Date
21 - 30 of 30
ACTH
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Lesley Bludworth
Ed,
That is hard to read/follow but I think the insulin on Gunner, although in the normal reference range for the lab, would be considered high as I think the preferred range is under 20?
If he was tested at least 4 hours after breaking a fast and had no grain in that 4 hour window. But, I'm really new to this whole concept in horses :)
From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of epersh@... <epersh@...>
Sent: Thursday, September 22, 2022 6:25:53 PM To: main@ECIR.groups.io <main@ECIR.groups.io> Subject: Re: [ECIR] ACTH Thank you very much for the replies!
So am I interpreting this correctly? As long as their insulin stays within the reference range there is no immediate threat of endocrinopathic laminitis, despite elevated levels of ACTH that are likely attributed to a seasonal secretion increase. That said, both horses are in the grey zone and need to be retested for PPID in Dec/Jan using the combination of baseline ACTH and TRH stimulation tests. Until then it should be safe to not put them on pergolide. Correct? Just to make sure I included their bloodwork below. Please forgive me for falling behind on their case histories. I need to update Atticus's and create one for Gunner. Both are on my short list to get done. The samples were drawn on September 1 (week 35) at around 9 am, after both horses spent the night on the (regrown and quite green) pasture with grazing muzzles on. Atticus appears to be in a much better shape despite being the one who foundered this year. Atticus (10 y/o stallion, foundered in February and recovering - no sign of lameness since May): Plasma, Edta ACTH Baseline Equine 35.7 pg/mL 2 - 30
Insulin Baseline Equine 13.59 uIU/mL 10 - 40
Leptin Baseline 8.76 ng/mL 1 - 10
-- Glucose 88 mg/dL 71 - 122
Lipemia idx 12 < 30
Gunner (13 y/o gelding, no history of laminitis or lameness ever): Plasma, Edta
ACTH Baseline Equine 49.8 pg/mL 2 - 30 Insulin Baseline Equine 36.42 uIU/mL 10 - 40
Leptin Baseline 11.14 ng/mL 1 - 10
Glucose 98 mg/dL 71 - 122
Lipemia idx 10 < 30
Thank you again! Ed P in TX 2022 https://ecir.groups.io/g/CaseHistory/files/Edward%20and%20Atticus https://ecir.groups.io/g/CaseHistory/album?id=273196 -- Lesley Bludworth Phoenix, AZ Sophie Case History 7/2022 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
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From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Trisha DePietro <RN1016@...>
Sent: Thursday, September 22, 2022 6:34:58 PM To: main@ECIR.groups.io <main@ECIR.groups.io> Subject: Re: [ECIR] ACTH Hi Lesley. Your vet is correct. In Nancy's link it states that the pergolide can be tested between 2-4 weeks.
https://www.ecirhorse.org/pergolide.php I usually use 3 weeks. As for the seasonal rise- I thought it was for the Northern Hemisphere and Arizona should still be in the Northern Hemisphere, unless somebody moved it :)
-- Trisha DePietro Aug 2018 NH Dolly and Hope's Case Histories Dolly's Photos Hope's Photos Primary Responder -- Lesley Bludworth Phoenix, AZ Sophie Case History 7/2022 https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=277749 |
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Sherry Morse
Hi Leslie, We recommend 3 weeks to be sure the therapeutic dosage is effective. It's splitting the difference between the 2 - 4 week recommendation in the link Nancy shared. As far as your vet claiming there is no seasonal rise in Arizona, well I'd take that thought with a very large grain of salt.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891
On Thursday, September 22, 2022 at 08:17:49 PM EDT, Lesley Bludworth <lesleyblud@...> wrote:
Question regarding testing efficacy after starting pergolide. My vet said we could retest ATCH after 2 weeks on desired dose of pergolide vs 3 weeks. Also said Cornell does not consider Arizona as having a seasonal rise? She suggested i call Cornell regarding that which i will do but thought I'd bring it up here and call tomorrow -- Lesley Bludworth Phoenix, AZ Sophie Case History 7/2022 https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=277749 |
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Sherry Morse
Atticus is in much better shape metabolically than the other horse. That horse probably needs a diet overhaul and I would be very careful about putting him out on grass. Is he in work?
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Trisha DePietro
Hi Lesley. Your vet is correct. In Nancy's link it states that the pergolide can be tested between 2-4 weeks. https://www.ecirhorse.org/pergolide.php I usually use 3 weeks. As for the seasonal rise- I thought it was for the Northern Hemisphere and Arizona should still be in the Northern Hemisphere, unless somebody moved it :)
-- Trisha DePietro Aug 2018 NH Dolly and Hope's Case Histories Dolly's Photos Hope's Photos Primary Responder |
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Thank you very much for the replies!
So am I interpreting this correctly? As long as their insulin stays within the reference range there is no immediate threat of endocrinopathic laminitis, despite elevated levels of ACTH that are likely attributed to a seasonal secretion increase. That said, both horses are in the grey zone and need to be retested for PPID in Dec/Jan using the combination of baseline ACTH and TRH stimulation tests. Until then it should be safe to not put them on pergolide. Correct? Just to make sure I included their bloodwork below. Please forgive me for falling behind on their case histories. I need to update Atticus's and create one for Gunner. Both are on my short list to get done. The samples were drawn on September 1 (week 35) at around 9 am, after both horses spent the night on the (regrown and quite green) pasture with grazing muzzles on. Atticus appears to be in a much better shape despite being the one who foundered this year. Atticus (10 y/o stallion, foundered in February and recovering - no sign of lameness since May): Plasma, Edta ACTH Baseline Equine 35.7 pg/mL 2 - 30
Insulin Baseline Equine 13.59 uIU/mL 10 - 40
Leptin Baseline 8.76 ng/mL 1 - 10
-- Glucose 88 mg/dL 71 - 122
Lipemia idx 12 < 30
Gunner (13 y/o gelding, no history of laminitis or lameness ever): Plasma, Edta
ACTH Baseline Equine 49.8 pg/mL 2 - 30 Insulin Baseline Equine 36.42 uIU/mL 10 - 40
Leptin Baseline 11.14 ng/mL 1 - 10
Glucose 98 mg/dL 71 - 122
Lipemia idx 10 < 30
Thank you again! Ed P in TX 2022 https://ecir.groups.io/g/CaseHistory/files/Edward%20and%20Atticus https://ecir.groups.io/g/CaseHistory/album?id=273196 |
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Lesley Bludworth
Question regarding testing efficacy after starting pergolide.
My vet said we could retest ATCH after 2 weeks on desired dose of pergolide vs 3 weeks. Also said Cornell does not consider Arizona as having a seasonal rise? She suggested i call Cornell regarding that which i will do but thought I'd bring it up here and call tomorrow -- Lesley Bludworth Phoenix, AZ Sophie Case History 7/2022 https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=277749 |
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Sherry Morse
Neither of those ACTH levels would be considered a sign of PPID this time of year. You can reference: https://ecir.groups.io/g/main/files/Blood%20Testing%20for%20IR%20and%20PPID/Blood%20Testing%20for%20Cushings%20-%20PPID/Seasonal%20Influences%20on%20ACTH/Liphook%20-%20Seasonal-Changes-in-ACTH-Secretion2.pdf and Microsoft Word - Pituitary pars intermedia dysfunction.docx (groups.io) If you want a confirmation of PPID status for either horse you'd need to run a TRH stim test after the seasonal rise (January time frame).
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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The upper limit of the seasonal rise varies from study to study and is likely higher (80 or so) for older horses. For horses with a history of fall laminitis, no increase is OK. If you are trying to diagnose and have a horse in the grey zone like those two are, wait until December. ACTH per se will NOT cause laminitis. It's the elevated insulin.
-- Eleanor in PA www.drkellon.com |
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Hello,
Please help me clear up some confusion about September bloodwork. I understand that ACTH can be elevated seasonally. The two main questions are: 1. how much elevation is within a normal fluctuation range for this time of year (my online "research" turned up the number 50 pg/mL as the upper bound of the "okay" range for the fall - is this accurate?), and 2. is elevated ACTH a laminitis risk factor in itself or only via its impact on insulin/glucose metabolism? In other words, if both glucose and insulin are within the reference range, but baseline ACTH is elevated (35.7 pg/mL one horse (10 y/o) and 49.8 pg/mL the other (13 y/o) - both are below 50 but one is pushing it) is it okay to wait until the winter to re-test baseline ACTH and/or do TRH stimulation and/or dexamethasone suppression tests, or am I playing with fire and need to put them on pergolide now? Thank you! -- Ed P in TX 2022 https://ecir.groups.io/g/CaseHistory/files/Edward%20and%20Atticus https://ecir.groups.io/g/CaseHistory/album?id=273196 |
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