13 yo Arab Appears to have Cushings


b1ecks
 

Hank hasn't been himself for several months, but since he's young, we didn't test for Cushings til now. Results of ACTH Pre TRH Response test:
Pre: 19.3pg/ml.   reference interval:2-30
Post: 213.0 pg/ml.   reference interval: 2-110

The vet clinic I use is massively understaffed suddenly so I can't get an answer, but this would appear to confirm Cushings?  They didn't to cortisol test or others that I believe are needed for the case history, so I assume that's the next step?  I would like to start him on pergolide but can I do that before any other baseline tests? 

Thanks. 
--
Barb B in CA 2019


Sherry Morse
 

Hi Barb,

You'll get a full welcome message soon but if this bloodwork was done in July it's not reliable to diagnosis PPID as we're already in the seasonal rise.  At this point the TRH response test is only considered reliable from January to June.  Did you have bloodwork pulled for IR (insulin and glucose).  Cortisol is not reliable and we do not recommend that test.




Eleanor Kellon, VMD
 

That result may or may not be diagnostic in July.   Why did you test him?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Not sure if the group and Dr Kellon agree with everything in the linked guidelines, but wanted to share this with you. See page 6.

Nancy Reed 
San Diego County
Jazzi March 2012, now also PPID


Eleanor Kellon, VMD
 

We're very familiar with it, Nancy. Do you have any questions?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kirsten Rasmussen
 

I'd say the EEG is finally starting to catch up to us!  lol!  We don't agree with everything in that document but I think it's an improvement on previous iterations.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


 

Thank you Dr Kellon.  I wanted to know if this group uses the information in the document, esp the testing cut offs, etc.  If you do not use them I will not post them.  Trying to be cognizant of the group rules.  Many thanks, Nancy 


Eleanor Kellon, VMD
 

You may post whatever you like for discussion on questions. No rules about that! We do not use the testing cut offs because they are based on statistics and standard deviations to give predictions of what level will give you the highest probability of a correct result. Biological organisms don't obey statistics. If you look at the literature on insulin in normal animals it is clear that the laboratory "reference ranges" are way too wide. To give you an idea of what I'm talking about, see https://wp.me/p2WBdh-O3 and https://wp.me/p2WBdh-1hR .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


b1ecks
 

He hasn't seemed himself since Jan/Feb...subtle personality change...where he used to be playful and sweet, he was uninterested and just stood around. He is dull at times, now pokey on the trail (unless he's at an endurance ride.)  Did a general blood workup in February which showed nothing. That vet wondered if we should test for Cushings. Instead, she put him on Heart Qi Tonic herb for 2 months and he felt marginally better. In researching that herb, it sounded like treating cushings symptoms (I've had 2 older horses with Cushings in the past.)   He then started dropping weight in May, and I cut back his riding to 3 days a week, but he still lost weight (even though he's on platinum, cocosoya, beat pulp, grass pellets, core builder, grass hay all day long in a net (he has allergies to many things including alfalfa and oat so doesn't get grain.)  He did only a 25 miler at the beginning of June, then I gave him two weeks off during which, his entire topline atrophied, including neck and croup. It was bizarre and alarming. That's when i read about early onset Cushings and he fits so many of the other symptoms. Our vet practice is in crisis here, so I could not get any response on the tests for 2 weeks.  They called today and said to start him on prascend. I am doing IR test tomorrow and will only feed him grass hay til they draw the blood. 
--
Barb B in CA 2019


b1ecks
 

Thanks Sherry. 
I have been a member for several years, as have had two previous older Cushings horses. I'm getting IR blood drawn tomorrow. 
--
Barb B in CA 2019


Sherry Morse
 

Hi Barb,

Have you had his Vitamin E level checked?  Do you have the results of the 'general bloodwork' that was done?




b1ecks
 

Still waiting on the Vit E results. 
I will start a case history file for Hank and upload the general blood panel. 
Thank you for your help. So very appreciative..

--
Barb B in CA 2019