horse in stall

PPID requires a comprehensive approach

Diagnosis of PPID includes:

  • Collection of a comprehensive patient history
  • Conducting a detailed physical examination
  • Submission of a plasma sample for confirmation

Management of PPID includes:

  • Revisiting the horse's diet and environment
  • Reviewing exercise habits
  • And medical treatment

Factors such as concurrent insulin dysregulation (ID) and equine metabolic syndrome (EMS) will impact PPID management approach.

STEP 1

Patient History

Talk to the owner about the horse’s history, both clinical and behavioral. Horse owners can help you uncover more subtle behaviors that take more time to notice such as:

  • Changes in attitude and lethargy
  • Weight loss
  • Decreased athletic performance
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STEP 2

Physical Examination

Identify any clinical signs associated with PPID such as:

  • Delayed coat shedding
  • Abnormal sweating
  • Regional muscle loss
  • Generalized muscle loss
stehoscope on horse

STEP 3

Blood Testing

For horses with advanced clinical signs:

  • Evaluate resting (basal) ACTH levels (alongside insulin and glucose)

 

The TRH stimulation test is recommended for:

  • Horses with early PPID
  • Horses previously tested using resting ACTH and results were within normal range
  • The TRH stimulation test is not recommended from July through December
test tubes

DECISION ALGORITHM

Diagnosis and management of PPID

Once a horse has been diagnosed with PPID, it’s important to determine how to manage the disorder in that particular horse. For example, 47% of horses exhibiting clinical signs of PPID were also diagnosed with insulin dysregulation.1 For more information on horses with insulin dysregulation, reference the Epidemiological Characteristics of Horses at Initial Diagnosis publication.

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decision algorythm

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EPIDEMIOLOGICAL CHARACTERISTICS OF HORSES AT INITIAL DIAGNOSIS

INTERPRETING LABORATORY RESULTS

Resting ACTH concentration reference ranges 

Use this chart and the 2023 EEG Recommendations for the diagnosis and management of PPID.

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Resting ACTH concentration reference ranges. Used to help diagnose and manage PPID.

INTERPRETING LABORATORY RESULTS

TRH stimulation test reference ranges

Use this chart and the 2023 EEG Recommendations for the diagnosis and management of PPID.

Click to enlarge
TRH stimulation test reference ranges chart. Used to help diagnose and manage PPID.

PPID MANAGEMENT

Developing a 360° care plan after diagnosis

To properly manage PPID, it is important to work closely with horse owners to build a plan. Concurrent illnesses, such as insulin dysregulation, can impact the PPID management plan. In general, the plan should include:

  • Medical management
  • Diet evaluation, including testing of forage and feedstuffs
  • Regular care from hoof to teeth
  • Body clipping, if necessary
  • Regular deworming
  • Proper vaccination
  • Adequate exercise

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Horse Owner’s PPID Management Guide

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REFERENCE

1Grubbs ST, Neal DL and TJ Keefe. Epidemiological characteristics of horses at initial diagnosis. J Vet Intern Med 2015;29:123