Podcast
Questions and Answers
What is the primary treatment for PPID?
What is the primary treatment for PPID?
Which of the following conditions may interfere with PPID diagnostic bloodwork?
Which of the following conditions may interfere with PPID diagnostic bloodwork?
What should be carefully managed in horses with PPID to avoid complications?
What should be carefully managed in horses with PPID to avoid complications?
When assessing nutritional needs for a horse with PPID, what is the first step?
When assessing nutritional needs for a horse with PPID, what is the first step?
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Which of the following is a common misconception regarding PPID diagnosis?
Which of the following is a common misconception regarding PPID diagnosis?
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What is the primary hormone associated with the regulation of the adrenal gland's function?
What is the primary hormone associated with the regulation of the adrenal gland's function?
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Which of the following symptoms is associated with advanced clinical signs of PPID in horses?
Which of the following symptoms is associated with advanced clinical signs of PPID in horses?
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How does the hypothalamus normally regulate ACTH production?
How does the hypothalamus normally regulate ACTH production?
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What percentage of horses are likely to develop PPID before the age of 20?
What percentage of horses are likely to develop PPID before the age of 20?
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What condition is often present alongside PPID in approximately 30% of horses?
What condition is often present alongside PPID in approximately 30% of horses?
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What is a primary contributor to the pathophysiology of PPID?
What is a primary contributor to the pathophysiology of PPID?
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Which of these is not considered a clinical sign associated with early PPID?
Which of these is not considered a clinical sign associated with early PPID?
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What should be included in testing if PPID is suspected in a horse?
What should be included in testing if PPID is suspected in a horse?
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Study Notes
Endocrine System
- Substances produced by one organ affect other organs.
- Feedback loops regulate distant organs through hormones.
Fat, Fuzzy, and Foundered
- Equine Metabolic Syndrome (EMS)
- Insulin Resistance
- Pituitary Pars Intermedia Dysfunction (PPID)
- Cushing's Disease
PPID & EMS Overlap
- Horses can have both EMS and PPID.
- Common symptoms include abnormal fat deposits, hyperinsulinemia, laminitis, exercise intolerance, infertility, and abnormal sweating.
PPID
- Primarily found in older horses.
- A life-long disease that can only be managed.
- 20-33% of horses develop PPID before age 20.
- Approximately 30% of PPID horses also have insulin resistance (IR), so testing for both is important.
Normal Brain to Adrenal Function
- Anatomy: Brain, hypothalamus, pituitary (pars intermedia lobe, anterior lobe, posterior lobe)
- Hypothalamus produces Corticotropin Releasing Hormone (CRH), which stimulates the anterior pituitary to release adrenocorticotropic hormone (ACTH).
- ACTH stimulates the adrenal cortex to produce cortisol.
- Negative feedback loops regulate the system.
Cortisol
- Stress hormone controlling blood sugar levels.
- Plays a role in detoxification and infection fighting.
Normal Hypothalamus Adrenal Function
- Increased cortisol levels negatively feedback on the hypothalamus to decrease dopamine and thus ACTH.
- Dopaminergic neurons inhibit pars intermedia, reducing ACTH release.
PPID Pathophysiology
- Slow degenerative disease of dopamine-producing neurons in the hypothalamus, like Parkinson's disease.
- Loss of dopamine inhibition of pars intermedia.
- Benign overgrowth of pars intermedia causes excess ACTH production.
PPID Clinical Signs (Advanced)
- Generalized hypertrichosis (excessive hair growth)
- Fatty bulges over eyes
- Pendulous abdomen
- Muscle wasting
- Dullness/depression
- Abnormal sweating
- Recurrent infections (hoof abscesses, skin infections, corneal ulcers)
- Increased drinking and urination
PPID Clinical Signs (Early)
- Slow shedding in spring
- Patchy shedding, guard hairs
- Laminitis
- Inappropriate lactation
- Infertility
- Regional adiposity
- Tendon laxity
PPID Testing
- Do not test for PPID unless a suspicion exists.
- Baseline ACTH elevation, TRH stimulation test, and insulin testing are included.
Equine Metabolic Syndrome (EMS)
- A syndrome characterized by obesity, cresty neck, laminitis, insulin dysregulation, and insulin resistance.
Normal Insulin Regulation
- Insulin produced by the pancreas in response to elevated blood glucose levels (produced after feeding).
- Enhances glucose uptake.
- Normally keeps glucose levels stable.
Insulin
- Pro-inflammatory agent.
- Causes hemodynamic alterations like vasoconstriction and hypertension.
- Cortisol alters insulin uptake in liver and adipose tissue, influencing leptin production.
Insulin Resistance (IR)
- Body cells do not respond normally to insulin, hindering glucose uptake.
- Causes elevated glucose levels.
Insulin Resistance Pathophysiology
- Common Features: Obesity, predisposition to insulin resistance, altered lipid metabolism, hyperglycemia, altered cortisol activity, increased leptin concentrations, increased inflammatory cytokines, and hypertension, laminitis.
Easy Keepers
- Fat storage is an adaptation for food scarcity.
- Fat tissue can cause additional issues.
Pathogenesis of Laminitis
- The exact mechanism is not fully understood.
- Glucose toxicity, similar to diabetic humans, is a potential cause, though issues like kidneys and eyes don't occur in the same way in horses.
Clinical Signs of EMS
- Obesity, cresty neck, laminitis, insulin dysregulation, and insulin resistance.
Diagnosis of EMS
- Bloodwork (fasting), high circulating glucose levels, high insulin levels, oral sugar test, sedatives affecting results, and normal thyroid values.
Killing with Kindness
- Client involvement is important, but often overlooked.
- Food is frequently the primary concern and must be addressed during intervention.
Nutritional Management of PPID
- Decrease body mass gradually (1.5% of total body mass each week).
- Use hay varieties with low NSC <10-12% on DM, forage based diet of mature grasses/unimproved field hay.
- Low glycemic index.
PPID Nutrition (Additional Considerations)
- If the horse has EMS or high BCS, be careful when changing feed, and consider using low NSC forage and high-fiber options.
- Senior horse feeds and ration balancers might not be suitable in PPID cases due to glycemic response.
- Supplement with Omega-3s.
EMS/PPID Nutrition (If needed)
- Underweight horses require additional calories from low-starch/high fiber feeds, vegetable oils, rice bran, alfalfa, beet pulp without molasses, and blankets for winter protection.
PPID Monitoring
- Regularly assess body condition score (BCS).
- Take photos of the horse for record-keeping.
- Perform bloodwork as needed.
- Monitor clinical signs.
- Assess feed consumption.
PPID Treatment
- Thyroid supplementation to encourage weight loss.
- Metformin to work in the gut, limit glucose uptake, and avoid use if client compliance is suspect.
- SGLT-2 inhibitors, like Ertugliflozin.
PPID Prevention
- Evaluate diet when BCS is over 6.
- Monitor high-risk breeds, spring pastures, and grazing locations.
- Monitor horses to quickly respond to laminitis.
Coexisting Disease
- Horses can have both EMS and PPID.
- Evaluate both conditions when making a treatment plan for PPID as they are not mutually exclusive.
PPID Monitoring (Additional Considerations)
- Utilize scales, weight tapes, and neck circumference measurements.
- Consider hay testing if necessary.
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Description
This quiz covers the endocrine system in horses, focusing on important conditions like Equine Metabolic Syndrome (EMS) and Pituitary Pars Intermedia Dysfunction (PPID). You'll explore the impact of hormones, common symptoms, and the interplay between these disorders. Test your knowledge about managing these lifelong conditions in equine care.
