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Equine (fourth year) > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

what does PPID stand for?

A

pituitary pars intermedia dysfunction

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2
Q

what are the three main parts of the pituitary gland?

A

pars distalis
pars intermedia
pars nervosa

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3
Q

what does the pars distalis produce?

A

prolactin, growth hormone, TSH, FSH, LH

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4
Q

what does the pars nervosa produce?

A

ADH and oxytocin

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5
Q

what does the pars intermedia produce?

A

ACTH and MSH

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6
Q

what is the pars intermedia receive information to release hormones?

A

neurotransmitter release from axons from the hypothalamus

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7
Q

what neurotransmitter inhibits release of ACTH and MSH from the pars intermedia?

A

dopamine

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8
Q

what neurotransmitter is responsible for PPID?

A

dopamine

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9
Q

why does the pars intermedia receive neurotransmitter from the hypothalamus unlike the pars distalis?

A

pars intermedia is poorly vascularised

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10
Q

how does the pars nervosa receive information regarding release/inhibiting hormone release?

A

direct axonal connection with hypothalamus

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11
Q

what hormones are released in excess from the pars intermedia in PPID cases?

A

beta-endorphin, alpha-MSH and ACTH

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12
Q

what is the first change within the body of a horse with PPID due to the decreased dopamine inhibition?

A

hyperplasia of the pars intermedia (due to increased hormone release)

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13
Q

what is MSH?

A

melanocyte stimulating hormone

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14
Q

what is alpha-MSH produced from in the pars intermedia?

A

ACTH (ACTH is processed further than in the other parts of the pituitary)

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15
Q

what is the only predisposing factor to PPID?

A

horses older than 15 (rarely less than 10 years old)

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16
Q

PPID is due to lack of dopamine inhibition on the pars intermedia, what type of disease does this mean PPID is?

A

neurodegenerative

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17
Q

what are the clinical signs of PPID?

A

hypertrichosis (delayed/abnormal shedding to a thick curly coat)
laminitis
weight loss/redistribution
wasted epaxial muscles and pot belly
bulging supraorbital fat
lethargy/reduced exercise tolerance
sweating
PUPD

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18
Q

what is hypertrichosis?

A

increased hair growth or delayed shedding

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19
Q

why is it important to confirm PPID diagnosis before treatment?

A

treatment will be lifelong
needed for monitoring horse (ACTH value)
determine if they have insulin dysregulation (laminitis risk)

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20
Q

how can you determine if a horse with PPID will develop laminitis?

A

evidence of insulin dysregulation

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21
Q

how is PPID diagnosed?

A

basal ACTH (don’t do when horse is stressed)

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22
Q

what type of tube is used to collect blood for a basal ACTH?

A

purple top tube (EDTA)

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23
Q

what time of year does basal ACTH test have the highest sensitivity?

A

autumn

24
Q

what is the dynamic endocrine test for PPID?

A

ACTH response to TRH (not used very much in this country)

25
Q

how commonly is the low dose dexamethasone test used for PPID used?

A

never in UK - invalid

26
Q

what needs to be considered along with the basal ACTH test results for PPID?

A

horses age and clinical signs

27
Q

what value should be used for the basal ACTH test if there are clear clinical signs and the horse is older than 15 years old?

A

lowest value (rule in the diagnosis) - low values have high sensitivity

28
Q

what value should be used for the basal ACTH test if there is no clear clinical signs of PPID?

A

upper value (rule out diagnosis) - high values have high specificity

29
Q

are induction of liver enzymes and stress leucograms seen in horses with PPID?

A

no (these should be investigated as a concurrent disease)

30
Q

what is basal endocrine test used for PPID, that is not diagnostic?

A

glucocorticoid and insulin levels

31
Q

what is the treatment for PPID?

A

pergolide (dopamine agonist)

32
Q

how often should horses be monitored when being treated for PPID?

A

monthly in early stages to get the correct dose then every 3 months

33
Q

what is used to monitor PPID treatment?

A

basal ACTH

34
Q

how much can the dosage of pergolide be increased in PPID treatment?

A

5 times the original dose

35
Q

should horses with PPID be put on a diet to prevent laminitis?

A

no - already have catabolism so don’t want to exacerbate this

36
Q

how long are horses treated for PPID for?

A

lifelong

37
Q

how is hypothyroidism tested for?

A

TRH stimulation of T3 and T4

38
Q

what does EMS stand for?

A

equine metabolic syndrome

39
Q

what does insulin do?

A

drives glucose into cells (decreases blood glucose levels)

40
Q

if the target cells fail to respond to insulin, what is this called?

A

type 2 diabetes

41
Q

what is EMS?

A

collection of risk factors for endocrinopathic laminitis

42
Q

what is the most important factor of EMS that leads to endocrinopathic laminitis?

A

insulin dysregulation

43
Q

what are the three main factors of EMS?

A

obesity
laminitis
insulin resistance

44
Q

what are the typical features of a obese horse (predisposing to EMS)?

A

bulging supraorbital fat
enlarged crest
fat pads

45
Q

what are the risk factors for EMS?

A

obesity
genetics

46
Q

what does the insulin resistance have to be driven by to develop EMS and laminitis?

A

hyperinsulinaemia (by feeding high carbohydrate diet)

47
Q

how is EMS diagnosed?

A

by diagnosing hyperinsulinaemia (using resting insulin)

48
Q

what is the cut off point for unpasted insulin levels? (relating to EMS)

A

if its greater than 20 uIU/ml it has EMS

49
Q

what is used as a dynamic test for EMS?

A

oral sugar/glucose test

50
Q

how is the oral sugar/glucose dynamic test for EMS carried out?

A

fast horse for 6-12 hours then feed and sample blood 2 hours later

51
Q

other than insulin resistance, what are the other clinical signs of EMS?

A

high blood pressure
hypertriglyceridaemia
mild basal cortisol elevation

52
Q

what age horses can be effected by EMS?

A

any (younger than PPID)

53
Q

how can EMS be managed?

A

reduce predisposing factor (obesity)
reduce hyperinsulinaemia
treat/manage laminitis
monitoring

54
Q

is diet or exercise better for managing obesity and EMS?

A

exercise

55
Q

what is done to the diet to manage obesity in EMS horses?

A

reduce caloric intake (give 1.5-2% body weight hay)
needs to be monitored and give protein, vitamins, minerals and salt supplements

56
Q

how can hyperinsulinaemia be managed?

A

exercise
diet
drug therapy (thyro L)
nutraceuticals

Equine (fourth year) (11 decks)

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