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Endocrine > Equine Endocrinopathies > Flashcards

Equine Endocrinopathies Flashcards

1
Q

What is PPID? What are other names for it?

A

Pituitary pars intermedia dysfunction

Cushing’s
Adenoma
Equine hyperadrenocorticism

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2
Q

What are the most important hormones produced by the pars intermedia in horse? What regulated the pars intermedia?

A

ACTH
a-MSH
CLIP
B-endorphin

Dopamine and serotonin from hypothalamus

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3
Q

Outline the pathophysiology of PPID

A

1) Loss of dopamine inhibition in pars intermedia
2) Melanotropes hypertrophy
3) Melantropes undergo adenomatous change
4) Overproduction of pars intermedia hormones and compression of adjacent structures

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4
Q

What pathology does compression by hypertrophied pars intermedia cause in PPID?

A

Reduced ADH secretion

Blindness, seizures

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5
Q

Outline the typical signalment of PPID

A
  • 19yo
  • F=M
  • Ponies > horses
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6
Q

What are the early clinical signs of PPID?

A

Poor performance, lethargy
Reduced shedding of coat
Regional adiposity
Laminitis

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7
Q

What are the late clinical signs of PPID?

A 
Lethargy
Hypertrichosis
Muscle atrophy
Rounded abdo
Sweating
PUPD
Recurrent infections
Adiposity
Infertility
Laminitis
Hyperglycaemia
Neuro deficits, blindness
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8
Q

What causes hypertrichosis in PPID?

A

Pressure on hypothalamic thermoregulation centre

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9
Q

What causes laminitis in PPID?

A

Excessive cortisol +/- insulin

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10
Q

What causes weight loss in a PPID horse?

A

Metabolic effects of cortisol
Susceptibility to infection and parasites
Dental care

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11
Q

What causes profound sweating in PPID horses?

A

Long hair coat

Elevated catecholamines action on B-adrenergic controlled sweat glands

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12
Q

What causes PU/PD in the PPID horse?

A

Cortisol antagonising ADH in collecting ducts

Cortisol –> hyperglycaemia –> osmotic diuresis

Compression on pituitary –> reduced ADH

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13
Q

How is PPID diagnosed?

A 
Hx, signalment
Clinical signs
Basal ACTH
TRH stim
Insulin dysregulation
Histology
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14
Q

What hormone assay is used to diagnose PPID? What are problems with this test?

A

Basal ACTH

  • ACTH varies with season
  • Only 75% spec and sens –> chance of false +ve and -ve results
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15
Q

What dynamic test is used to diagnose PPID? Outline the test and what can affect the results…

A

TRH stim
Inject 1mg TRH IV - measure ACTH at 0 and 10 minutes

Season
Feeding

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16
Q

What can cause insulin dysregulation in PPID? Why does this worsen prognosis?

A

Cortisol antagonises insulin
CLIP stimulate insulin secretion
Inflammation and oxidative stress from EMS –> PPID

Increased risk of laminitis

17
Q

What is the most life-limiting clinical sign of PPID? How can clinical signs be managed?

A

Laminitis

  • prevent/treat lami
  • prevent/treat 2’ infections
  • clip coat
  • alter diet
18
Q

How can PPID be managed medically?

A

Pergolide - dopamine agonist that inhibits pituitary gland

19
Q

How is PPID treated/managed?

A

Manage clinical signs
Medication
Diet and exercise
Monitor wt and BCS

20
Q

How should PPID be monitored?

A

Improvement of CS

Repeat ACTH/TRH stim

21
Q

What is the prognosis for PPID?

A

Good, although life long

Euthanasia is usually due to laminitis

22
Q

What is EMS?

A 
Equine Metabolic Syndrome
A combination of:
- Insulin dysfunction
- Increased fast tri levels
- Altered adipokines
- +/- obesity
- Increased risk of laminitis
23
Q

Outline the current theory for EMS pathogenesis…

A

Horses on pasture high in WSC:
Prolonged insulinaemia –> endothelial dysfunction –> laminitis
Hindgut carb overload –> inflammatory injury to laminae

24
Q

What is the theory for pathogenesis of endocrinopathic laminitis?

A

Insulin binds to receptors in lamellar tissue –> increase cell growth, adhesion and survival –> lamellar epidermal cell proliferation and weakening

25
Q

How is EMS diagnosed?

A

History, signalment
Clinical signs
Resting glucose/insulin conc
Dynamic tests - oral glucose/sugar test

26
Q

Outline the typical signalment of EMS

A

Good doers
<15yo
Ponies, arabs, morgans

27
Q

What are the clinical signs of EMS?

A

+/- obesity

+/- regional adiposity

Recurrent laminitis

28
Q

Outline dynamic tests used to diagnose EMS…

A

Oral sugar/glucose test - measure insulin a 0 and 60/120 mins

Insuline tolerance test - measure blood glucose at 0 and 30 mins

29
Q

What levels in the blood can be measured to diagnose EMS?

A

Adiponectin

Tri levels

30
Q

How is diet in obesity-related EMS managed?

A 
No grain or pasture - only hay
Limit WSC intake
1.5% bw feed
vit and mineral supplementation
weight every 30 days
31
Q

What effects does exercise have in treating obesity-related EMS?

A

Promotes glucose uptake and use by skeletal muscle

Improves insulin sensitivity

Reduces inflammation

Decreases feed intake

32
Q

What pharmacological intervention can be used to treat obesity-related EMS?

A

Metformin - improves insulin sensitivity, decreases insulin conc

Thyroxine - increases metabolic rate

Chromium, magnesium, cinnamon

33
Q

How is diet in lean EMS managed?

A

Low glycaemic diet
Low NSC, high fat, high quality fibre
Vit/mineral/protein ration balancer

Endocrine (10 decks)

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