Showing posts with label ACTH. Show all posts
Showing posts with label ACTH. Show all posts

Wednesday, January 31, 2018

Laminitis research: Feeding a high starch diet can influence PPID (Equine Cushings Disease) test results



Summary: New research, conducted in collaboration with the British horse feed company SPILLERS®, has shown that the equine diet, and more specifically, a starch rich food, can influence adrenocorticotropin hormone ,or ‘ACTH’, test results. This could potentially lead to an incorrect disease diagnosis in some horses when ACTH is used to test for Pituitary Pars Intermedia Dysfunction (PPID).

Key point: The threshold values for diagnosis of the disease currently vary dependent on the season, but these new findings suggest that diet should also be considered. 

Hoof Blog note: Laminitis in older horses is commonly blamed on PPID, but a definitive diagnosis by hormonal test results is required to determine if an underlying endocrine condition is the cause of laminitis. Some horses with PPID may lose weight, which might lead owners to increase feed or change to a higher-starch diet to counter weight loss. Horse owners and veterinarians should communicate about a horse's feed intake before testing; future research may reveal more specific guidelines about how feed type influences test results.

Wednesday, December 04, 2013

PPID: Equine endocrinology researchers revise guidelines for "Cushings" tests for horses


Equine Cushings Disease or pituitary pars intermedia dysfunction (PPID) has been easy to identify, with overt signs like a long coat. Underlying PPID is now being identified in younger horses and in horses that show none of the typical signs. Researchers say that an episode of otherwise-unexplained laminitis may be their first and only clue. 
Edited from press release

Equine pituitary pars intermedia dysfunction (PPID) can be detected earlier and more reliably with a new set of guidelines developed by the Equine Endocrinology Group (EEG), a body of leading veterinarians and researchers in the field of equine endocrinology.

Tuesday, September 04, 2012

Autumn Laminitis: Prepare to Prevent--Instead of Treat--Seasonal Flair-Ups of Endocrine Conditions in Horses

This is what a foot looks like after laminitis...could this damage and deformation have been prevented? In Great Britain, a study found that 43 percent of horse owners waited more than a week after suspecting laminitis before seeking veterinary intervention. (Boehringer Ingelheim photo)

If Labor Day is over, can autumn laminitis season be far behind?

This summer's drought has been relieved in some states, but many of the horses in the United States are standing in parched pastures, munching on hay, as they have been all summer. The drought put a quick end to the grazing season in many states, and horse owners have been saddled with increased hay bills.

Horse owners who grow their own hay found that they were feeding it as soon as they baled it. Second cuttings were poor in many areas. And a third cutting probably isn't even going to happen.

Fall rains usually send a dark green growth spurt up through brown pastures and with this signal comes the warning to horse owners that the fall can be just as dangerous as spring for horses to develop laminitis as they gorge on the grass.

This video from the British Veterinary Association's Animal Welfare Foundation is a quick primer on the general disease of laminitis and features veterinarian Ben Mayes, president of the British Equine Veterinary Association.

Recent research has shown us that the lush grass does not, by itself, cause laminitis. If two horses had a grazing contest, it's possible neither of them would develop laminitis no matter how much they eat.

But if one or both horses has an endocrine system vulnerable to cycling hormones that may cause laminitis when and if they are pushed, the results can be a stretched white line, hoof rings, a gimpy gait, or full-fledged laminitis.

The time to be vigilant is now, while it is still technically summer and the nights are still pretty warm. But across the country, night-time temperatures are dipping, and snow will soon be showing up on high peaks of the mountains.

Laminitis is a wholly preventable disease, and in the case of endocrine-related laminitis, it is part of a larger syndrome that indicates the horse may have a problem in the way the body processes glucose, in that the condition of insulin resistance prevents normal glucose metabolism or that circulating hormones are elevated by pituitary pars intermedia dysfunction (PPID).

Is this your perception of a horse with Cushings syndrome (PPID)? While there are still plenty of older horses with the problem out there, the obvious change in hair coat is not seen in the early-teens horses whose blood tests yield information about high levels of the pituitary hormone ACTH. (Photo © Dr. Christian Bingold, Pferdeklinik Großostheim, used with permission)

Some of the recommended management suggestions include evaluating a horse's weight and condition and stepping up the exercise for horses kept at pasture during the fall months when risk is increased.

Another simple thing that horseowners can do is get their hay tested. Some hay can have as much or even more sugar than pasture grass. Soaking hay or feeding lower calorie hay to horses with higher laminitis risk quotients may be helpful.

Additionally, horse owners can ask for help from farriers this time of year. Ask to see or photograph the horse's feet after they have been trimmed--is the white line tight or is it stretched? Are there red spots in the line? Ask the farrier if the hoof wall is smooth and healthy or if it is ridged and has "fever rings" that are telltales of some disruption in the horse's diet or metabolism in recent months.

Finally, testing a horse's ACTH levels is now recommended to be done in the fall. Boehringer Ingelheim, manufacturers of the PPID medication Prascend, has recommended that the testing for Cushing's be done in the fall, when differences in test results would be most evident.


Dr. Don Walsh of the Animal Health Foundation explains the basic tenets of laminitis prevention, including insulin resistance and Cushings syndrom (PPID) in this brief video.

Current thinking and evidence suggests that 90 percent of laminitis cases occur as a result of an underlying hormonal condition(1,2) such as Cushing’s disease (PPID) or Equine Metabolic Syndrome. With this in mind, owners - particularly those with a horse over 10 years of age - are being urged to get their horses tested for Cushing’s as soon as possible if they suspect that the horse may be suffering from laminitis, or even if it simply appears a little foot-sore.

Despite the severity of laminitis, only two-thirds of laminitis cases reported by owners in Great Britain were treated by a veterinarian (3) and, in one study, 43 percent of horse owners waited more than a week after suspecting laminitis before seeking veterinary intervention (4).

Boehringer Ingelheim Vetmedica's data shows that one third of laminitic middle aged horses (defined as between the ages of 10 and 15 years) test positive for PPID (Cushing's)(5).

Over 3,100 horses were tested for Cushings as part of the company's Talk about Laminitis campaign in Great Britain during the spring of 2012. The pharmaceutical company is offering free testing for Cushing's in Great Britain again this fall, thanks to the Redwings Horse Sanctuary, which is providing funding.

Horse owners may have to pay for the ACTH and insulin resistance tests in the United States, but there is no price that can be put upon the peace of mind of knowing more about a horse's potential risk for laminitis.

To learn more:
Visit the Animal Health Foundation laminitis web site and watch more videos there.
Boehringer Ingelheim's "Talk About Laminitis" web site is meant for British horse owners, but most of the information is relevant worldwide; Prascend is available in the USA.
Read "Six Steps to Prevent Autumn Laminitis".
Plan to attend the Laminitis West conference in Monterey, California in November 2012.

References from the text:

  1. Donaldson, M.T., Jorgensen, A.J.R and Beech, J. (2004) Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis.  Journal of the American Veterinary Medical Association 224, 1123-1127.
  2. Karikoski, N.P., Horn. I., McGowan. T.W. and McGowan, C.M. (2011) The prevalence of endocrinopathic laminitis among horses presented for laminitis at a first-opinion/referral equine hospital. Domestic Animal Endocrinology 41,111-117.
  3. Ireland, J.L., Clegg, P.D., McGowan, C.M., McKane, S.A., Pinchbeck, G.L., 2011.  A cross-sectional study of geriatric horses in the United Kingdom Part 2: health care and disease.  Equine Veterinary Journal 43, 37-44.
  4. Knowles, E.J., Withers, J.M. and Mair, T.S. (2012) Increased plasma fructosamine concentrations in laminitic horses. Equine Veterinary Journal 44, 226-229.
  5. Boehringer Ingelheim Vetmedica. Resting ACTH results of 724 horses aged 10 to 15 years. 
Do you know your way around the inner hoof wall? This wall chart will remind you of the layers of sensitive and insensitive tissue that make up the hoof capsule. Click this text to go to the ordering page.

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  
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Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.

Thursday, November 03, 2011

Prascend® PPID (Equine Cushings Disease) Treatment Approved by FDA for US Horses


Maybe I'm biased, but I thought that the CSI (Cushings Scene Investigation) ad run by Boehringer-Ingelheim Vetmedica in British horse magazines was the most clever horse ad so far this year. It heralded the introduction of Prascend to treat Cushings-suffering horses; Prascend will soon be available in the USA.

The following press release is not an ad, it is published here as a "heads up". Anyone involved in the world of Hoofcare + Lameness is going to hear about this. Farriers and veterinarians will be asked questions by horseowners about this medication, and you need to know about how pergolide has evolved into Prascend®.

Prascend has been available in the United Kingdom for a few months, and Boehringer-Ingelheim Vetmedica has launched an awareness campaign there to urge horse owners to have their horses tested for PPID. I don't know yet what B-I has planned in the USA, but I feel confident in saying that "this is news".

In 2007, this blog reported that a potential crisis loomed for horseowners who were treating the symptoms of their horses' PPID condition with Permax (pergolide). (See links at end of this blog post.) The medication was taken from the market temporarily because of problems with human prescriptions. Before long, it became available again in the compounded form, which many horse owners ordered directly and in different forms.

Compounding pharmacies have been at the center of a controversy in the veterinary industry. At this time, it is too early to give a reliable answer whether compounded (and less expensive) pergolide will remain an option for horseowners as pill-only Prascend enters the marketplace. Ideally, horseowners will have safe and multiple alternatives to keep their horses comfortable.

Much more information will be available at or following the AAEP Convention in San Antonio later this month.
 

Everyone can recognize the advanced PPID (Cushing disease) horse. But laminitis and stretched white lines in younger horses may not seem to be related to PPID until much later, when a definitive diagnosis is made. Only careful testing will discern if horses without obvious signs suffer from PPID. (photo provided by Dr. Christian A. Bingold)

Boehringer Ingelheim’s Prascend® Approved for PPID in Horses
Product is the first and only FDA-approved treatment for the management of PPID.

ST. JOSEPH, Mo. (November 2, 2011) – Boehringer Ingelheim Vetmedica, Inc. (BIVI), has received approval from the Food and Drug Administration (FDA) to market Prascend® (pergolide mesylate), for treatment of clinical signs associated with pituitary pars intermedia dysfunction (PPID), also known as equine Cushing’s disease.

PRASCEND is the first and only FDA-approved product for the management of PPID in horses. (1) Administered in tablet form, treatment with PRASCEND can improve the quality of life for PPID-affected horses by managing clinical signs and decreasing the risk of complications of the disease, including those that have the potential to be life-threatening.

It is estimated that one in seven horses over the age of 15 has PPID (2) and horses as young as seven years of age have been diagnosed with the disease (3). In addition, up to 70 percent of clinical laminitis cases also may be affected with underlying PPID4. The most common clinical signs of advanced-stage PPID that occur in horses are hirsutism (hypertrichosis) or an abnormal amount of hair growth, abnormal sweating, weight loss, muscle wasting, abnormal fat distribution, lethargy, laminitis, polyuria/polydipsia and chronic/recurrent infections.

“Unfortunately, PPID is not a curable disease,” says Dr. John Tuttle, BIVI equine technical services veterinarian. “However, PRASCEND does offer a safe and efficacious treatment option to veterinarians and horse owners that can help reduce the clinical signs of the disease and effectively improve the quality of life of infected horses.”

While PPID is typically considered a late-stage-of-life disease in the horse, Tuttle adds that with horse owner vigilance and regular veterinary care, the disease may be detected earlier.

“Because the early symptoms of PPID may be difficult to recognize, some horses with PPID may go undiagnosed until the disease becomes more advanced,” says Tuttle. “Through regular veterinary wellness exams, oftentimes the disease can be caught earlier. By beginning treatment in the earlier stages of the disease, we are able to reduce the risk of some of the potential complications associated with PPID, such as laminitis, recurring infections, dental disease and other potential issues of uncontrolled PPID.”


Farriers often notice the early signs of PPID in horses' feet while trimming. As Cushings diseases advances, farriers are challenged to keep PPID sufferers comfortable and manage any flare-ups of chronic lamiitis. (Massachusetts farrier Allie Hayes trimming a Cushings-affected pony, photo © Hoofcare Publishing)

Not only can PRASCEND aid in the management of clinical signs of disease, the FDA approval also assures the product has been thoroughly evaluated for safety and efficacy. In addition, PRASCEND has met the standards set forth by the FDA in regard to production to preserve its identity, strength, quality, purity and consistency from batch to batch, and the product has demonstrated stability and effectiveness over time through a variety of environmental conditions.

“We are excited to offer a treatment option for horses suffering from PPID,” says Tuttle. “We encourage horse owners to continue to work with their veterinarians to find the best treatment for their horse and are confident that PRASCEND can help make a difference in the lives of horses suffering from this disease.”

PPID horses may be quite thin under all that hair. Cushings sufferers are also believed to be more highly perceptible to worms than non-sufferers. Many people clip their long-haired horses to be more aware of body condition. (photo © Hoofcare Publishing)
PRASCEND is for use in horses only. PRASCEND has not been evaluated in breeding, pregnant or lactating horses. Refer to the package insert for complete product information or contact Boehringer Ingelheim Vetmedica at 800-325-9167.

(Hoof Blog note: A web address should be available soon.)

Reference:
  1.  PRASCEND® (pergolide mesylate) [Freedom of Information Summary]. St. Joseph, MO: Boehringer Ingelheim Vetmedica, Inc.; 2011.
  2. McGowan TW, Hodgson DR, McGowan CM. The prevalence of equine Cushing’s syndrome in aged horses. In: Proceedings from the 25th American College of Veterinary Internal Medicine Forum; June 6–9, 2007; Seattle, WA. Abstract 603.
  3. Schott HC. Pars pituitary intermedia dysfunction: challenges of diagnosis and treatment. In: Proceedings from the 52nd American Association of Equine Practitioners Annual Convention; December 2–6, 2006; San Antonio, TX.
  4. Donaldson MT. Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis. J Am Vet Med Assoc. 2004;224(7):1123–1127.

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 TO LEARN MORE


AAEP Statement on FDA Withdrawal of Pergolide for Human Use: Will It Still Be Available for Horses?

Pergolide Cleared for Equine Veterinary Use by FDA

Laminitis Research: Australian Breakthrough on Insulin Function in Equine Foot

Too Fat? Too Thin? British Court Faces Conflict Over "Abused" Horse with Cushings Disease

Cornell Laminitis Research Beneficiary of Arabian Horse Foundation Grant to Study Genetic Markers in Equine Metabolic Syndrome and Cushings Disease

Equine Pituitary Dysfunction Test Choices Analyzed by New Bolton Center's Jill Beech VMD

Three Chimneys Farm Works to Help Slew 'o Gold Keep His Cool



© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  
Follow Hoofcare + Lameness on Twitter: @HoofcareJournal
Read this blog's headlines on Facebook
 
Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.

Friday, November 26, 2010

Equine Pituitary Dysfunction Test Choices Analyzed by New Bolton Center's Jill Beech VMD

In our new age of horses as companion animals, a significant proportion of our equine population would be considered into or at least approaching the geriatric phase of life. Equine pituitary disease and disorders are a concern in the horse-owning public and what we call simply "Cushings Disease" is being studied by researchers as a complex condition or even set of conditions and/or disease.

For horse owners, the problem is always to obtain a definitive diagnosis and to understand a prognosis, if it is possible to have one. Laminitis, in subtle or complex forms, often is a side effect of pituitary disease and any progress in understanding, diagnosing and treating the disease more effectively is welcome. Here's an update from one researcher at the University of Pennsylvania.

Jill Beech VMD presented data resulting from recent research at the Dorothy Havemeyer Geriatric Workshop in Cambridge, Massachusetts, October 24-27. Dr. Beech (show left, University of Pennsylvania photo) is the Georgia E. and Philip B. Hofmann Professor of Medicine and Reproduction at University of Pennsylvania School of Veterinary Medicine’s New Bolton Center in Kennett Square, PA. Her clinical and research expertise is focused on equine pituitary disease and disorders. The Dorothy Russell Havemeyer Foundation, Inc. is a private foundation that conducts scientific research to improve the general health and welfare of horses.

Dr. Beech’s research compared two different diagnostic tests, using two different hormones, to measure equine pituitary dysfunction. “First,” says Dr. Beech, “I compared measuring alpha-melanocyte stimulating hormone [MSH] with measuring adrenocorticotropic hormone [ACTH] to determine if one hormone was superior to the other in making a diagnosis. MSH is more specific for the part of the pituitary that is abnormal in horses with Cushing’s disease.”

Although both hormones are secreted from that area, ACTH is also secreted from another area in the pituitary, so it was hypothesized that MSH would be more specific and a better hormone for evaluation. Results, however, did not indicate that MSH was a more sensitive or specific indicator for pituitary dysfunction. Those data, along with the fact that ACTH, but not MSH, can be measured in diagnostic laboratories available to veterinarians has important practical application.

“This means,” says Dr. Beech, “that veterinarians can continue to measure ACTH in a reliable laboratory. At New Bolton Center, we use the laboratory at Ryan Veterinary Hospital of the University of Pennsylvania or the New York State diagnostic laboratory at Cornell.”

Data collected also indicates that when horses have high levels of these hormones, single samples can be misleading due to variability of endogenous concentrations; veterinarians should therefore obtain several basal samples for ACTH measurement.

“If basal levels of ACTH are high, it can be an indication that the horse has Pituitary Pars Intermedia Dysfunction [PPID] or Cushing’s Disease. However, some affected horses have normal basal levels, and in those cases,” says Dr. Beech, “ACTH response to a thyroid releasing hormone [TRH] test should be performed. Affected horses have an abnormal and prolonged increase in their ACTH levels compared to normal horses.”

She and her co-investigators also compared the TRH stimulation test to the domperidone stimulation test, a diagnostic test that initially appeared promising for diagnosing pituitary disease in horses. In this population of horses, the domperidone stimulation test did not appear as good as the TRH stimulation test in differentiating horses with PPID from normal horses.

--end press release--

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.
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