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UPDATED GUIDELINES FOR PPID
NEW PPID DIAGNOSTIC RECOMMENDATIONS ARE NOW AVAILABLE FROM THE EQUINE ENDOCRINOLOGY GROUP.1
Pituitary pars intermedia dysfunction, or PPID, also called
“equine Cushing’s disease,” can sometimes be difficult to diagnose. To help veterinarians identify and test for this disease, the Equine Endocrinology Group (EEG) updated its recommendations to include updated reference ranges for ACTH while also adding additional early and advanced signs of the disease.
There are two types of procedures available for PPID testing. TRH stimulation procedure (measuring ACTH at T0 and T10) is used for horses with early signs of PPID or suspected horses with a normal resting ACTH. Resting ACTH is recommended for the suspected PPID horse with moderate or advanced clinical signs. If resting ACTH is normal or equivocal in horses with advanced signs, the follow-up procedure is the TRH stimulation.
Seasonal variations in ACTH have been previously
documented in the horse. Testing in the fall months has been shown to increase the sensitivity of resting ACTH in horses with signs of early PPID. TRH stimulation testing in the fall is not recommended as sufficient data to establish accurate cutoff values is being further evaluated.
It’s
important for veterinarians to use seasonally adjusted resting ACTH reference ranges specific for the time of year they’re testing for PPID.
1
For horses showing signs of PPID, Boehringer Ingelheim offers complimentary testing for up to three horses per veterinarian. This testing is part of a study to identify epidemiological information for horses with PPID at initial diagnosis. This offer continues through June 13, 2018. For more information about complimentary testing and the complete 2017 EEG diagnostic guidelines for PPID, please visit
www.test4PPID.com.
Recommendations for the Diagnosis and Treatment of Pituitary Pars Intermedia Dysfunction, Equine Endocrinology Group. Available at
https://sites.tufts.edu/equineendogroup/files/2017/11/2017-EEG-Recommendations-PPID.pdf. Accessed February 14, 2018.
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“If a horse is borderline for PPID after a resting ACTH test, veterinarians can then utilize the TRH stimulation procedure, giving a more precise diagnosis,” says Steve Grubbs, DVM, PhD, DACVIM, equine technical manager for Boehringer Ingelheim. “Information from the history, clinical signs and testing results should all be utilized when making the diagnosis of PPID. Each aspect is extremely important for the proper diagnosis.”
The new EEG guidelines also updated the clinical presentation of the early and advanced signs of PPID. Additions to early signs include abnormal sweating (increased or decreased), infertility, desmitis and tendonitis. Additions to the advanced signs include dull attitude/altered mentation,
excessive mammary gland secretions and suspensory ligament laxity.
exercise intolerance,
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