ACTH results rocketing since being on Prascend??

LittleBlackMule

LittleBlackMule

Well-Known Member
Joined
15 August 2010
Messages
1,673
Location
West Sussex
Visit site
I am posting this on behalf of a friend, at her request.

The horse in question is in his 20's, and has been listless, hard to keep weight on and with chronic LGL for a long time, to the point where just standing still was uncomfortable for him. The farrier's cure-all of natural balance shoes, pads, shoes with raised heels etc., wasn't working and he was taken barefoot and the farrier ditched.
He was tested for Cushings a couple of months ago with a score of around 85, and has been on one Prascend tablet a day since.
During that time his access to grazing has been cut down and apart from getting hay when he is in, his diet of Fast Fibre and Happy Hoof is unchanged.

He was tested again last week, with a score of 400!
The vet's response seems to have been 'it happens' and advised to double the Prascend. What my friend would like to know and couldn't get out of her vet, (so would I) is how and why that could happen.

Any insights gratefully received, thanks.
 
the acth levels increase at this time of year naturally so if he is getting older and cushings is progressing this could lead to a high reading..is he definately eating the tablets? mine used to eat her feed and spit the prascend out into her bed so i have to hand feed her to make sure she gets the right dose....my horse has had cushings for a couple of years and i have had to gradually increase the prascend and she is now on 3 daily...she is 22
 
He is definitely eating the tablets, they are fed to him by hand.
If the levels had increased over a longer period we could understand, but such an enormous amount, when he hadn't been on anything previously.. it doesn't make sense to me.
 
That happened to my old girl too, she was tests at around 80, had 8 weeks on 1 prascend, and her results had gone up to 110. The prascend was upped to 1.5 tabs, and she was retested 8 weeks later at approx 40.

I used to dissolve the tablets, and then use that water as part of her fast fibre.
 
I will be watching this thread with great interest as I am having the same issue with my boy. My boy started on 129 and despite being on 2.5 prascend tablets a day, which he is definitely eating, his ACTH levels keep going up, currently 171, due to be retested the end of this month. Like your friend no real reason from the vet other than seasonal change, but the vet did say seasonal change would not have had that sort of impact so just waiting until the next test now :(
 
I can't answer the question, but the graph in this link to some details on PPID from Liphook is quite interesting, showing average levels of ACTH in normal and PPID horses at different times of year: http://liphookequinehospital.co.uk/wp-content/uploads/2012/03/PituitaryParsIntermediaDysfunction.pdf

I guess it's only really tests at exactly the same time of year that can be properly compared to each other, and I don't know how much the expected ACTH rise could be affected by "unseasonal" weather - for example, would an indian summer have an effect, and would a lot of wet weather (like last year) have an effect. No answers, just more questions!

Because my mare is still below the "official" ACTH level for Cushing's, but has responded well to pergolide, we're not doing regular blood tests, but I'm just monitoring how she is in terms of lethargy, depression and footiness, and adjusing the dose depending on that.

Sarah
 
Try cutting out the happy hoof and going onto hi fi molasses free ( happy hoof full of sugar) and soak his hay for at least 6 hours...his grazing should be a pretty bare-ish paddock or muzzled...the levels at this time of year are high too so your reading will come back higher...
 
Pergolide/Prascend doesn't work for every horse - it is not a magic cure, it's just the best we have at the moment and it can sometimes take 4 or 5mg per day before the ACTH starts to come under control when it does work!

It is also not possible to predict how quickly Cushings disease progresses in each horse - some horses test at a level and each year as they get older it gradually goes up, some seem to go from 0 to the hundreds in weeks! Also the level of ACTH is not indicative of the progression/severity of the disease itself either! Some can have ACTH in the hundreds and never get Lami (which is what we are trying to avoid by medicating) and some get Lami with ACTH levels barely above normal, like my boy!

My old boy (21 when diagnosed) who we lost last year was similar: first blood test in the 60s, started 1 pergolide, then second blood test over 200! Sadly pergolide never controlled his ACTH but we kept him sound and happy on a combo of 3 pergolide and 3 metpirone for 3 1/2 years before we lost him to colic!

My younger boy (17 now) only ever had a high ACTH of 45, but it takes 4 pergolide per day to keep him around normal!
 
flintfootfilly said:
I can't answer the question, but the graph in this link to some details on PPID from Liphook is quite interesting, showing average levels of ACTH in normal and PPID horses at different times of year: http://liphookequinehospital.co.uk/wp-content/uploads/2012/03/PituitaryParsIntermediaDysfunction.pdf

I guess it's only really tests at exactly the same time of year that can be properly compared to each other, and I don't know how much the expected ACTH rise could be affected by "unseasonal" weather - for example, would an indian summer have an effect, and would a lot of wet weather (like last year) have an effect. No answers, just more questions!

Because my mare is still below the "official" ACTH level for Cushing's, but has responded well to pergolide, we're not doing regular blood tests, but I'm just monitoring how she is in terms of lethargy, depression and footiness, and adjusing the dose depending on that.

Sarah
Click to expand...

Sorry to hijack OP, am about to start my horse on a 2 week prascend trial due to lethagy and depression too, he's never had laminitis but is occasionally slightly footy (barefoot). His levels were 51 during the seasonal rise (cut off 47) and 26 last feb (cut off 29). How soon did you see a difference in yours Sarah? Is 2 weeks long enough to make a difference? Thanks.
 
Ditto Rjd84, check out the facebook page PPID/EMS group, they will be able to help you hugely...Diet change now and add salt, mag ox and vit e tablets (from your chemist, if he is on restricted grazing)
Hollybear, being slightly footy is LGL, my lad was the same, not full blown lami but low grade, the sooner you alter their diets, the sooner you are helping them to start recovery, soaked hay, hi fi molasses free or top spec chop lite and tens or vits n mins supplement, plus the above additives. (Happy hoof has too much sugar despite being recommended) restricted grazing or muzzled, its a bit of a slog but worth it in the end :) Its been 4 months since my diagnosis and he is now starting work again, in hand and looking slimmer and perkier, despite the second flush of grass we have just had.
 
No, Prascend doesn't suit all. I've now got my mare on Vitex Equid. Only been on it a week, so can't comment. However, I totally changed her diet after the pergolide fiasco: I got lots of useful information from Simple Horse Feeds and she now has Lucie Stalks, Lucie Nuts, Metaslim and Joint Eclipse. This diet, prior to the Vitex, has kept her acth levels to within normal parameters although the vet thinks that as they are at the high end of the scale, that Vitex could help.

Incidentally, she has NO symptoms of any metabolic disorders and never has had. Never been overweight. She has only suffered laminitis following injury and has always had poor quality hooves despite every specialised balancer and additive known to man over the last 20 years.

She also has Better4Hooves supplement, with regular applications of Keratex Hoof Gel, and stockholm tar around her toes.
 
You must log in or register to reply here.
Top