Re: Elevated Acth results


Hi, Julie - Dr. Kellon says:"The correct dose of pergolide is the one that controls the ACTH" (and the symptoms).  You can retest 3 weeks after increasing the dose.  Are the units in pmol/L?  If so, then normal ACTH is 2- 10 pmol/L. It might not sound like 10.5 is a huge elevation, but many Cushings horses seem to need the ACTH in the mid to low normal range, ie 4 to 6 pmol/L

I hope you are not using both bute and previcox. As they are both non-steroidal anti-inflammatories (NSAIDS) , and work by similar mechanisms, using both is the same as giving an overdose.  BTW, the dose of Previcox for a 1,000 lb horse is 45 g, or just a little over 3/4 of a 57 mg tablet. Previcox is commonly overdosed.

Anyway, back to the pergolide and ACTH - lots of horses on this list are on more than 1 mg of pergolide. My crew is on 3 mg, 8 mg, and 17 mg.

The other thing that is important is how the blood is handled, and where it is sent to.  Hopefully your vet sends to Guelph University Animal Diagnostic lab. Sending to Cornell University is ideal, but I am not sure if there is an overnight courier that will get from Mayerthorpe to Cornell in a timely manner.  If your vet uses Idexx, the ACTH is sometimes sent to MSU, and MSU tends to have lower ACTH values than Cornell (thanks, Melanie, who sent duplicate samples of Peaches' blood to both Cornell and MSU, and found this out)

The blood needs to be be drawn non-fasting, into a purple-topped tube, and spun, separated and frozen asap, then sent to the lab on ice. Not separating the blood soon enough, or having it exposed to warm temperatures can result in a falsely low reading. Ask fr glucose, insulin and leptin as well, because it is important to know the insulin status and whether or not he is IR. 

I still haven't figured out how to copy and paste on this danged tablet, so can't give you the link, but if you go to Files, look at the DDT/e overview folder, and you will find information on diagnostic bloodwork.  

More to follow!

Jaini (BSc, BVSc), Merlin, Maggie, Gypsy
ECIR mod/support

---In EquineCushings@..., <juliewood372@...> wrote :

I am just wondering if anyone can offer me some advice about elevated ACTH and the correct dosage of Pergolide. Following symptoms that his Cushings was not well controlled I had him re tested and my vet told me  his ACTH came back as 10.5 (I am still waiting for the complete test results to be emailed to me). My vet advised me to increase from .5mg to 1mg which I have done. How long should I leave it before retesting and what should his levels be. I am still in the process of completing his history sheet as I am waiting for information coming from 2 different vets. He is still a little sore in his feet but I seem to be able to control this with Bute and Previcox. Is there any other painkillers that I could try which works well with a laminitic horse?  I also have him in soft ride boots which seem to help with the hard ground.
Thank you in advance

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