Insights into Equine Metabolic Syndrome and Equine Cushing's

What 3 things are characteristic of EMS

Insulin dysregulation, obesity/regional adiposity, abnormal adipokine profile

Hyperinsulinaemia, obesity/regional adiposity, abnormal adipokine profile

Insulin resistance, increased endogenous ACTH and laminitis

Insulin dysregulation, increased endogenous ACTH and laminitis

Which of these breeds is most likely to develop EMS

Standardbreds

Thoroughbreds

Welsh cobs

Warmbloods

Diagnosis of hyperinsulinaemia can be done by the following tests:

a. Oral sugar test and fasting blood glucose

b. Oral sugar test and oral glucose test

c. Basal insulin levels

b and c

In order to encourage optimal weight loss and improved insulin sensitivity, the following management strategies can be implemented:

Restricting access to pasture by strip grazing and regular moderate intensity exercise

Feeding low NSC/soaked hay at a limited amount and regular moderate intensity exercise

Feeding good quality grass hay at a limited amount and regular moderate intensity exercise

Use metformin and/or levothyroxine at the beginning of a EMS management plan, along with diet modification and an exercise program.

Modifiable risk factors for EMS include:

Age, breed, basal insulin, obesity

Age, breed, activity level, obesity

Pasture access, activity level, laminitis

Laminitis, obesity, hypertriglyceridemia

PPID is best described as:

Increased circulating cortisol levels due to excessive stimulation of the adrenal gland secondary to a pituitary adenoma

Reduced output of POMC-derived peptides from the pars intermedia of the pituitary gland due to loss of dopaminergic control by the hypothalamus

Increased production and secretion of ACTH due to increased activity of the pars distalis

A neurodegenerative condition that leads to loss of dopaminergic inhibition of the pars intermedia of the pituitary gland

The following comments about PPID below are false apart from:

All PPID affected horses have ID

All horses and ponies with PPID are prone to laminitis

ACTH secreted by the pars intermedia of the pituitary gland is less biologically active than from the pars distalis

Pergolide is a dopamine receptor antagonist

The most reliable time to test for PPID using endogenous ACTH is:

During the quiescent phase

During the autumn equinox

During the acrophase

Any time, because ACTH does not vary throughout the year

Interpretation of endogenous ACTH levels when diagnosing PPID should take into account:

Time of the year

Physiological status of the animal

Geographic location

All of the above

Treatment of PPID is indicated when:

ACTH levels are increased and there are clinical signs consistent with PPID

Basal ACTH results are above cut-off values in an aged horse

There is evidence of chronic or active endocrine-associated laminitis

Both basal ACTH and hyperinsulinaemia are diagnosed simultaneously

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Insights into Equine Metabolic Syndrome (EMS) and Equine Cushing's (PPID)