Equine metabolic syndrome

Question 1

What are the three factors of EMS?

Answer 1

• Obesity - predisposition - generalised / regional
• Laminitis = clinical effect
• Insulin dysregulation = primary pathophysiology

Question 2

What are risk factors for EMS?

Answer 2

• Obesity
• Age
• Mares
• Breed - Welsh pony breeds
• Genetics
• Sedentary main activity - showing, breeding, companions

Question 3

What associated hoof problems can you get as well as laminitis?

Answer 3

• Foot abscesses
• Seedy toe / white line disease
• Abnormal growth rings
• Dropped sole

Question 4

How is EMS diagnosed?

Answer 4

• Identify insulin dysregulations
  1. Basal hyperinsulinaemia - fed/fasted
  2. Exaggerated insulin response to feed - oral glucose test
  3. Tissue insulin resistance - CGIT, insulin tolerance test
  4. Risk factors for insulin dysregulations - tests for PPID/obesity
• Proxies
• Dynamic testing - oral glucose test / oral sugar test

Question 5

How does EMS clinical syndrome compare to PPID?

Answer 5

 Younger than horses or ponies with PPID
 No hypertrichosis
 Negative for PPID on dynamic and basal tests
 normal basal ACTH
 negative TRH stimulation test or ODST
 absence of pituitary pathology
 Positive diagnostic tests for PPID in EMS cases means concurrent endocrinopathies

Question 6

What are the treatment aims of equine metabolic syndrome?

Answer 6

1. Reduction of hyperinsulinaemia/ improvement of insulin sensitivity (regulation)
2. Reduction of the predisposing factors
   - obesity management
3. Treatment and management of laminitis
4. Monitoring response

Question 7

How is hyperinsulinaemia managed?

Answer 7

• Diet
• Exercise
• Drug therapy
• Nutraceuticals

Question 8

How is obesity managed?

Answer 8

• Diet - soak hay + reduce caloric intake - provide salts
• Exercise - better than diet if possible (as it improves insulin sensitivity)