Hello all,  I just entered test and medication information into the new site, but I'll recap here for purposes of my question.  Back in June 2022, Abbey had the TRH test done, she was at 25.0 pg/mL Pre (range was 2-30) and 305 after (range was 2-110).  I just had her re-tested at the end of January, she was at 21.5 pg/mL Pre (range 2-30) and at 670 pg/mL Post (range 2-110).  She is on 2mg of compounded pergolide given once per day in the morning and was not fasted either time.  The first time she was tested in the morning and this last time it was 5 pm.   I don't know if that makes a difference, but just thought I would throw that out there.   What exactly does the post number tell me?   I read in another post that once they are diagnosed you shouldn't have to repeat the TRH test, but I just went with what my vet did.  I have been texting with my vet to try to figure out what to do, but she is very unresponsive and now has basically 'fired me' for asking too many questions, she told me to call another vet in the area that I think treats many horses with PPID, who she told me suggested switching her to Prascend and adding cyproheptadine, which also doesn't seem like the right answer to me.  

Any advice would be much appreciated!
--
Lori J in NC 2022
Abbey's Case History: https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey 
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Thanks Sherry,  So are you saying the Post test number doesn't really tell us anything?   She is on 2mg of compounded pergolide from Chewy pharmacy right now.  I just store it on the counter, but I did order qty 90 and that was back in December, also in mid-January my husband was taking care of her for a few days and when I came back I noticed the cap was crooked and not completely on, so I'm wondering if that might have affected it.   She seems totally fine to me, has an appetite, has energy, no issues with her feet or weight right now and she is shedding a little bit.  I'm leaning toward ordering just 30 at a time and keeping them in the fridge and then maybe re-testing her again after 3 weeks of using that, but, if I don't need the TRH test, then is there really any point in having her tested again since her Pre number was fine?   

Lori


--
Lori J in NC 2022
Abbey's Case History: https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey 
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Hi Lori

I will leave your TRH questions to others, but hoping I can ask you to add your NEW CH Site URL to  your signature.

This is Abbey's new CH link>>>> https://ch.ecirhorse.org/case-history.php?id=86

Here's where to your add to your signature.  https://ecir.groups.io/g/main/editsub
Keep the groups.io CH links in your sig as they are.
Don't forget to hit save.

Many thanks

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President 2023-2024

Skip and Sonny New Site CH links:
Skip:  https://ch.ecirhorse.org/case-history.php?id=1
Sonny:  https://ch.ecirhorse.org/case-history.php?id=4

Beau groups.io CH links:
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Beau

ECIR Group NEW Case History site is now open Bookmark and save this link somewhere on your device(s). https://ch.ecirhorse.org/ 
HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993

There is one study from the UK on the effect of pergolide treatment on TRH stimulation results https://pubmed.ncbi.nlm.nih.gov/35477010/ . I have the full paper but cannot post it because of copyright restrictions.  Long story short, it was found that the response to TRH generally decreased but did not usually return to normal. There was no information given on dosages, original findings, etc..
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Time of day won't influence the response but time of year does. I would expect results to be higher in January than in June but it appears like your pergolide dose is not doing much of anything. Cypro won't help. If you do try going to Prascend, retest in June.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Thank you Dr. Kellon,  So the fact that the Post number was higher does mean the pergolide isn't working for her PPID?    What would your recommendation be for her as far as dosage and do you feel like switching her to Prascend would be the best option?


--
Lori J in NC 2022
Abbey's Case History: https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey 
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 
Abbey's New CH:  https://ch.ecirhorse.org/case-history.php?id=86

The first question we have no answer for is what does a normal baseline ACTH and abnormal TRH response mean? Are all these horses going to progress to symptomatic PPID or does it just mean the pituitary is enlarged but not active unless artificially stimulated? I suspect both scenarios are possible so that means you have to look for clinical signs specific to PPID. Did she have any? If so, have they improved?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

--when you mentioned that the pituitary might be enlarged but not active, would a higher TRH number reflect activity? I.e. true Cushing’s? 
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 

Not necessarily. The TRH stimulation is an artificial condition. You could have an inactive hypertrophy that only responds to the abnormal situation.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Last spring she completely shed out as usual, but then in May/June timeframe she grew a thicker coat back in.  She definitely had gained more weight than normal, had fat pads, cresty neck (because she is also IR) and seemed to have less energy than normal, unfortunately she also ended up with laminitis.   She is shedding a little bit now, but not as much as she normally does this time of year.  She no longer has a cresty neck and has lost weight, so her topline looks much different to me, but I don't know if that is a symptom of PPID or just a result of her being on the IR diet and losing weight.   Her energy seems pretty much back to normal, her appetite is good and everything else about her seems normal.   Her coat growing back in was what prompted me to have her tested.

--
Lori J in NC 2022
Abbey's Case History: https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey 
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 
Abbey's New CH:  https://ch.ecirhorse.org/case-history.php?id=86