovial triamcinolone treatment is not associated with incidence of acute laminitis
evj 2021

34
Q

What is the prevalence and risk factors associated with laminitis in donkeys ?

A

Prevalence of laminitis in UK Donkey Sanctuary ∼49%
Risk factors differ from those reported in horses:
- more likely to be younger,
- less likely to get extra feed or have an additional medical problem,
- less likely to have undergone dental work, movement, imaging or surgery in the month preceding the episode.

Cross- sectional study to identify the prevalence of and factors associated with laminitis in UK donkeys
evj 2022

35
Q

What is the current hypothesis regarding the pathophysiology of supporting limb laminitis (SLL) ?

A

Lamellar inflammatory signaling was higher in tissue from horses subjected to prolonged unilateral weight-bearing, suggesting that these pathways could be relevant to the pathophysiology of SLL.

Digital lamellar inflammatory signaling in an experimental model of equine preferential weight bearing
jvim 2023

36
Q

Which diagnostic tests best quantify the risk of future laminitis development in nonlaminitic ponies ?

A
  • Basal insulin (unfasted)
  • OST (insulin T60 post corn syrup 0,3 mL/kg)
  • Adiponectin concentration
  • Divergent hoof growth

Predictors of laminitis development in a cohort of nonlaminitic ponies
evj 2023

37
Q

Which assessment is true about vitamin D status in horses ?
A-25(OH)D3 is the predominant metabolite in horses, which is depending on season.
B- 25(OH)D2 is the predominant metabolite in horses, with a seasonal effect and without endogenous production of vitamin D3.
C- 25(OH)D3 is the predominant metabolite in horses, which is independent on season.
D- 25(OH)D2 is the predominant metabolite in horses, which is independent on season.

A

Answer B
In horses, 25(OH)D2 is the predominant vitamin D metabolite, and there is an apparent lack of endogenous vitamin D3 production. In grazing ponies, 25(OH)D2 concentrations were significantly higher on long days compared to short days.

The effect of season, management and endocrinopathies on vitamin D status in horses
evj 2023

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