New research on PPID protocols from Tufts University - thyrotropin stimulation test


Ruth Vale
 

New research on PPID protocols from Tufts University published in December 2013.  Has this group evaluated this research yet?  Results do align with advice given by this group - to not use DST - I had to convince my vet for precisely the reasons quoted.  On-farm test for PPID is a good thing - do we know anything further about the new test?

http://www.sciencedaily.com/releases/2013/12/131204181421.htm
From the article:

The newly established guidelines retain the recommendation to measure resting ACTH concentrations, but the group has lowered the recommendation for using the DST. Recent research shows that the DST is no better at detecting PPID than other tests, and horse owners have concerns about dexamethasone inducing laminitis, a painful condition affecting the feet that can lead to death.

Instead, the EEG group recommends a thyrotropin-releasing hormone (TRH) stimulation test, which is particularly useful when horses with early PPID have normal resting ACTH concentrations. TRH causes the pituitary gland to release more hormones and ACTH concentrations increase to a higher level in horses with PPID. This test is easily performed on the farm by taking a baseline blood sample, injecting TRH intravenously, and collecting a second blood sample 10 minutes later. At present, the TRH stimulation test should only be used between December and June, which is the only period in which cut-off values have been established. Cut-off values allow veterinarians to interpret results and determine whether the horse suffers from PPID


Ruth Vale
 

Oops - forgot to sign.

Ruth Vale and Whippoorwill Amulet (Bounce)
joined Sept 2013
Caledon, Ontario CANADA

Case History
http://groups.yahoo.com/neo/groups/echistory7/files/Ruth%20and%20Bounce%20Case%20History%20-%20Ontario%2C%20Canada/
Photos
http://groups.yahoo.com/neo/groups/echistory7/photos/albums/841667078


Nancy C
 

Hi Ruth

Thanks for signing!

There have been a number of conversations over the years regarding TRH test. The test is not new  but the protocol push is a more recent development. A big concern is that it is a  sensitive test with some 30 percent false positives.  With the number of unresolved pergolide veil issues we've heard about recently I've been wondering if the TRH test is a factor. In most of the conversations that promote this test, there is no info about symptoms or ultimate outcome.
https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/176771

This link has a study that compares TRH to ACTH
https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/176696

This thread with BI vets who are members of this group is a little tricky to negotiate but worth the read for the big picture.  BI makes Prascend and  funds the EEG. No discussion of symptoms or outcomes.
https://groups.yahoo.com/neo/groups/EquineCushings/conversations/topics/175606
Here are more discussion threads
https://groups.yahoo.com/neo/groups/EquineCushings/conversations/topics/166897
https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/180123

As I write this, I wonder what the impact the variations of lab results recently discussed might have on this whole picture.  We've seen varying results from some labs vs Cornell, with members running side by side tests from same blood draw.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
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---In EquineCushings@..., <rmvale@...> wrote :

Oops - forgot to sign.

Ruth Vale and Whippoorwill Amulet (Bounce)
joined Sept 2013
Caledon, Ontario CANADA

Case History
http://groups.yahoo.com/neo/groups/echistory7/files/Ruth%20and%20Bounce%20Case%20History%20-%20Ontario%2C%20Canada/
Photos
http://groups.yahoo.com/neo/groups/echistory7/photos/albums/841667078


Claudia Goodman
 

I had read this as well about using TRH as a better second tier test for PPID just prior to setting up our yearly blood testing with my vet. I felt I'd need more confirmation if my mare's eACTH tested borderline  - as I was in a bit of denial about believing my mare really had PPID. The TRH test value (170 pg/mL) convinced me, altho her eACTH turned out to be 50pg/mL which would have been enough to override my denial. 
My vet didn't have an easy time getting the TRH, but was able to do so in time for our scheduled appt. The cost of the 1mg injection of TRH was $100. Worth it, though, since it really fully confirmed the diagnosis for me. (I would not have chosen a Dex suppression test in any case for my IR mare.)

Claudia & Silhouette 2014 California

https://groups.yahoo.com/neo/groups/echistory8/files/Claudia%20%26%20Silhouette/




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

>New research on PPID protocols from Tufts University published in December 2013.  Has this group evaluated this research yet?  Results do align with advice given by this group - to not use DST - I had to convince my vet for precisely the reasons quoted.  On-farm test for PPID is a good thing - do we know anything further about the new test?

http://www.sciencedaily.com/releases/2013/12/131204181421.htm