FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / J Vet Intern Med / Investigation of single and paired measurements of adrenocor...
Journal of veterinary internal medicine2014; 29(1); 355-361; doi: 10.1111/jvim.12489

Investigation of single and paired measurements of adrenocorticotropic hormone for the diagnosis of pituitary pars intermedia dysfunction in horses.

Abstract: Paired measurement of ACTH concentration may be more reliable than a single measurement. Objective: To determine whether the mean of 2 measurements of ACTH concentration is more reliable in assessing pituitary pars intermedia dysfunction (PPID) than a single measurement. Methods: Paired ACTH measurements were performed on (1) 148 occasions from 124 horses being investigated for PPID, (2) 90 occasions from 76 horses with PPID that were receiving treatment with pergolide, and (3) 63 occasions from 50 horses in which there was no clinical suspicion of PPID. Histologic examination of the pars intermedia was performed in 67 of the untreated horses. Methods: Outcome of testing using single and the mean of paired samples was compared directly and both methods were compared against histology, which was considered the gold standard. Results: Paired ACTH measurement altered binary classification as healthy or diseased in 6 of 211 cases, all off which had equivocal initial ACTH concentrations between 20 and 39 pg/mL. Using histology as the gold standard, optimal sensitivity and specificity for diagnosing PPID were 69.4 and 80.9%, respectively, for a single measurement and 72.2 and 76.2%, respectively, for paired measurements. The area under the receiver operating characteristic curve was 0.72 and 0.73 for single and paired measurements compared with histopathologic diagnosis, respectively. Conclusions: Paired measurement of ACTH concentration offers no advantage over a single measurement.
Copyright © 2014 by the American College of Veterinary Internal Medicine.
Get Full Text
Publication Date: 2014-10-13 PubMed ID: 25312676PubMed Central: PMC4858100DOI: 10.1111/jvim.12489Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This study investigates whether taking two measurements of adrenocorticotrophic hormone (ACTH) is more accurate than one for diagnosing pituitary pars intermedia dysfunction (PPID) in horses, but concludes that there’s no clear advantage to the paired approach.

Objective and Methods

  • The research was aimed at exploring if averaging two measurements of ACTH concentration gave more precise readings for diagnosing PPID in horses than a single measurement. ACTH concentration readings can help diagnose PPID, a common endocrine disease in aged horses.
  • Three groups of horses were studied: 124 horses under examination for PPID, 76 horses diagnosed with PPID and under pergolide treatment, and 50 horses with no suspected PPID.
  • The measurements for these horses were taken as single readings and averages of two readings.
  • For a more reliable comparison, histological examinations (examination of tissues under a microscope) were done on the pars intermedia of 67 untreated horses. These histology findings served as the gold standard, or reference point, for comparison.

Outcome of Testing

  • The dual measurement methodology changed the health classification of six out of 211 cases. These horses initially had uncertain ACTH concentrations between 20 and 39 pg/mL.
  • Comparing the measurement methods to histology, the study found that best sensitivity (ability to correctly identify those with the disease) and specificity (ability to correctly identify those without the disease) for single measurement were 69.4% and 80.9%, respectively.
  • For dual measurements, these numbers were slightly different: sensitivity was 72.2%, while specificity reached 76.2%.
  • For the binary outcome of healthy or diseased, the area under the receiver operating characteristic curve (used to illustrate the performance of a binary classifier system) was very similar for both single and double measurements compared with histopathologic diagnosis (0.72 for single and 0.73 for double measurements).

Conclusions

  • Overall, the research concluded that paired measurement of ACTH concentration does not offer a significant advantage over a single measurement when diagnosing PPID in horses.
  • Despite a marginal increase in sensitivity with dual readings, the results did not show a substantial difference in the overall effectiveness of single versus paired ACTH measurement.

Cite This Article

APA
Rendle DI, Duz M, Beech J, Parkin T, Durham AE. (2014). Investigation of single and paired measurements of adrenocorticotropic hormone for the diagnosis of pituitary pars intermedia dysfunction in horses. J Vet Intern Med, 29(1), 355-361. https://doi.org/10.1111/jvim.12489

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 29
Issue: 1
Pages: 355-361

Researcher Affiliations

Rendle, D I
  • The Liphook Equine Hospital, Liphook, Hampshire, UK.
Duz, M
    Beech, J
      Parkin, T
        Durham, A E

          MeSH Terms

          • Adrenocorticotropic Hormone / blood
          • Animals
          • Dopamine Agonists / therapeutic use
          • Female
          • Horse Diseases / blood
          • Horse Diseases / diagnosis
          • Horse Diseases / drug therapy
          • Horses
          • Male
          • Pergolide / therapeutic use
          • Pituitary Diseases / blood
          • Pituitary Diseases / diagnosis
          • Pituitary Diseases / drug therapy
          • Pituitary Diseases / veterinary
          • Pituitary Gland, Intermediate / pathology

          References

          This article includes 33 references
          1. McFarlane D. Advantages and limitations of the equine disease, pituitary pars intermedia dysfunction as a model of spontaneous dopaminergic neurodegenerative disease.. Ageing Res Rev 2007 May;6(1):54-63.
            pubmed: 17374512doi: 10.1016/j.arr.2007.02.001google scholar: lookup
          2. Dybdal NO, Hargreaves KM, Madigan JE, Gribble DH, Kennedy PC, Stabenfeldt GH. Diagnostic testing for pituitary pars intermedia dysfunction in horses.. J Am Vet Med Assoc 1994 Feb 15;204(4):627-32.
            pubmed: 8163420
          3. Beech J, Garcia M. Hormonal response to thyrotropin-releasing hormone in healthy horses and in horses with pituitary adenoma.. Am J Vet Res 1985 Sep;46(9):1941-3.
            pubmed: 3931519
          4. Beech J, Boston R, Lindborg S, Russell GE. Adrenocorticotropin concentration following administration of thyrotropin-releasing hormone in healthy horses and those with pituitary pars intermedia dysfunction and pituitary gland hyperplasia.. J Am Vet Med Assoc 2007 Aug 1;231(3):417-26.
            pubmed: 17669045doi: 10.2460/javma.231.3.417google scholar: lookup
          5. Miller MA, Pardo ID, Jackson LP, Moore GE, Sojka JE. Correlation of pituitary histomorphometry with adrenocorticotrophic hormone response to domperidone administration in the diagnosis of equine pituitary pars intermedia dysfunction.. Vet Pathol 2008 Jan;45(1):26-38.
            pubmed: 18192571doi: 10.1354/vp.45-1-26google scholar: lookup
          6. Messer NT 4th, Johnson PJ. Evidence-based literature pertaining to thyroid dysfunction and Cushing's syndrome in the horse.. Vet Clin North Am Equine Pract 2007 Aug;23(2):329-64.
            pubmed: 17616317doi: 10.1016/j.cveq.2007.04.004google scholar: lookup
          7. Divers T. Pergolide and cyproheptadine: Which medication to choose for treatment of equine Cushing's disease?. J Equine Vet Sci 2008;28:370–371.
          8. Redekopp C, Irvine CH, Donald RA, Livesey JH, Sadler W, Nicholls MG, Alexander SL, Evans MJ. Spontaneous and stimulated adrenocorticotropin and vasopressin pulsatile secretion in the pituitary venous effluent of the horse.. Endocrinology 1986 Apr;118(4):1410-6.
            pubmed: 3004914doi: 10.1210/endo-118-4-1410google scholar: lookup
          9. Irvine CH, Alexander SL. A novel technique for measuring hypothalamic and pituitary hormone secretion rates from collection of pituitary venous effluent in the normal horse.. J Endocrinol 1987 May;113(2):183-92.
            pubmed: 3585231doi: 10.1677/joe.0.1130183google scholar: lookup
          10. Alexander SL, Irvine CH, Livesey JH, Donald RA. Effect of isolation stress on concentrations of arginine vasopressin, alpha-melanocyte-stimulating hormone and ACTH in the pituitary venous effluent of the normal horse.. J Endocrinol 1988 Mar;116(3):325-34.
            pubmed: 2832503doi: 10.1677/joe.0.1160325google scholar: lookup
          11. Cudd TA, LeBlanc M, Silver M, Norman W, Madison J, Keller-Wood M, Wood CE. Ontogeny and ultradian rhythms of adrenocorticotropin and cortisol in the late-gestation fetal horse.. J Endocrinol 1995 Feb;144(2):271-83.
            pubmed: 7706980doi: 10.1677/joe.0.1440271google scholar: lookup
          12. Durham AE, Fey K, McGowan CM. Pituitary pars intermedia dysfunction: Diagnosis and treatment.. Equine Vet Educ 2014;26:216–223.
          13. Copas VE, Durham AE. Circannual variation in plasma adrenocorticotropic hormone concentrations in the UK in normal horses and ponies, and those with pituitary pars intermedia dysfunction.. Equine Vet J 2012 Jul;44(4):440-3.
            pubmed: 21848531doi: 10.1111/j.2042-3306.2011.00444.xgoogle scholar: lookup
          14. Perkins GA, Lamb S, Erb HN, Schanbacher B, Nydam DV, Divers TJ. Plasma adrenocorticotropin (ACTH) concentrations and clinical response in horses treated for equine Cushing's disease with cyproheptadine or pergolide.. Equine Vet J 2002 Nov;34(7):679-85.
            pubmed: 12455838doi: 10.2746/042516402776250333google scholar: lookup
          15. Rendle DI, Litchfield E, Heller J, Hughes KJ. Investigation of rhythms of secretion and repeatability of plasma adrenocorticotropic hormone concentrations in healthy horses and horses with pituitary pars intermedia dysfunction.. Equine Vet J 2014 Jan;46(1):113-7.
            pubmed: 23742059doi: 10.1111/evj.12114google scholar: lookup
          16. Beech J, McFarlane D, Lindborg S, Sojka JE, Boston RC. α-Melanocyte--stimulating hormone and adrenocorticotropin concentrations in response to thyrotropin-releasing hormone and comparison with adrenocorticotropin concentration after domperidone administration in healthy horses and horses with pituitary pars intermedia dysfunction.. J Am Vet Med Assoc 2011 May 15;238(10):1305-15.
            pubmed: 21568777doi: 10.2460/javma.238.10.1305google scholar: lookup
          17. Beech J, Boston R, Lindborg S. Comparison of cortisol and ACTH responses after administration of thyrotropin releasing hormone in normal horses and those with pituitary pars intermedia dysfunction.. J Vet Intern Med 2011 Nov-Dec;25(6):1431-8.
            pubmed: 22092639doi: 10.1111/j.1939-1676.2011.00810.xgoogle scholar: lookup
          18. McFarlane D, Breshears M, Cordero M. Comparison of Plasma ACTH Concentration, Plasma a‐MSH Concentration, and Overnight Dexamethasone Suppression Test for Diagnosis of PPID.. Boston: Equine Endocrine Summit; 2012.
          19. Mc Gowan TW, Pinchbeck GP, Mc Gowan CM. Evaluation of basal plasma α-melanocyte-stimulating hormone and adrenocorticotrophic hormone concentrations for the diagnosis of pituitary pars intermedia dysfunction from a population of aged horses.. Equine Vet J 2013 Jan;45(1):66-73.
            pubmed: 22563728doi: 10.1111/j.2042-3306.2012.00575.xgoogle scholar: lookup
          20. Alexander SL, Roud HK, Irvine CH. Effect of insulin-induced hypoglycaemia on secretion patterns and rates of corticotrophin-releasing hormone, arginine vasopressin and adrenocorticotrophin in horses.. J Endocrinol 1997 Jun;153(3):401-9.
            pubmed: 9203994doi: 10.1677/joe.0.1530401google scholar: lookup
          21. Fazio E, Medica P, Cravana C, Ferlazzo A. Effects of competition experience and transportation on the adrenocortical and thyroid responses of horses.. Vet Rec 2008 Dec 13;163(24):713-6.
            pubmed: 19074788doi: 10.1136/vr.163.24.713google scholar: lookup
          22. Nagata S, Takeda F, Kurosawa M, Mima K, Hiraga A, Kai M, Taya K. Plasma adrenocorticotropin, cortisol and catecholamines response to various exercises.. Equine Vet J Suppl 1999 Jul;(30):570-4.
            pubmed: 10659320doi: 10.1111/j.2042-3306.1999.tb05286.xgoogle scholar: lookup
          23. Alexander SL, Irvine CH, Ellis MJ, Donald RA. The effect of acute exercise on the secretion of corticotropin-releasing factor, arginine vasopressin, and adrenocorticotropin as measured in pituitary venous blood from the horse.. Endocrinology 1991 Jan;128(1):65-72.
            pubmed: 1846116doi: 10.1210/endo-128-1-65google scholar: lookup
          24. Luna SP, Taylor PM. Pituitary-adrenal activity and opioid release in ponies during thiopentone/halothane anaesthesia.. Res Vet Sci 1995 Jan;58(1):35-41.
            pubmed: 7709057doi: 10.1016/0034-5288(95)90085-3google scholar: lookup
          25. Taylor PM. Equine stress responses to anaesthesia.. Br J Anaesth 1989 Dec;63(6):702-9.
            pubmed: 2692673doi: 10.1093/bja/63.6.702google scholar: lookup
          26. Ayala I, Martos NF, Silvan G, Gutierrez-Panizo C, Clavel JG, Illera JC. Cortisol, adrenocorticotropic hormone, serotonin, adrenaline and noradrenaline serum concentrations in relation to disease and stress in the horse.. Res Vet Sci 2012 Aug;93(1):103-7.
            pubmed: 21641009doi: 10.1016/j.rvsc.2011.05.013google scholar: lookup
          27. Towns TJ, Stewart AJ, Hackett E. Cortisol and ACTH concentrations in ill horses throughout 6 days of hospitalization.. J Vet Emerg Crit Care 2010;20:S1, A16–A17.
          28. Donaldson MT, Jorgensen AJ, Beech J. Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis.. J Am Vet Med Assoc 2004 Apr 1;224(7):1123-7.
            pubmed: 15074858doi: 10.2460/javma.2004.224.1123google scholar: lookup
          29. Hodson NP, Wright JA, Hunt J. The sympatho-adrenal system and plasma levels of adrenocorticotropic hormone, cortisol and catecholamines in equine grass sickness.. Vet Rec 1986 Feb 8;118(6):148-50.
            pubmed: 3006320doi: 10.1136/vr.119.6.148google scholar: lookup
          30. Couëtil L, Paradis MR, Knoll J. Plasma adrenocorticotropin concentration in healthy horses and in horses with clinical signs of hyperadrenocorticism.. J Vet Intern Med 1996 Jan-Feb;10(1):1-6.
            pubmed: 8965262doi: 10.1111/j.1939-1676.1996.tb02016.xgoogle scholar: lookup
          31. McFarlane D, Sellon DC, Gaffney D, Hedgpeth V, Papich M, Gibbs S. Hematologic and serum biochemical variables and plasma corticotropin concentration in healthy aged horses.. Am J Vet Res 1998 Oct;59(10):1247-51.
            pubmed: 9781456
          32. Donaldson MT, McDonnell SM, Schanbacher BJ, Lamb SV, McFarlane D, Beech J. Variation in plasma adrenocorticotropic hormone concentration and dexamethasone suppression test results with season, age, and sex in healthy ponies and horses.. J Vet Intern Med 2005 Mar-Apr;19(2):217-22.
            pubmed: 15822567doi: 10.1892/0891-6640(2005)19<217:vipahc>2.0.co;2google scholar: lookup
          33. McFarlane D, Paradis MR, Zimmel D, Sykes B, Brorsen BW, Sanchez A, Vainio K. The effect of geographic location, breed, and pituitary dysfunction on seasonal adrenocorticotropin and α-melanocyte-stimulating hormone plasma concentrations in horses.. J Vet Intern Med 2011 Jul-Aug;25(4):872-81.
            pubmed: 21745243doi: 10.1111/j.1939-1676.2011.0745.xgoogle scholar: lookup

          Citations

          This article has been cited 6 times.
          1. Humphreys S, Kass PH, Magdesian KG, Goodrich E, Berryhill E. Seasonal variation of endogenous adrenocorticotropic hormone concentrations in healthy non-geriatric donkeys in Northern California. Front Vet Sci 2022;9:981920.
            doi: 10.3389/fvets.2022.981920pubmed: 36032308google scholar: lookup
          2. Thane K, Uricchio C, Frank N. Effect of early or late blood sampling on thyrotropin releasing hormone stimulation test results in horses. J Vet Intern Med 2022 Mar;36(2):770-777.
            doi: 10.1111/jvim.16362pubmed: 35049089google scholar: lookup
          3. Wright S. Highlights of recent clinically relevant papers. Equine Vet Educ 2015 Apr;27(4):167-168.
            doi: 10.1111/eve.12362pubmed: 32313391google scholar: lookup
          4. Hodge E, Kowalski A, Torcivia C, Lindborg S, Stefanovski D, Hart K, Frank N, van Eps A. Effect of thyrotropin-releasing hormone stimulation testing on the oral sugar test in horses when performed as a combined protocol. J Vet Intern Med 2019 Sep;33(5):2272-2279.
            doi: 10.1111/jvim.15601pubmed: 31432575google scholar: lookup
          5. Spelta CW. Equine pituitary pars intermedia dysfunction: current perspectives on diagnosis and management. Vet Med (Auckl) 2015;6:293-300.
            doi: 10.2147/VMRR.S74191pubmed: 30101114google scholar: lookup
          6. Secombe CJ, Tan RHH, Perara DI, Byrne DP, Watts SP, Wearn JG. The Effect of Geographic Location on Circannual Adrenocorticotropic Hormone Plasma Concentrations in Horses in Australia. J Vet Intern Med 2017 Sep;31(5):1533-1540.
            doi: 10.1111/jvim.14782pubmed: 28661009google scholar: lookup
          Subscribe to our newsletter
          Join 99,359 horse owners like you who receive our email updates on horse health and nutrition.