Endocrine diseases and associated laminitis in the horse #horsehealth
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#horsesa #horse #horsehealth Dr Gustavo Ferlini, University of Adelaide Equine Health and Performance Centre presented at the Horse SA Northern Horse Forum 2019 Hosted by Horse SA https//www.horsesa.asn.au a non-profit organisation working with and for horse owners on common topics. Why not join, sponsor or donate today https://www.horsesa.asn.au/join-sponsor-or-donate or visit our website for more events, webinars or download free resources. Note: Horse SA has hosted this presentation only. It is up to individuals to seek their own advice. It is also the responsibility of individuals to familiarise themselves with laws relating to the provision of animal services which may fall under Acts or Regulations associated with veterinary services, animal welfare and related areas, which vary between Australian states, and in jurisdictions within different countries.
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Endocrine diseases and associated laminitis in the horse #horsehealth
- 1. Endocrine diseases & associated laminitis in the horse Gustavo Ferlini agne, MV, MS, DACVIM-LA gustavo.ferliniagne@Adelaide.edu.au
- 2. Outline Pituitary Pituitary Pars Intermedia Dysfunction (PPID) Metabolic disease Equine metabolic syndrome (EMS)/I.D
- 5. Signalment All breeds Ponies Donkeys Usually >15 years of age, not less than 7 yrs
- 6. 1/3 Horses in Queensland > 15 years This is a disease of middle-aged / older horses (McGowan et al EVJ 2013) PPID: Pituitary Pars Intermedia Dysfunction (EquineCushing’s disease)
- 7. PPID Prevalence in Australia 21.2% of horses > 15 years inAUS
- 8. Muscle wasting Pot belly Bulging orbital fat Long, Curly haircoat Quiet demeanor Laminitic changes
- 9. Weight Loss/Muscle Wasting Hirsutism/ Hypertrichosis (persistent long hair coat)
- 10. abnormal / regional fat deposition secondary (Type II) diabetes lethargy & infertility anhidrosis & heat stress sec. exercise intolerance* * Spelta & Axon, cases series (n=11) in a tropical climate,AVJ 2012 PPID: Pituitary Pars Intermedia Dysfunction (EquineCushing’s disease)
- 12. Polyuria (Increase in urination) Polydipsia (Increase in drinking)
- 15. Mechanism of clinical signs Increased action of glucocorticoids? Effects on glucose and insulin homeostasis Laminitis Protein catabolism Muscle wasting Immune system Immunosuppression Increased b-endorphins in CSF Docile, lethargic
- 16. Laminitis Occurs commonly in horses with PPID True link between PPID-Laminitis still unknown Insulin dysregulation (ID) and hyperinsulinemia changes insulin-induced vasoreactivity Protein catabolism and laminar breakdown
- 17. Hirsutism/ hypertrichosis >90% of PPID horses Hair coat changes are progressive (not curly all at once!) Mechanism: hair is “stuck” in anagen (growth phase)
- 20. How do we Diagnose PPID? Clinical signs Signalment: Aged horse Baseline testing Dynamic testing
- 21. Diagnosis: Direct measurement of POMC peptides Endogenous ACTH: GOOD test
- 22. Secombe et al. AVJ 2018 Plasma EndogenousACTH inAustralian Horses
- 23. Diagnosis: Dynamic tests Thyrotropin releasing hormone-ACTH response test: GOOD test 1. Baseline: measure [ACTH] 2. GiveTRH IV 3. Measure [ACTH] after 10 min TRH elevates [ACTH]
- 24. TRH-ACTH response test NORMAL Horse: minimal ⇑in [ACTH] PPID horse: ⇑⇑ in [ACTH] Measuring ACTH afterTRH is a good test for PPID especially in mild clinical signs (grey zone) *Some difficulty obtaining TRH for testing: originally not a medical grade product but there is now a compounded product available.
- 26. Any side effects from Pergolide? Decrease in appetite (16-33% reported) Usually resolves with dose adjustment Less common (Diarrhoea and Depression)
- 27. Any other medications? Cyproheptadine Seratonin STIMULATES secretion of POMC from anterior pituitary and cyproheptadine antagonizes Seratonin antagonist Maybe useful in horses that do not respond to pergolide but typically not as effective Can cause depression and sometimes colic signs: start at a lower dose and increase gradually
- 29. PPID What else we know? Will Pergolide fix damaged hoof from previous laminitis? No, but may help preventing further episodes Regular hoof care is essential Is there any nutraceutical/supplements that can be used? No evidence at the moment
- 30. PPID What else we know? How long until treatment effect can be seen? Variable (2-7 months for clinical improvement) Is continued monitoring necessary? Yes ACTH levels 1 months after treatment initiated ACTH levels 2x per year If ID, Insulin measured concurrently
- 32. EMS: Equine Metabolic Syndrome • EMS: collection of risk factors for endocrinopathic laminitis • Risk factors: - Obesity - Lack of exercise - Insulin dysregulation - Hypertriglyceridemia Smith, Large Animal Internal Medicine (2009)
- 33. EMS: Equine Metabolic Syndrome • Breed: Ponies > Morgans > Arabs > Fjords • “Easy-keepers” • Environmental factors also play a role Diet Exercise • EMS = disease of adult horses • (> 5 years) • No sex predilection
- 34. Abnormal fat deposition Cresty neck, rump fat, sheath fat Laminitis Infertility Normoglycemia + Hyperinsulinemia http://www.vet.utk.edu/cemr/index.php EMS Clinical Findings
- 38. Is obesity and I.D in horses a problem inAUS? • 24.5% of Australian pleasure horses and ponies are overweighted
- 40. http://www.anslab.iastate.edu Body condition score 4 – Moderately thin (ideal)
- 41. http://www.anslab.iastate.edu Body condition score 5 – Moderate (ideal)
- 42. http://www.anslab.iastate.edu Body condition score 6 – Moderate- fleshy
- 43. http://www.anslab.iastate.edu Body condition score 7 – Fleshy
- 47. How do we Diagnose ID? Resting Insulin OST OGT Pro-inflammatory/ ID/ Laminitis Oxidative damage PPID Predisposition to PPID EMS ID = insulin dysregulation
- 48. How do we manage EMS/I.D? Exercise program Energy restriction Nutrition composition of forage: Low NSC - Hays with low NSC content (<10%) are recommended - Soak hay for 60 min (rinse afterwards) ID = insulin dysregulation
- 49. NSC=Starch + Sugars 7 + 4= 11% NSC
- 50. How do we manage EMS/I.D? Until I.D under control avoid grazing Once under control restricted grazing Restrict grazing alone: limited effect on DMI
- 51. Key Dietary recommendations for EMS/I.D How much weight loss per week? - Ideal target is 0.5%-1% of body mass loss per week How much forage to be fed? - 1.4-1.7% of body mass as fed forage How much NSC? - Forage with NSC < 10% is recommended Do I need to add anything else to the diet? -Yes. Ratio balancer supplement since vitamins and proteins will loss by soaking hay.
- 52. Key exercise recommendations for EMS/I.D How much exercise for non-laminitic horses? - Low-moderate exercise (canter to fast canter – HRs 130-170 bpm) for > 30 min, 5 x per week
- 53. Key exercise recommendations for EMS/I.D My horse has/had laminitis recently. Should I start exercise? - Likely not. Exercise based on lamellar stability. How much exercise for previously laminitic horses (w/ stable hoof lamellae)? - Low intensity exercise on a soft surface (fast trot to canter, unridden – HRs 110-150 bpm) for > 30 min, > 3 times per week
- 54. Equine Metabolic Syndrome Middle aged horses Obesity/regional adiposity Insulin resistance Laminitis Infertility http://www.vet.utk.edu/cemr/ecd.php http://www.alexbrollo.com/johnthevet/metasyn.html PPID Older horses Abnormal fat deposition Insulin resistance Laminitis Hirsutism/hypertrichosis PU/PD Infertility
- 55. Questions? Gustavo Ferlini agne, MV, MS, DACVIM-LA gustavo.ferliniagne@Adelaide.edu.au