ACTH Results seem too high - could the blood have been compromised?


Lisa Toms
 

Hi there.  Can blood be compromised and return a high ACTH for a non-cushings mare?

My IR mare lost quite a bit of muscle tone nearing the end of our summer, around 5 weeks ago.  I have checked faecal count, teeth and increased her roughage intake.  I also requested a Gluocose/Insulin and ACTH test just as a precaution not expecting the ACTH to come back as cushings because she isn't showing any signs of cushings apart from the muscle loss.

The ACTH test results came back as 157 pg/ml - the vet said this was 4 times the norm.  The vet was quite young and firstly froze the blood for my sugar/glucose test <sigh> along with freezing the blood for the ACTH test (so I couldn't get a glucose insulin reading).  The ACTH blood stayed frozen for around 4 days as he didn't get it couriered before the public holidays started.

I am wondering if its worth getting another vet out to draw blood again and do a new ACTH test?  I really don't want to start her on Pergolide unless I have 100% confirmed she is cushings.

I have posted recent photos in her photo album and the ACTH test results in her Case History files folder.

Thanks so much!

--
- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740


Lavinia Fiscaletti
 

Hi Lisa,

Short answer is that mishandling will lower results, not increase them.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Maxine McArthur
 

Lisa, when you say the vet froze the blood for the ACTH test, was it after he spun (centrifuged) it? If so, that’s the usual practice, to preserve the sample while in transit. However, if he froze the blood without spinning, that could affect results—but the lab would have commented and probably rejected the sample. Do you have the actual lab report? 


--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Lisa Toms
 

Hi Maxine and Lavinia

Thank you.  Gosh, I have no idea - he didn't have a machine with him to spin it, which the other vets usually do for the Insulin testing.  He said he put it in his freezer at home due to the public holiday, so I am thinking not.  To be safe I will get the test done again, this time I will forward the ECIR instructions on how to work with an ACTH blood sample to vet before hand.  So, just so that I am prepared for the next blood results... if the 157 pg/ml is correct - does this mean she is now at late stage Cushings and I somehow missed the signs? 
 
--- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740


Lisa Toms
 

I forgot the link to the ACTH lab results:  ACTH Test Results 2022-05-09
--
- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740


Maxine McArthur
 

Hmm, there’s no comment on the results. I think the easiest thing to do is ask the vet if he spun it down before freezing. My vet doesn’t have a portable centrifuge and often I will take the sample back to their office if the vet has a busy day ahead and is unlikely to get back to the office in time. 


The number on the test does not correlate neatly with symptoms, unfortunately. Don’t beat yourself up for missing things. Some horses with very high numbers have few symptoms (although they will develop symptoms if not treated) and vice-versa. All you can do is monitor and treat your horse as an individual. 

There is a lot of information in our Files, have a read through the PPID folder for a start. 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Lisa Toms
 

Thank you so much Maxine.  I will read through the articles first as I have a ton of questions ;-)  
--
- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740


Lavinia Fiscaletti
 

Hi Bonnie,

While 157pg/ml is a definitive positive for PPID at any time of the year, it's not something to panic about. For instance, one of my boys had a result of 1166pg/ml and another had 1250pg/ml the first time I tested them after they came to me.

It means she really needs to be started on pergolide to get things under control, then retest after 3 weeks at the target dose to see where things stand.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Lisa Toms
 

Hi Lavinia,

Thank you so much for that, it really helped to create some perspective for me. I feel a ton better now... just to get my ducks in a row and do this without the veil, lots of reading up to do ;-)

--
- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740


Eleanor Kellon, VMD
 

If you mean the blood was frozen before the cells were taken off then yes, that can falsely elevate ACTH.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Lisa,

157 isn't terribly high. Horses vary in their presenting signs but the coat changes are late stage.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lisa Toms
 

Hi everyone,

I got a new test done, by a different vet clinic and the results are 70.30 pg/ml, half of the original results which were 157 pg/ml.  Does this mean that Bonnie is not PPID?  or is it normal for the range to vary so much between tests?  I am not too sure what to do from here... treat with pergolide to get it to a lower range of +- 40 pg/ml or wait for symptoms to show, or rather wait out the autumnal seasonal increase and test again later in the year?

The lab mentioned the following:
The endogenous ACTH was elevated into a range which could be consistent with PPID provided that there are supportive clinical symptoms and other lab results. It has been shown recently that SA horses also experience the autumnal seasonal increase in ACTH but this result exceeds that peak. The insulin concentration was not elevated and basalcortisol is difficult to interpret on a random sample

Test Results:  https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie/Bonnie%20ACTH%20Test%20Results%2020220518-.pdf

--
- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740


Sherry Morse
 

Hi Lisa,

Based on the test results Bonnie is PPID.  Were she mine I would be getting her on medication sooner rather than later to try to avoid any other detrimental effects on her health.  Can you update her CH with current diet and weight information when you have a moment?  It would really help us help you.




Eleanor Kellon, VMD
 

Was this a fasting sample? Fasting will lower both insulin and ACTH. Both tests are clearly abnormal. You want to aim for the normal levels.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

P.S. Your seasonal increase is Spring, not Autumn.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Maxine McArthur
 

Dr Kellon, do you mean that SA horses experience a seasonal rise at the opposite end of the year? That is, in the vernal equinox? In the Southern Hemisphere that would be September/October. 

Or did you mean the SA rise is in the Southern Hemisphere autumn also (March/April), which time of the calendar year correlates to spring in the northern hemisphere? 



--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


 
Edited

I was wondering when the earlier sample was done because they should just be coming out of their rise now, I would think.  It would make sense that the more recent test results are lower.  I don’t see either of these tests in the case history and there could be any number of other differences between the testing circumstances if there wasn’t a focus on consistency.

I did find the earlier text and it was about a month ago.  Also reread all the posts here and realize there is reason to suspect handling error.  Regardless, I agree with everyone else that she needs pergolide.
--
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


 
 


Eleanor Kellon, VMD
 

In the southern hemisphere, the seasonal rise is 6 months after in the northern hemisphere so yes, it correlates to spring in the northern hemisphere.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lisa Toms
 

Thanks for the really quick replies.

I will update her case history asap with her latest details and start reading up on the pergolide (and if I remember correctly, the herbs that help with the veil).  I guess my denial is officially over ;-) 

Thanks once again!



--
- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740


Lisa Toms
 

I forgot to mention @Dr Kellon, no this wasn't a fasting sample.
--
- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740