equine cushing's test results

Pituitary Pars Intermedia Dysfunction (PPID) — Equine Cushing's Disease. The Dexamethasone suppression test. The most commonly used tests for the diagnosis and monitoring of equine PPID are: combined baseline tests for endogenous ACTH and Insulin; the TRH-response test measuring ACTH; and the Dexamethasone-suppression test (DST) measuring Cortisol. The treatment for Equine Cushing’s disease is a prescription-only medicine, known as a POM-V, and can only be prescribed by your vet. testing ACTH and/or Insulin, either individually or combined. If accounts like this happen it is best to allow the event to settle (normally with in a two week time scale) and re test. Phone: (607) 253-3900 Insulin levels are often very high (>250 μU/mL) in ECS. The pituitary gland secretes high levels of the hormone ACTH (adrenocorticotrophic hormone), which stimulates the production of cortisol, a stress hormone. From what I can gather at present, a ponys blood results should be 27 and a horse 50 and under, this info is for a quick reference point. Equine Pituitary Pars Intermedia Dysfunction / Cushing’s Testing. Horses with Cushing’s disease have high levels of plasma ACTH. In most cases, corticotrophs (ACTH-producing cells) are abnormally stimulated by TRH (thyrotropin-releasing hormone), causing increased ACTH production by the pituitary pars intermedia. Insulin levels in equine metabolic syndrome (EMS) are raised but there can be considerable variation over a 24-hour period. 40 minutes after TRH, normal horses depress further but ECS horses show a significant rise in cortisol (> 50% from 3 hour sample). Measurement of Plasma Adrenocorticotropic hormone (ACTH) concentration. From how I see it, it is a progressive disease. Sending frozen plasma with frozen cold packs using an overnight courier service will usually ensure the sample is received chilled and is recommended especially in summer months. Take two further blood samples 40 minutes and 19 – 21 hours later, (22 – 24 hours after Dexamethasone). A transport kit should be obtained from Cambridge Specialist Laboratory Services (Tel 01223-493400) and placed in a freezer overnight. Normal horses have a CCR less than 20 x 10-6. Before weekly reference ranges were suggested, when the cut-off from November to July was suggested to be 29 pg/ml, research by David Rendle et al. ACTH – In horses and ponies a single sample analysed for ACTH has been shown to be a very sensitive (100%) test for equine ECS. Your email address will not be published. Additionally, this test provides too many equivocal results to be reliable as a ECD test and again is non diagnostic for Metabolic Syndrome. See www.careaboutcushings.co.uk. Free ACTH testing for horses in the UK Owners of horses in the UK may be able to claim a free ACTH test - horses not already receiving treatment for PPID can have a free ACTH test, and in addition members of Care About Cushing's will be emailed 1 free monitoring ACTH voucher code each year. Immediately inject 1.1 mg TRH (Cambridge Laboratories) i/v. Do NOT send whole blood. Lucky’s test showed he had 120 U/L which is still elevated but not much. If your horse or pony is prone to laminitis, it’s important to test for Cushing’s disease. Equine Cushing's disease, also known as Pars Pituitary Intermedia Dysfunction (PPID) is a disorder of the horses’ endocrine system (hormonal system). However, only more recently have they become a focus of significant research on the topics of diagnosis and efficacy of treatment. On physical exam, the veterinarian noted a pot-bellied appearance and thinning hair coat. Other common clinical signs include weight loss, weight distribution (pot belly, loss of epaxial musculature, increased supraorbital fat) lethargy, laminitis, polyuria, polydipsia and hyperhidrosis. Equine Cushing’s most commonly affects pony breeds, but larger breeds can be affected and it is primarily seen in older horses … post-TRH (ACTH) levels after treatment has started, but it should be lower than when originally tested. An increased plasma ACTH concentration is indicative of PPID. Collect a Pre (or baseline) blood specimen into a purple-top (EDTA) tube. Gently invert the specimen several times to mix blood and anti-coagulant and then chill sample (refrigerator/cooler/etc.). Most horses showing symptoms of Cushing’s can be diagnosed with this test, however, plasma ACTH levels can fluctuate with the season. Label samples clearly and request cortisol. Whilst the dexamethasone suppression test or the combined ACTH stimulation / dexamethasone suppression tests are regarded as providing a definitive diagnosis of hyperadrenocorticism, I have known horses either develop laminitis, or suffer a deterioration in a pre-existing laminitis, following their use. The most commonly used tests for the diagnosis and monitoring of equine PPID are: combined baseline tests for endogenous ACTH and Insulin; the TRH-response test measuring ACTH; and the Dexamethasone-suppression test (DST) measuring Cortisol. Insulin – The analysis of Insulin on a basal serum sample is very useful as this detects the presence of peripheral insulin resistance. However, the test still has limitations and ongoing research is needed to help us fully understand how to interpret the results. A 2ml blood sample should be taken by syringe and needle (not glass vacutainer) and placed in the EDTA tubes provided. ACTH stands for adrenocorticotropic hormone, and its levels indicate if the horse has Cushing’s disease. To follow will be information I have searched that I hope helps explains what your horses blood levels should be in a bit more detail, as oppose to the Cushings condition itself. The sample should ideally be received cool or cold. Collect an additional EDTA blood specimen at exactly 10 minutes (necessary) and 30 minutes (optional) after injection. THANKS!!!!! common screening test for the presence of Cushing’s disease and is often performed as an alternative to the dexamethasone suppres-sion test in horses with a history of laminitis. At 22 – 24 hours normal horses suppress below 30 nmol/L and ECS horses remain elevated, usually above the value of the 3-hour sample. are labeled pre and post and as plasma. Flossie Sellers - 01/20/2014 Health. They, sometimes, tend to talk over your head……I won’t be on their level, but it will help to understand everything better. The result must be compared to the seasonal reference range, as there is a normal rise in ACTH during the autumn months (August–October). Take a basal blood sample at about 17.00 hours (5 pm). Our highest level: 565.  Some labs have seen levels over 1000. http://thehormonelab.com/handbook/adrenocortical-function/equine-pituitry-pars-intermedia-dysfunction. Pituitary adenoma cells seem to lose receptor specificity for hypothalamic-releasing hormones. Although equine Cushing’s resembles human Cushing’s disease (hence its popular moniker) the equine form differs somewhat. It took sometime to get Luck from the field when the vet arrived- he ran around non stop. Pituitary pars intermedia dysfunction (PPID), also referred to as equine Cushing’s disease, is one of the most common endocrine disorders in horses. 9 out of 10 laminitis cases are caused by an underlying hormonal disease. due to potential assay interference. Equine Cushing's disease It involves the pituitary gland, which is a gland located at the base of the brain that produces hormones in response brain signals. Cortisol/Creatinine Ratio (CCR) – This can be useful as a screening test to exclude ECS but must not be used to diagnose ECS as it is not very specific and other factors such as exercise may give a positive result. Required fields are marked *. There are many signs of Cushing’s Diseases in horses. X, My 14.1 poby had 124 reading tested on 25 August, blood was taken in morning however he had been fed and had haylage just prior to testing. Cushing’s Disease Diagnosed with Low Dose Dexamethasone Suppression Test Julie Piccione, DVM, MS, DACVP A 13-year-old female spayed Beagle was presented to its veterinarian for increased urination. Excitement, exercise, and/or severe illness can elevate ACTH concentration. However, the cortisol rhythm test may yield false positive or false negative results, and one needs to be cautious basing a diagnosis on this test alone. Normal and ECS animals show depression from basal levels at 3 hours (usually > 50%). a.   In the fall, normal horses have elevated levels in our findings of about 75-100, but studies say it can get up to 200. b.   In the fall, you are looking for extreme ACTH elevations to diagnose Cushings of over 300. PPID/Cushing's Disease is a disorder of the pituitary gland and results in hormonal disturbances. To the Claimant (Horse owner) This free basal ACTH test voucher code is for the laboratory fees for a blood basal ACTH test, performed at the Liphook Equine Hospital Laboratory UK or such other laboratory selected by the promoter from time to time. The test works by introducing dexamethasone, a potent synthetic form of the hormone cortisol, into the horse's system and then testing his blood: If … EMS is seen primarily in horses younger than 15 years, while PPID usually affects horses older than 15 years. Endogenous ACTH is considered to be a very sensitive test and can be done alone or in conjunction with either the regular overnight Dexamethasone test or the combined TRH/overnight Dexamethasone test. This can lead to a variety of problems for horses, ranging from unexplained laminitis to an abnormal … The two most practical tests for Cushings in horses are. Treatment options … This should help me to discuss the results with the vet in a lot better way. Researchers at the University of Pennsylvania have found that seasonal variations in adrenocorticotropic hormone (ACTH) can affect the results of the dexamethasone-suppression test, considered the "gold standard" for diagnosing Cushing's. The plasma sample collected for ACTH can also be used for insulin testing or serum can be collected as detailed below. This produces excess secretions of a variety of closely related peptides derived from pro-opiomelanocortin including alpha-MSH, B- endorphin and CLIP, and smaller amounts of ACTH, which results in increased adrenocortical production of cortisol. Managing the Illness Get medication for your horse. The test should ideally be performed first thing in the morning after the horse has been stabled overnight with no food provided. It is a progressive disease. EMS and PPID (Pituitary Pars Intermedia Dysfunction or Cushing's syndrome)* may be seen singly or together. slowly over one minute. However, this level of diagnostic accuracy requires strict sample handling procedures are followed (see canine section page 20). This can lead to a variety of problems for horses, ranging from delayed shedding to loss of muscle mass. The test is safe for the laminitic, involves one blood sample and is relatively inexpensive. The horse Insulin hormone is the key hormone to get tested, but if you are concerned enough to test, also check the Glucose, total T4 and the ACTH (if suspect Cushings). This is all technical and confusing, so lets try and help each other x, INSULIN, CORTISOL & ACTH NORMAL VALUES FOR EQUINE. The diagnostic tests presently recommended for diagnosis and follow up of EMS are: Insulin, the Oral Sugar Test (OST), and Leptin. Fax: (607) 253-3943 One such disease is pituitary pars intermedia dysfunction (PPID), also referred to as equine Cushings disease. However, if the EDTA tubes are kept upright and placed in a cold refrigerator to settle, the plasma can be drawn off later in the day and transferred to the transport kit. After centrifugation transfer plasma sample to a vial (plastic preferred) suitable for frozen storage and shipping. PPID (formerly known as Equine Cushing’s Disease) Pituitary Pars Intermedia Dysfunction is one of the most common diseases of the endocrine system that can affect horses. Submit the paired serum samples together, optimally shipped so they are received chilled as in Insulin testing above. Draw the blood specimen into a “plain” red-top collection tube.*. From Mid-July to Mid-December, normal horses will experience a … However very high levels (>300pg/mL) are still highly suggestive of ECS and a normal level in the autumn (<100 pg/mL) is more likely to be truly negative. Normal horses should suppress cortisol levels to below 30 nmol/L and ideally <20 nmol/L. Insulin levels are frequently raised but insulin alone should not be used to diagnose ECS. If these tests are to be carried out, please check how your vet would like you to prepare x. If you suspect Cushings, always test the Insulin at the same time. 3 PPID causes the horse's pituitary gland, which utilizes hormones to control body functions, to work overtime. Recent studies have shown this test to be a more sensitive dynamic test for the diagnosis of PPID in equidae. With the plethora of tests used to confirm hypercorticism, which ones are safe for the laminitic and give most information relating to both Cushing’s disease and Metabolic Syndrome? A combined dexamethasone suppression / TRH response test has the disadvantages noted for both tests above. Consequently, normal levels of plasma cortisol constitute a broad range; the levels found in Cushing’s syndrome may at any given time fall within the “normal” range. The most common endocrine disorders dealt with today by equine practitioners and owners are pituitary pars intermedia dysfunction (PPID, a.k.a. “Our collective research has shown that horses can often develop this disease earlier in life, yet earlier clinical signs don’t always translate into positive test results,” says Nicholas Frank, DVM, professor and chair of the Department of Clinical Sciences at the Cummings School of Veterinary Medicine at Tufts University and coordinator of the Equine Endocrinology Group. I had my horse tested just before he had to have two teeth removed my vet said he had the lowest form at 26.5 and put him on Pergamum after six weeks he told me it was still high at 26.1 I am so con fused because I thought this level was okay when I quired this he then said it was at least 140 but after reading what you have to say even this is not high also would the stress of having teeth removed elevated the level. The Dexamethasone suppression test aims to identify the cortisol levels in the horse’s blood stream before and after a dexamethasone injection. Diagnostic Options for Equine Cushing’s Syndrome, or Pituitary Pars Intermedia Dysfunction (PPID) ... plasma adrenocorticotropic hormone (ACTH) derived from the abnormal pars intermedia is the most common diagnostic test for PPID. Normal ACTH levels vary according to the time of year and are significantly increased in the autumn (August, September, October) so this must be taken in to account when interpreting results for the diagnosis of ECS. Take a further blood sample 20 hours later. THANK YOU, Hi Michele, I am not trained to answer this question, it would be best to talk to a vet regarding obtaining the answer. ACTH is stable at least 6 months in the freezer. Also, even when laboratories use the same assay techniques, results vary somewhat from lab to lab. Often the signs increase overtime. 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