PPID (pituitary pars intermedia dysfunction), previously known as Cushing’s disease, is a progressive disease that can have a wide range of symtoms. It is one of the leading causes of laminitis..
What is PPID or Cushing’s disease?
PPID is caused by a benign growth in the pituitary gland. It causes a derailment of hormones, which can lead to a wide range of symptoms. Not every horse shows the same symptoms, and early signs of the disease can often be very subtle. Therefore PPID may often be overlooked until the disease is in an advanced stage.
|Clinical signs of PPID||Early||Advanced|
|Changes in attitude/lethargy||✔|
|Decreased athletic performance||✔|
|Regional hypertrichosis (long/curly hair coat)||✔|
|Delayed hair coat shedding||✔|
|Loss of topline muscle mass||✔|
|Abnormal sweating (increased or decreased)||✔||✔|
|Regional fat depositions||✔|
|Laminitis/recurrent sole abscesses||✔||✔|
|Dull attitude/altered mentation||✔|
|Generalized hypertrichosis (long/curly hair coat)||✔|
|Loss of seasonal hair coat shedding||✔|
|Loss of skeletal muscle||✔|
|Excessive thirst and / or urination||✔|
|Regional fat depositions (cresty neck / bulging fat above the eyes / etc.)||✔|
|Tendon and suspensory ligament laxity||✔|
PPID was previously thought of as an older horse disease. However, more and more horses are being diagnosed with PPID/Cushing’s disease at an earlier age, some as young as 5 years of age. The disease progresses over time, which means that the quality of life decreases, eventually to the point where it can no longer be justified. Luckily, we can decrease the symptoms associated with PPID/Cushing’s disease with Prascend, improving the quality of life and therefore the lifespan of the affected horse significantly.
We can test for PPID by doing a blood test. The hormone levels that we test for change throughout the year, and the best months to test in are February-March-April-May. The hormone levels in the blood help diagnose PPID / Cushing’s disease. The other advantage is that when horses have started therapy, we can compare hormone levels with the first sample to monitor progress.
We can test horses for PPID because they are showing signs of the disease. Because horses with PPID can get laminitis under otherwise normal circumstances and thus quite unexpectedly, we recommend testing for PPID as soon as it may be suspected.
We can also test horses as part of a screening. PPID occurs more often in older horses than young horses, with the youngest horse with PPID being 5 years old. It happens in 21% of horses over the age of 15 years, which is quite significant. The older the horse the higher the chances are. In horses over 20 years of age owners might consider annual testing.
The horse’s pituitary gland is located in the brain and utilises hormones to control body functions. In PPID, a benign growth in the pituitary gland causes it to work overtime, derailing hormone production, which disturbs a wide range of body functions. Pergolide, a dopamine antagonist, controls the output of those hormones. Prascend contains pergolide, which is considered the gold standard for treatment of PPID / Cushing’s disease. There is currently no cure for PPID. It is a chronic, lifelong disease that requires daily medical treatment.
When it comes to treating PPID, the earlier the better. Although some early signs can be managed (e.g, extra clipping and grooming will control hypertrichosis), a case can be made in support of starting medical treatment when clinical signs are initially recognized. Early treatment can minimise progression of PPID and prolong the life of the horse.
When caught early, PPID treatment is very successful in reducing common signs and allowing affected horses to live normal lives. Even when a horse has advanced disease, treatment usually gives the horse a longer, healthier life.
Prascend tablets need to be administered orally, once daily. They can be given with food. Prascend tablets can also be hidden in an apple or treat. Do not crush the tablet, as this exposes you to pergolide. If only half a tablet is needed you can split the tablet. If you are unable to split the tablet, you can ask your vet for a tablet cutter, which can split the tablet in two halfs. Prascend influences the horse’s hormones and treatment should therefore never be skipped. Additionally, experience worldwide indicates that when Prascend is discontinued for a while and then started up again, it may lose its efficacy and doses might need to be doubled or tripled.
Treatment with Prascend may cause loss of appetite. Most cases are mild. Weight loss, lack of energy and behavioral changes also may be observed. These signs may only be temporary, but if severe, a temporary dose reduction may be necessary. Contact your vet if any of these signs occur.
Every horse responds a little differently to Prascend. For that reason, the first checks are to make sure your horse has started on the right dose. These checks are done at (1 and) 3 months into treatment.
Because PPID / Cushing’s disease is a progressive disease, regular (yearly) checks are needed to ensure your horse is (still) on the right dose. Therefore, if you are caring for a horse who has been diagnosed with PPID, scheduling yearly veterinary visits is important. We will check on your horse to ensure proper dosing and that clinical signs are not advancing. Working together is key to managing PPID.
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