Management of pituitary pars intermedia dysfunction in practice: A clinical audit.
Authors: Steel N L, Ireland J L, McGowan C M
Journal: Veterinary journal (London, England : 1997)
Summary
# Editorial Summary: Management of Pituitary Pars Intermedia Dysfunction in Practice Pergolide mesylate is the gold-standard treatment for equine pituitary pars intermedia dysfunction (PPID), with published guidelines recommending consistent initiation and regular monitoring via basal adrenocorticotropic hormone (ACTH) concentration testing to assess therapeutic response. Steel and colleagues conducted a clinical audit of 480 horses and ponies diagnosed with PPID between 2012 and 2016 at a single UK practice, examining whether diagnostic and treatment protocols aligned with contemporaneous recommendations. Most animals presented with laminitis (51.2%) or delayed coat shedding (24.5%), and whilst pergolide was appropriately initiated in 78.7% of ACTH-positive cases (248 animals), concerning gaps emerged in post-diagnosis monitoring: only 77.7% of treated animals had any documented monitoring, and just 48.1% received repeat basal ACTH testing within the recommended 1–3 month window following treatment commencement. These findings highlight a significant practice-level deficit in PPID management, particularly regarding systematic follow-up testing needed to individualise pergolide dosing and confirm therapeutic efficacy. For practitioners managing PPID cases, this audit underscores the importance of establishing structured monitoring protocols—including baseline ACTH measurement, timely post-treatment reassessment, and seasonal rechecking—to optimise outcomes and prevent complications such as uncontrolled laminitis in this geriatric population.
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Practical Takeaways
- •Over half of PPID cases in this UK practice went untreated despite positive diagnostic results; ensure your practice has clear protocols for treatment initiation based on diagnostic thresholds and clinical signs
- •Post-diagnosis monitoring is critically deficient: establish systematic follow-up basal ACTH testing at 1-3 months after starting pergolide to assess therapeutic response and adjust dosing accordingly
- •Document all PPID management decisions and monitoring results; this audit shows most cases lacked adequate records, which impairs clinical decision-making and continuity of care
Key Findings
- •51.7% of 480 horses/ponies tested were classified as PPID-positive based on basal ACTH concentration, with laminitis (51.2%) and hypertrichosis (24.5%) as most common presenting signs
- •78.7% of positive cases were treated with pergolide mesylate, but only 87.2% of treatment initiations followed published recommendations
- •Only 77.7% of pergolide-treated animals had documented PPID monitoring, and just 48.1% received follow-up basal ACTH testing within 1-3 months of diagnosis
- •Management of PPID in veterinary practice fell significantly below contemporaneous recommendations, particularly in post-treatment monitoring protocols