Topics

High ACTH no symptoms


Kirsten Rasmussen
 

Oh my goodness,  I see I've mixed up Brenda and Bonnie's 2 posts!   No wonder Brenda's case history for Stormy doesn't have the results Bonnie was sharing!  Lol

Brenda, most of what I wrote above still applies to you I think, but you can definitely disregard this comment:

Was Stormy the one with the mild symptoms and baseline ACTH of 176 more recently?  That higher baseline ACTH during seasonal rise is normally considered a positive for early PPID here.

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


Kirsten Rasmussen
 

Hi Brenda,

I don't see your new results in Stormy's Case History, but looking at the previous testing I would say we generally don't recommend a TRH stim test in the seasonal rise because we have no knowledge of what the stim result should be for a diagnosis.  So not sure if the post-stim is actualky diagnostic, although it was awfully high.  His baseline was a smidge above normal but that was in August when the seasonal rise is underway so that on its own is not concerning.  Was Stormy the one with the mild symptoms and baseline ACTH of 176 more recently?  That higher baseline ACTH during seasonal rise is normally considered a positive for early PPID here.

I also learned here that PPID can flare up in some horses around the spring equinox, or March 21, which is interesting given that Stormy had elevated ACTH then (or did you transcribe the 107 glucose number there by accident?) plus a laminitis event on Mar 2.

As Martha said, ACTH does not tell the whole story.  There are other hormones that would be a better indicator of PPID that we should be testing for but do not/cannot at this time.
when you consider that of all the hormones put out by the pituitary in PPID, ACTH is by far at the lowest concentration. We're way past the time to switch to testing POMCs across the board or alpha-MSH instead.
https://ecir.groups.io/g/main/message/215025

I think I personally would not treat now (assuming they have no signs that have worsened in the autumn) and the seasonal rise is on the down swing.   But I would be closely watching ACTH and insulin in the spring and again next fall, as well as possible signs of PPID, and if you do another TRH stim test it should be between December and June.

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


Brenda Gasch Mittelstadt
 

Kirsten 

I am so glad you asked that. I’ve still not started Pergolide as I don’t believe we’ve had symptoms. We did have a slight laminitis but as both my pony size horses had at same time and I was feeding very inappropriate hay and it was March, no grazing happening, I feel they are not connected. That said the IR certainly was an issue and I’ve made dramatic progress in seven months correcting that and am still in process. 


ACTH tests were odd for seasonal rise. That info in case history. 
--
-Brenda

September 2020, Dodgeville WI USA

Case History: https://ecir.groups.io/g/CaseHistory/files/Brenda%20and%20Stormy


 

The ACTH test I ran on Logo, after he’d been on cabergoline for awhile, was, at 150ish, the highest he’d ever tested, yet he looked incredible.  I had been maintaining his ACTH in the low 30’s where he had Issues with his skin and no topline.  I got so used to some of his skin issues that I didn’t see them as symptoms, until they went away.  

So I see three possibilities – the samples were switched, ACTH levels don’t tell the entire story and/or his symptoms might be very subtle.

I seem to recall Dr. Kellon’s suggesting not to test if there were no symptoms but it’s a little late for that now.  What I think would follow from that would be not to treat.  Just a guess.
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Kirsten Rasmussen
 

It's always possible there was a mixup, but since they are both positive and we recommend re-testing after 3-4 weeks on pergolide, you should have another chance to get bloodwork results and see if the one with no signs is still higher.

However, some horses seem to have high (refractory?) ACTH even on pergolide with their signs controlled so I don't see why a horse couldn't have high ACTH with no signs of PPID.  My question for Dr Kellon would be "do you still treat for PPID with pergolide even if there are no signs other than very high ACTH?".  I'd like to know too.

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


Bonnie Eddy
 

We had our 2 geldings tested for PPID, one because he had some mild symptoms, and the other just because he is 20, but absolutely not one symptom. 
The no symptoms was 596
The mild was 176
Done at Cornell, high normal is 35.

My question, is it possible to have such a high ACTH  yet NO symptoms?
I'm almost wondering if the 2 samples could have gotten mixed up somehow? I saw the vet write the names on each vial, with each horse.
Thank you, 
--
Bonnie with Racham (over the rainbow) from Southern California, Nov/2016

Case History
Racham's Photos 
Ω