Diagnosis & Management
Identifying PPID requires a comprehensive approach using three main components.

Arriving at a complete diagnosis of PPID can be complicated. The three main components are: collecting a comprehensive patient history, conducting a detailed physical examination and submitting plasma samples for testing. 

Management of PPID includes revisiting the horse’s diet, exercise habits, grooming, and medical treatment. Factors such as concurrent insulin dysregulation and equine metabolic syndrome (EMS) will impact the 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 like changes in attitude and lethargy, weight loss, or decreased athletic performance.

Step 2
Physical Examination

As you examine the horse, remember to look for clinical signs of PPID such as delayed coat shedding, abnormal sweating and regional or generalized muscle loss. 

Step 3
Blood Testing

If you see one or more clinical signs, it’s time to test. In the fall, the most effective approach for both horses that appear to be in the early stages and horses displaying more advanced clinical signs is considered to be testing resting adrenocorticotropic hormone (ACTH) levels (alongside insulin and glucose) in order to confirm whether or not the horse has PPID.


The TRH stimulation test in the fall months is not recommended at this time.

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 had insulin dysregulation.1 For more information on horses with insulin dysregulation, reference the Epidemiological Characteristics of Horses at Initial Diagnosis publication.

Interpreting Your Results

Resting ACTH concentration and TRH stimulation test

Use this chart and the 2019 EEG Recommendations for the diagnosis and management of PPID.

ppid management
Developing a 360° care plan from hoof to teeth

To properly manage PPID, it is important to work closely with horse owners to build a plan. Concurrent illnesses such as insulin dysregulation or equine metabolic syndrome (EMS) can impact the PPID management plan, but, in general, the plan should include:

  • Medical management
  • Regular care from hoof to teeth
  • Body clipping, if necessary
  • Regular deworming
  • Proper vaccination
  • Proper diet and adequate exercise 
ready to test
Diagnosed a horse with PPID? Now you’re ready to test.

It is easy to take part in our IDPPID Testing Program. Just enroll a horse that shows clinical signs of PPID by filling out a form, then submitting their plasma samples. Typically, it takes approximately 3 to 5 days after the sample arrives at the Cornell University Animal Health Diagnostic (AHDC) to receive final results.