My horse had ACTH of 19 the end of June and an ACTH of 66 in November and was started on .5 mg of pergolide.
ACTH came down to 44.
Can I stop the pergolide for now and do the TSH stim test in the spring? or should I leave her on it until the end of December?
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Lesley Bludworth 
Phoenix, AZ   7/2022
Sophie TWH mare IR/EMS, PPID?
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749

Hi Lesley.  I reviewed your CH- but its not current, so I apologize for the additional questions: 
1. 9-12-22 you tested ACTH levels- this is part of the seasonal rise time frame- Did Sophie have symptoms of PPID?  Why were you testing ACTH?
2. 10-18-2022- You did a full panel of bloodwork- but the insulin was still pending- do you have an insulin result for that date?
3. Pergolide was started 9/14/22  and her retest was down to 44.  What were the reference parameters? I don't see that bloodwork uploaded or added to your Case history. 

If you  are wanting the pergolide to be altering the ACTH to be therapuetic- we like to see horse be high teens to low 20's year round. ( That is when they definitely are diagnosed with PPID). Testing during the seasonal rise, can skew the diagnosis. 
Retesting in the spring with the TRH test seems reasonable. Keep Sophie on the pergolide till seasonal rise is over- would be my "safety net" if she were my horse. Here's some info on the TRH test. 

The Thyroid-Releasing (TRH) Stimulation Test: Thyroid releasing hormone (TRH) stimulates release of ACTH. In normal horses the rise is very small but in PPID horses it is pronounced. Samples for ACTH are drawn before and 10 minutes after TRH injection. This test has more false positives than endogenous ACTH but because of its higher sensitivity is a good test for horses strongly suspected to be early PPID horses but which test negative by endogenous ACTH. Results are not reliable during the fall seasonal rise.

When able, it would be super helpful to update your CH. If you could also add a comment of your current situation to the comment section that would help the next volunteer who answers your questions. Thanks! 

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Trisha DePietro
Aug 2018
NH
Primary Responder
Dolly and Hope's Case Histories
Dolly's Photos 
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HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993     

Trisha,
Thank you for your questions :)
Her insulin is/was had to control and the metformin wasn't working.
So we tested ACTH looking for another cause of high insulin. She does pee a lot and has has a little bit of odd hair growth on her hind legs.
She had the equivocal ACTH number in June with the very high insulin.
So we tested ACTH again to see if she would be in the normal range during the rise and I was told on this site that 66 was not normal so we started pergolide but not really certain she is truly PPID.
I thought ACTH levels unlike insulin levels were unaffected by stress or pain and she is still not great with walks longer than 15 min so not sure if her pain would raise ACTH?
Dr Kellon said I could stop the pergolide after the rise, im just not sure when the rise is over. 
I will update the CH but in my phone now and do not have the reference ranges.
Insulin is always sent to Cornell and the ACTH sent to someplace else?
She is on soaked hay balanced with minerals and 1 lb twice a day soaked tc balance cubes to hold supplements.
Syringed PC, alcar, taurine, Alpha lipoic acid and resveratrol, yum!
She was swimming for exercise but now its too cold.
Thank you!

Lesley Bludworth 
Phoenix, AZ   7/2022
Sophie TWH mare IR/EMS, PPID?
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749
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Lesley Bludworth 
Phoenix, AZ   7/2022
Sophie TWH mare IR/EMS, PPID?
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749