A Whole-Horse Approach to PPID

by Boehringer Ingelheim/March 5, 2024

The importance of the recognition, diagnosis and management of the disease.

Pituitary pars intermedia dysfunction (PPID), formerly known as equine Cushing’s disease, is one of the most common endocrine diseases in horses. PPID affects nearly 21% of horses older than 15 years old, and although rare, it has been diagnosed in horses as young as 5.² While there is no cure for the disease, a horse diagnosed with PPID can continue to live a happy life following diagnosis, medical treatment and ongoing management.

RECOGNITION

Recognizing the clinical signs of PPID is the first step to receiving a diagnosis. While there are early and advanced clinical signs, many of them are present throughout all stages, at varying severity. Initially, owners may identify subtle changes in their horse, such as lethargy, decreased performance, abnormal sweating, and loss of top-line muscle and/or regional hypertrichosis (delayed shedding in a specific region). As the disease progresses, horse owners may notice generalized delayed shedding when compared to herd mates, loss of muscle mass and increased urination or thirst, among others.²

“If a horse is showing any of the clinical signs of PPID, they should be examined by a veterinarian,” advised Steve Grubbs, DVM, Ph.D., DACVIM, Boehringer Ingelheim Technical Services Veterinarian.

DIAGNOSIS

To arrive at a diagnosis of PPID, the veterinarian will likely follow these three steps¹:

Collect a thorough history of the horse
“Talking with the horse owner to gain an understanding of the horse’s history can provide a veterinarian with additional historical clinical signs associated with PPID that may not be present at the time of examination,” said Dr. Grubbs. “For example, a change in attitude or decreased performance may not be something identified during a physical exam. Horse owners or caretakers who interact with the horse every day may notice these more subtle clinical signs, and should discuss them with their veterinarian.”
Perform a detailed physical examination
During a physical examination, a veterinarian will look over the horse for further signs of PPID not previously identified in the horse’s history. These clinical signs may include delayed coat shedding, abnormal sweating, and regional or general muscle loss.
Submit plasma for testing
“Blood testing is another important piece of information that we use to confirm a PPID diagnosis,” Dr. Grubbs explained. “For horses with advanced clinical signs, resting adrenocorticotropic hormone [ACTH] levels, a hormone released by the pituitary gland, in addition to insulin and glucose levels, should be evaluated. For horses that are still in the early stages of PPID and may have normal resting ACTH levels, the thyrotropin-releasing [TRH] stimulation test is recommended.” Work with your veterinarian to determine which testing procedure is the most appropriate for your horse.

Overall, the diagnosis of PPID should be made using all information obtained from the history, physical examination and laboratory results.

MANAGEMENT

So, your horse has received a diagnosis of PPID. What’s next?

“After a horse receives a diagnosis of PPID, we look next at what we can do to address the 'whole horse,'” stated Dr. Grubbs. “This often includes pharmaceutical treatment and diet evaluation/management, among other things.”

Pergolide is the drug of choice when treating PPID, and can greatly improve a horse’s quality of life.³ Talk to your veterinarian about Prascend^® (pergolide tablets), the most-proven PPID treatment available.³In addition to PRASCEND, the horse with PPID should be managed with a proper diet.

“Horse owners should work with their veterinarian and a nutritionist to evaluate forage, feed and supplement options to determine a proper diet based on the horse’s specific diagnosis,” says Dr. Grubbs.

With a lifelong disease like PPID, ongoing management is critical to maintaining your horse’s quality of life. “This isn’t a disease in which you can give the medication once a day and be done,” stressed Dr. Grubbs. “Managing a horse with PPID requires a whole-horse approach for optimum results.”

Horses with PPID should be kept up to date on relevant vaccinations, keeping in mind the area where they reside and their competition schedule, among other risk factors. They should also receive routine hoof trims every four to six weeks, a dental exam, as needed and regular deworming. “Horses with PPID have been shown to have higher fecal egg counts when compared to age-matched controls,” says Dr. Grubbs. “Performing fecal egg counts and administering deworming treatments will help manage the parasites.”³ Some horses, especially those experiencing delayed shedding, may benefit from body clipping when necessary.

A PPID diagnosis in your horse may at first feel overwhelming. However, by receiving a diagnosis from your veterinarian, starting medical treatment as soon as the disease is detected, and continuing to practice good, whole-horse management, a horse with PPID can definitely have an improved quality of life.

IMPORTANT SAFETY INFORMATION: PRASCEND has not been evaluated in breeding, pregnant or lactating horses. Treatment with PRASCEND may cause loss of appetite. Most cases are mild. Keep PRASCEND in a secure location out of reach of dogs, cats and other animals to prevent accidental ingestion or overdose. Adverse reactions may occur if animals other than horses ingest PRASCEND tablets. Not for human use. Do not ingest the product. Refer to the package insert for complete product information.

REFERENCES

¹IDPPID Testing Program. Available at: https://idppid.com/diagnosis-management. Accessed March 3, 2023.

²Young A. Pituitary Pars Intermedia Dysfunction (PPID). UC Davis Veterinary Medicine Center for Equine Health. 2020 Available at: https://ceh.vetmed.ucdavis.edu/health-topics/pituitary-pars-intermedia-dysfunction-ppid#:~:text=The%20most%20common%20clinical%20signs,)%2C%20lethargy%2C%20and%20laminitis. Accessed December 22, 2022.

³Prascend. Available at https://prascend.com/prascend. Accessed March 6, 2023.