Why we test

PPID is a complex disorder that we are still working to understand. But recently our knowledge about equine endocrine disorders has expanded — thanks to independent researchers such as the Equine Endocrinology Group (EEG), as well as dedicated research contributed by Boehringer Ingelheim.

In 2013, we established a testing program to gather epidemiological information concerning PPID, such as age, breed, sex and clinical signs at initial diagnosis. We wanted to look at these factors and their association with ACTH and insulin values in order to increase the knowledge around PPID. We are using these results to better recognize and diagnose PPID.

Enroll a Horse

How the IDPPID Testing Program works

Our testing program provides veterinarians with tools to help recognize and diagnose PPID. Here are the steps:
Pre-diagnosis

What You See: In conversations with horse owners and trainers, identify horses displaying early or advanced clinical signs that meet program criteria, and when the signs were first observed. These clinical signs may include changes such as delayed shedding, abnormal sweating and muscle wasting, to name a few.

Enroll

What You Do: Sign up to create a profile. You can register as an individual veterinarian or as a veterinary clinic, and enroll the horse being evaluated. Signing up will also give you access to a dashboard where you can see instructions, plasma sample submission forms, and test results.

Data gathering and analysis

What We Do: Boehringer Ingelheim will compile data collected (over 32,000 horses have been tested) to gain new insights that may lead to better understanding of the clinical signs and their association with the disease. You can find more information about the results in the Clinical Research section.

TESTING CRITERIA
Have you seen a horse in your practice that may have clinical signs consistent with PPID?
Clinical Signs & Diagnosis Chart
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Before submitting a plasma sample, make sure your patient qualifies to be enrolled. In order to enroll a horse for testing, we request the following:
  • Only new cases suspected of PPID (not previously diagnosed)
  • Patient should exhibit one or more early or advanced clinical signs
  • Patients currently being administered medical therapy for PPID are excluded, except horses being administered compounded pergolide
Enroll a Horse
Resting ACTH

Detecting excessive endogenous plasma adrenocorticotropic hormone (ACTH) is the most common diagnostic test for PPID. EDTA plasma is specifically needed for resting ACTH testing. Follow the instructions in the attachment below to draw and submit a plasma sample to be submitted for evaluation.

PDF Download: 
Resting ACTH Testing Instructions
TRH stimulation Test (non-fall months only)

The thyrotropin-releasing hormone (TRH) stimulation test is recommended by the Equine Endocrinology Group for diagnosing PPID in cases when horses have signs of early PPID or when horses have normal resting ACTH concentrations. This test is easily performed, but should only be conducted during the non-fall period. Follow the instructions in the attachment below to collect and submit a plasma sample. 

 

TRH testing in the fall months is not recommended at this time.

PDF Download: 
TRH Stimulation Test Instructions
Insulin & Glucose

Insulin dysregulation can be confirmed by measuring insulin in the blood. Glucose concentration can also be measured during this process. The plasma sample collected for testing ACTH can also be used for insulin and glucose testing. Follow the instructions in the attachment below to collect and submit a plasma sample from your horse to be used in resting insulin evaluation.

PDF Download: 
Insulin & Glucose Testing Instructions
acth levels vary by season
Accounting for seasonal changes to reference ranges

From mid-November to mid-July, the EEG recommends using the TRH-stimulation test for horses suspected of early PPID. Resting ACTH is recommended to evaluate if horses have moderate to advanced clinical signs. If you observe horses with either early or advanced clinical signs of PPID from mid-July to mid-November, the EEG recommends evaluating resting ACTH. 

Use seasonal (fall) reference ranges when testing for resting ACTH in the fall months to account for the increased pituitary activity that produces increased resting ACTH levels.

Collecting & Processing blood Samples
How to process your sample
  1. For sample submission, only one (1) purple-top (EDTA) is required per horse. 
  2. Follow the feeding instructions detailed in the Feeding Instructions Prior to Determination of Resting Insulin downloadable PDF.
  3. The purple-top (EDTA) tube is for ACTH, insulin and glucose. 
  4. After obtaining the sample, immediately place sample in a cool place. 
  5. Within the same calendar day as you obtain the sample, spin sample and remove plasma (portion on top) from the purple-top (EDTA) tube and transfer plasma to either a red-top or purple-top (EDTA) tube. 
  6. Caution:  Cornell University Animal Health Diagnostic Center (AHDC) will NOT process samples if the purple-top (EDTA) tube is not spun down and plasma separated.
  7. Plasma can now be shipped unfrozen, or frozen if shipment is going to be delayed. 
  8. Ship plasma with an ice pack.
  9. If samples are frozen prior to shipment and shipped with an ice pack, they will arrive at the diagnostic laboratory thawed but still cool. 
Interpreting your Results

Resting ACTH concentration and TRH stimulation test

Use this chart and the 2019 EEG publication to help interpret your results.
2019 EEG PPID Recommendations
Join our IDPPID Testing Program Today
Our program includes easy-to-use tools for clinics and veterinarians to enroll horses and keep track of the results. 

When you sign up for our IDPPID Testing Program, our dashboard can help keep your results organized. Individual veterinarians can enroll horses, track progress and view results. Veterinary clinics can track their group of veterinarians and assist them with enrollment and submissions. To explore the dashboard, sign up for a new account or log in with an existing account from previous testing years.

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Frequently Asked Questions
Frequently Asked Question: 
Question: 
WHAT BOEHRINGER INGELHEIM PAYS FOR?
Answer: 

Boehringer Ingelheim will cover the cost for the following tests per horse:

  • ACTH
  • Insulin
  • Glucose
Question: 
HOW MANY HORSES MAY BE TESTED?
Answer: 

Boehringer Ingelheim will cover the cost to test two horses per veterinarian.

Question: 
Should I fast horses prior to having blood pulled for resting insulin?
Answer: 

No. Do not feed grain within 4 hours of pulling blood sample for resting insulin. Leave horses on hay and/or pasture as per normal management practices.1 See Feeding Instructions Prior to Determination of Resting Insulin.

Reference

1Recommendations for the diagnosis and treatment of equine metabolic syndrome (EMS). 2018. Equine Endocrinology Group.