Management of pituitary pars intermedia dysfunction in practice: A clinical audit.
Abstract: In horses/ponies with pituitary pars intermedia dysfunction (PPID), pergolide mesylate treatment, with monitoring of therapeutic response, is recommended by contemporaneous literature and equine endocrinologists. However, it is unknown whether these recommendations are adhered to in private practice. This clinical audit aimed to compare treatment and monitoring of PPID cases in veterinary practice against available recommendations. Case data and basal plasma adrenocorticotropic hormone (ACTH) concentrations from all equids tested for PPID between 2012 and 2016 from a single veterinary practice in the UK were obtained. Records were reviewed and information on treatment and monitoring over the subsequent 2-6 years was extracted and compared with published recommendations. After exclusions, the audit population was 480 animals (median age, 20 years). The most common presenting signs were laminitis and/or historical laminitis (51.2%) and hypertrichosis and/or delayed coat shedding (24.5%). Based on seasonally adjusted reference intervals for basal ACTH concentration, 51.7% (n = 248) of animals were classified as positive, 37.1% (n = 178) as negative and 11.3% (n = 54) as equivocal for PPID. Records were available for 459 animals; of which pergolide treatment was initiated in 78.7% (n = 185/235) of positive cases, 19.2% (n = 10/52) of equivocal cases and 6.4% (n = 11/172) of cases classified as negative. Overall, 87.2% (n = 129/148) of cases commenced treatment as per recommendations. Only 77.7% (n = 160/206) of pergolide-treated animals had documented PPID monitoring and of these, only 48.1% (n = 77/160) had follow-up basal ACTH testing in the first 1-3 months following diagnosis. The findings confirm that management of PPID in veterinary practice fell below contemporaneous recommendations, especially for monitoring.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
Publication Date: 2022-09-24 PubMed ID: 36162625DOI: 10.1016/j.tvjl.2022.105899Google Scholar: Lookup
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- Journal Article
- Case Reports
- Clinical Study
- Diagnosis
- Disease
- Disease Diagnosis
- Disease Management
- Disease Treatment
- Endocrine System
- Equine Health
- Geriatric Horses
- Hormones
- Horses
- Observational Study
- Pituitary Pars Intermedia Dysfunction
- Pony
- Veterinary Care
- Veterinary Medicine
- Veterinary Practice
- Veterinary Procedure
- Veterinary Research
Summary
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This research study investigates how guidelines for the treatment and monitoring of pituitary pars intermedia dysfunction (PPID) in horses are followed in a real-world veterinary practice. It uncovers that while most cases receive treatment as recommended, monitoring protocols are not consistently adhered to.
About the Research
The researchers embarked on a clinical audit of veterinary practice, specifically looking at the treatment and monitoring of pituitary pars intermedia dysfunction (PPID) in horses and ponies. Their key interest was to see whether the recommended treatment and monitoring guidelines, including the use of pergolide mesylate and tracking therapeutic response, were actually being implemented in a typical veterinary setting.
Methodology
- The study involved a review of case records and plasma adrenocorticotropic hormone (ACTH) concentrations of all equids (a term that includes horses, donkeys and mules) tested for PPID between 2012 and 2016 from a single veterinary practice in the UK.
- The information extracted from these records was then compared with published recommendations on PPID treatment and monitoring.
- The final audit population, after exclusions, consisted of 480 animals.
Findings
- Out of the total audit population, 51.7% were found to test positive for PPID, 37.1% were negative and 11.3% had an equivocal or unclear result.
- Treatment with pergolide was initiated in the recommended manner in 78.7% of positive cases, 19.2% of equivocal cases, and 6.4% of negative cases.
- Only 77.7% of pergolide-treated animals had documented evidence of PPID monitoring. Even then, only 48.1% of these had a follow-up basal ACTH test within the recommended period of 1-3 months after diagnosis.
Conclusion
The results from this clinical audit show that there is a significant gap between the recommended guidelines for managing PPID in equids and what happens in practice, particularly when it comes to monitoring the animals post-treatment. This disjoint suggests that efforts need to be directed towards enhancing adherence to the complete set of guidelines in real-world veterinary practice.
Cite This Article
APA
Steel NL, Ireland JL, McGowan CM.
(2022).
Management of pituitary pars intermedia dysfunction in practice: A clinical audit.
Vet J, 289, 105899.
https://doi.org/10.1016/j.tvjl.2022.105899 Publication
Researcher Affiliations
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK.
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK.
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK. Electronic address: cmcgowan@liverpool.ac.uk.
Conflict of Interest Statement
Conflict of interest statement The authors have previously received funding for specific equine endocrinology research projects from Boehringer Ingelheim Animal Health Ltd. However, this audit did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors and none of the authors has any other financial or personal relationships that could inappropriately influence or bias the content of the paper.
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