Endocrinopathic Laminitis

Question 1

describe the epidemiology of endocrinopathic laminitis

Answer 1

1. considerable important to horses and horse owners
   -1.5-34% of horses
   -13% of horse operations
   -lifetime risk of 15%
2. PPID and laminitis like to occur simultaneously
3. endocrinopathy present in >80% of laminitis cases
   -1/3 PPID
   -2/3 hyperinsulinemic
4. significant clinical and economic impact
   -no effective cure
   -no effective method for prevention
5. epidemiological approach:
   -considers welfare, what is relevant to naturally-occurring disease, risk factors for development of disease, guide management/prevention strategies, and reduce burden of disease
   -logical first step study: case control
   -collect info about signalment, activity level, dietary history, pasture management, body morphometrics, hoof care, and steroid therapy between lame and healthy horses on the same farm
   -OR: 10.5

Question 2

describe diagnostics for endocrinopathic laminitis

Answer 2

1. big question is determining whether laminitis is associated with endocrinopathy
   -clinical exam may be supportive of diagnosis
   -laminitis + old + hypertrichosis = PPID
   -laminitis + young + obese = EMS
2. not always clear!
   -laminitis + middle aged + normal coat + normal BCS = hard!
   -overall approach: assess insulin sensitivity and rule in/out PPID
3. consider signalment and clinical features!
   -prevalence of disease affects the predictive value of the test!!
   -always consider the risk of PPID AND EMS
4. ongoing pain and stress impact results!
   -but moderate pain may not
   -most efficient testing:
   –wait at least 1 day after transport
   –wait at least 2-5 days after acute founder
   –try to get horse more comfortable via pain meds, foot support, etc

Question 3

describe management of endocrinopathic laminitis (IMPORTANT)

Answer 3

1. treat underlying condition
   -PPID: prascend/pergolide
   -PPID with insulin dysregulation: prascend
   -EMS: diet +/- thyro L, metformin
   -EMS + PPID: all of the above
   -do NOT skip diagnostics! inaccurate diagnosis = inaccurate treatment
2. address foot/feet mechanically
   -mechanical breakdown can be fatal even if primary endocrinopathy is controlled
   -soft ride, impression material, wooden clogs
3. control pain
   -phenylbutazone (an NSAID) so
   –ALSO MONITOR THE KIDNEYS
   -opioids: butorphenol, meperidine, fentanyl
   -lidocaine/ketamine/detomidine CRI

Question 4

what to do with laminitis of unknown origin?

Answer 4

1. rule in/out endocrine disease
2. look for systemic illness and carb overload
3. PPID vs EMS:
   -clinical differences
   -may occur simultaneously
   -management differences: need to understand if dealing with one or the other or both
   -clinical judgement
   -diagnostic testing as appropriate
4. mechanical support of the foot and pain control are VITAL