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Treatment and Monitoring of PPID in Horses

Overview of PPID

Pituitary pars intermedia dysfunction (PPID) is a significant endocrine disorder in horses, particularly affecting older horses as they age. It results from the degeneration of neurons in the hypothalamus leading to an overproduction of adrenocorticotropic hormone (ACTH) from the pituitary gland. This disorder can cause various health issues including hormonal imbalances that may lead to changes in coat appearance, weight loss, and an increased risk of laminitis.

Learning Outcomes

Understanding Treatments:

• Describe the treatments available for PPID and their mechanisms, including how they influence hormone levels and overall health in affected horses.

• Outline potential side effects of each treatment, including how these may impact the horse’s quality of life and the importance of monitoring.

Estimating Treatment Costs:

• Provide an estimate for treatment costs associated with PPID, factoring in both medication and any necessary veterinary consultations or monitoring tests.

Helpful Resources:

• Equine Endocrinology Group Recommendations for PPID: [Link]

• "Therapeutics for Equine Endocrine Disorders" by A. Durham, Vet Clinics, 2017: [Link]

Case Study: Charlie

Patient Profile:Charlie is a 24-year-old retired gelding who has developed several concerning symptoms, particularly those related to alterations in his coat and muscle condition, which are common indicators of PPID.

• Owners Report Issues:

  • Hasn’t shed his winter coat as expected, leading to a shaggy appearance.

  • Significant muscle loss observed, indicating may have difficulty with mobility and maintaining normal body weight.

Initial Diagnosis:To confirm the diagnosis, a blood test for basal ACTH was performed.

• ACTH Result:

  • The result was 203 pg/ml, which confirms the suspicion of PPID, indicating excessive hormone production signaling an endocrine disorder.

Treatment Options

Licensed Medication:

Pergolide (Prascend):

• Mechanism of Action:Acts as a dopamine D2 receptor agonist, effectively compensating for the impaired dopamine signaling in horses with PPID by inhibiting excess ACTH release from the pituitary gland. This helps restore normal hormone levels and improve the horse's overall health.

• Main Side Effect:One notable side effect is a decreased appetite and general dullness as the horse's body adjusts to the changes in dopamine levels. Owners should be advised to monitor appetite closely and provide support if needed.

• Starting Dosage for Charlie:

  • Weight: 250 kg.

  • Recommended Dosage: Half a tablet once a day, which can conveniently be mixed with food to encourage consumption.

Client Inquiries

Duration of Medication:

• Lifelong treatment is required to manage PPID effectively. It is crucial to assess the treatment's effectiveness approximately 4-6 weeks after starting. Practitioners should consider retesting blood levels to adjust dosage if necessary to optimize therapeutic outcomes.

Cost of Medication:

• The approximate cost per tablet ranges from £1.04 to £1.12 depending on the box size. This results in a daily cost estimate of about 52-56p, making it a relatively affordable treatment option over the long term.

Alternative Options if Concerns Persist

If there are concerns regarding side effects with Pergolide, consider the following options:

• Trilostane (0.4-1 mg/kg SID PO)

• Cyproheptadine (0.25-1.2 mg/kg SID PO)

• Bromocriptine (up to 0.04 mg/kg SID PO in the morning and up to 0.02 mg/kg in the evening)

• Cabergoline

Monitoring and Management

Repeat Examination:

It is essential to schedule a follow-up examination to assess the treatment's effectiveness. Key assessments include retesting baseline ACTH levels to evaluate any improvements in the horse’s condition.

Additional Management Advice:

• Emphasize dietary management tailored to the specific needs of horses with PPID, promoting the intake of low starch and high-fiber diets.

• Encourage regular exercise to maintain muscle mass and overall health.

• Minimize the risks associated with laminitis by implementing strategies such as limiting grazing on lush, sugar-rich grass and soaking hay to reduce its sugar content effectively.

By monitoring the treatment and ensuring a proper management plan, horses diagnosed with PPID, such as Charlie, can lead healthier and more comfortable lives.