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Equine Cushing's Disease or Syndrome (ECD)

By: Dr. Philip Johnson

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Diagnosis

Diagnosis of ECD is based, first of all, on recognition of the appropriate clinical symptoms in the older horse. Specific diagnosis entails the use of various blood tests. Blood ACTH and/or insulin levels are unusually high in ECD. Blood glucose and urine glucose are also increased, and the white blood count reflects a picture of stress (high white blood cell count which is mostly neutrophils).

If a diagnosis of ECD is confirmed, treatment is often very effective. The two most effective drugs are pergolide and cyproheptadine. These drugs are used to attempt to restore the brain's neurotransmitter imbalance and suppress ACTH release from the pituitary gland. If ACTH release can be inhibited, cortisol release from the adrenal glands will also be reduced and the severity of the clinical symptoms will be lessened.

It might require several weeks for a beneficial response to treatment to be noticed, because, under on-going stimulation by ACTH, the adrenal glands become quite enlarged. In some cases, one or another symptom will improve to the greatest extent. Laminitis is sometimes difficult to reverse, but in the horse with low-grade laminitis, it can usually be controlled. Excessive water drinking and sweating are the easiest to control.

Sometimes these drugs are not effective at reducing ACTH release, so obvious changes will not be seen in the blood work.

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