Relationship between endogenous plasma adrenocorticotropic hormone concentration and reproductive performance in Thoroughbred broodmares

Tsuchiya, Tomonori; Noda, Ryusuke; Ikeda, Hiroki; Maeda, Masaya; Sato, Fumio

doi:10.1111/jvim.16145

Cited by 3 publications

(4 citation statements)

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“…Eleven publications 1,24,28,31,33–39 that provided PPID prevalence estimates in diverse equine populations were identified. For measures of diagnostic test accuracy, the panel chose to make recommendations for equids with a high, moderate, or low pre‐test probability of PPID based on the clinical suspicion determined above.…”

Section: Resultsmentioning

confidence: 99%

“…One systematic review 17 and 13 additional publications [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] were identified that provided data on the frequency of clinical signs within veterinary-diagnosed PPID cases, which were considered in combination with the outcomes from the panel Delphi consultation to categorise clinical signs by the index of clinical suspicion (Table 5). Generalised or regional hypertrichosis (± delayed/abnormal coat shedding) was the most commonly reported sign across all studies (Figures 1-5).…”

Section: Case Selection For Diagnostic Testing and Pretest Probabilitymentioning

confidence: 99%

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BEVA primary care clinical guidelines: Diagnosis and management of equine pituitary pars intermedia dysfunction

Menzies‐Gow,

Banse,

Duff

et al. 2023

Equine Veterinary Journal

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BackgroundPituitary pars intermedia dysfunction (PPID) is a prevalent, age‐related chronic disorder in equids. Diagnosis of PPID can be challenging because of its broad spectrum of clinical presentations and disparate published diagnostic criteria, and there are limited available treatment options.ObjectivesTo develop evidence‐based primary care guidelines for the diagnosis and treatment of equine PPID based on the available literature.Study designEvidence‐based clinical guideline using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.MethodsResearch questions were proposed by a panel of veterinarians and developed into PICO or another structured format. VetSRev and Veterinary Evidence were searched for evidence summaries, and systematic searches of the NCBI PubMed and CAB Direct databases were conducted using keyword searches in July 2022 and updated in January 2023. The evidence was evaluated using the GRADE framework.Results and recommendationsThe research questions were categorised into four areas: (A) Case selection for diagnostic testing, pre‐test probability and diagnostic test accuracy, (B) interpretation of test results, (C) pharmacological treatments and other treatment/management options and (D) monitoring treated cases. Relevant veterinary publications were identified and assessed using the GRADE criteria. The results were developed into recommendations:(A) Case selection for diagnostic testing and diagnostic test accuracy: (i) The prevalence of PPID in equids aged ≥15 years is between 21% and 27%; (ii) hypertrichosis or delayed/incomplete hair coat shedding provides a high index of clinical suspicion for PPID; (iii) the combination of clinical signs and age informs the index of clinical suspicion prior to diagnostic testing; (iv) estimated pre‐test probability of PPID should be considered in interpretation of diagnostic test results; (v) pre‐test probability of PPID is low in equids aged <10 years; (vi) both pre‐test probability of disease and season of testing have strong influence on the ability to diagnose PPID using basal adrenocorticotropic hormone (ACTH) or ACTH after thyrotropin‐releasing hormone (TRH) stimulation. The overall diagnostic accuracy of basal ACTH concentrations for diagnosing PPID ranged between 88% and 92% in the autumn and 70% and 86% in the non‐autumn, depending on the pre‐test probability. Based on a single study, the overall diagnostic accuracy of ACTH concentrations in response to TRH after 30 minutes for diagnosing PPID ranged between 92% and 98% in the autumn and 90% and 94% in the non‐autumn, depending on the pre‐test probability. Thus, it should be remembered that the risk of a false positive result increases in situations where there is a low pre‐test probability, which could mean that treatment is initiated for PPID without checking for a more likely alternative diagnosis. This could compromise horse welfare due to the commencement of lifelong therapy and/or failing to identify and treat an alternative potentially life‐threatening condition.(B) Interpretation of diagnostic tests: (i) There is a significant effect of breed on plasma ACTH concentration, particularly in the autumn with markedly higher ACTH concentrations in some but not all ‘thrifty’ breeds; (ii) basal and/or post‐TRH ACTH concentrations may also be affected by latitude/location, diet/feeding, coat colour, critical illness and trailer transport; (iii) mild pain is unlikely to have a large effect on basal ACTH, but caution may be required for more severe pain; (iv) determining diagnostic thresholds that allow for all possible contributory factors is not practical; therefore, the use of equivocal ranges is supported; (v) dynamic insulin testing and TRH stimulation testing may be combined, but TRH stimulation testing should not immediately follow an oral sugar test; (vi) equids with PPID and hyperinsulinaemia appear to be at higher risk of laminitis, but ACTH is not an independent predictor of laminitis risk.(C) Pharmacologic treatments and other treatment/management options: (i) Pergolide improves most clinical signs associated with PPID in the majority of affected animals; (ii) Pergolide treatment lowers basal ACTH concentrations and improves the ACTH response to TRH in many animals, but measures of insulin dysregulation (ID) are not altered in most cases; (iii) chasteberry has no effect on ACTH concentrations and there is no benefit to adding chasteberry to pergolide therapy; (iv) combination of cyproheptadine with pergolide is not superior to pergolide alone; (v) there is no evidence that pergolide has adverse cardiac effects in horses; (vi) Pergolide does not affect insulin sensitivity.(D) Monitoring pergolide‐treated cases: (i) Hormone assays provide a crude indication of pituitary control in response to pergolide therapy, however it is unknown whether monitoring of ACTH concentrations and titrating of pergolide doses accordingly is associated with improved endocrinological or clinical outcome; (ii) it is unknown whether monitoring the ACTH response to TRH or clinical signs is associated with an improved outcome; (iii) there is very weak evidence to suggest that increasing pergolide dose in autumn months may be beneficial; (iv) there is little advantage in waiting for more than a month to perform follow‐up endocrine testing following initiation of pergolide therapy; there may be merit in performing repeat tests sooner; (v) timing of sampling in relation to pergolide dosing does not confound measurement of ACTH concentration; (vi) there is no evidence that making changes after interpretation of ACTH concentrations measured at certain times of the year is associated with improved outcomes; (vii) evidence is very limited, however, compliance with PPID treatment appears to be poor and it is unclear whether this influences clinical outcome; (viii) evidence is very limited, but horses with clinical signs of PPID are likely to shed more nematode eggs than horses without clinical signs of PPID; it is unclear whether this results in an increased risk of parasitic disease or whether there is a need for more frequent assessment of faecal worm egg counts.Main limitationsLimited relevant publications in the veterinary scientific literature.ConclusionsThese findings should be used to inform decision‐making in equine primary care practice.

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Section: Resultsmentioning

confidence: 99%

Section: Case Selection For Diagnostic Testing and Pretest Probabilitymentioning

confidence: 99%

BEVA primary care clinical guidelines: Diagnosis and management of equine pituitary pars intermedia dysfunction

Menzies‐Gow,

Banse,

Duff

et al. 2023

Equine Veterinary Journal

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“…Regarding ACTH, a study conducted on female horses demonstrated that abnormal ACTH blood levels strongly influence reproductive performance [ 6 ]. Therefore, unexplained infertility is a potential cause of pituitary hormone deficiency and should be considered high frequency in ART.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Ovulation Induction Aimed to Pregnancy in Eight Hypopituitarism Patients

Horibe,

Nakabayashi,

Murata

et al. 2024

Cureus

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Background: Female sex hormones work in concert. Gonadotropin-releasing hormone and ovulation-inducing agents are required in female patients with infertility owing to hormone dysregulation. Although drug-induced follicular development can be expected in patients with endogenous female hormone deficiency, data are lacking on the protocols and drugs used. Methods: We retrospectively examined the success rates of ovulation induction, assisted reproductive technology, and pregnancy outcomes in 66 cycles of eight patients with pituitary insufficiency at our hospital. Results: Ovulation occurred in 75.4% (49/66); 82.6% (38/46) of patients <40 years and 57.9% (11/19) of patients ≥40 years of age. Five of the eight patients became pregnant, and three delivered babies. The fertilization rate was 78% with in vitro fertilization, and the recombinant follicle-stimulating hormone usage was 3,717.1 ± 1,528.9 International Unit in hypopituitarism patients. Conclusion: Hypopituitarism patients can achieve ovulation, pregnancy, and delivery after optimal gonadotropin administration. Further studies are needed to determine the effects of gonadotropins on other pituitary hormones, such as growth hormones.

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“…Despite that transrectal ultrasound examination in mares induces cortisol increases (Schönbom et al, 2015), no short‐term effect on reproduction was observed (Berghold et al, 2007). However, long‐term reproductive performances in old mares are associated with high ACTH value (Tsuchiya et al, 2021). It has been shown, for example, that long‐term psychological and pathological stress (Vigil et al, 2022) impacts fertility in men and women by causing ovulatory dysfunction (Kalantaridou et al, 2010) as well as various diseases that enhance anovulation in dairy cows (Monteiro et al, 2021).…”

Section: The Role Of the Hpa System On The Hpgmentioning

confidence: 99%

Pathogenesis of the crosstalk between reproductive function and stress in animals—part 1: Hypothalamo–pituitary–adrenal axis, sympatho‐adrenomedullary system and kisspeptin

Kaiser,

Jaillardon

2023

Reprod Domestic Animals

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Stress is defined as a disruption of the body homeostasis in response to modest as well as perceived challenge. Two main physiological routes, the hypothalamic–pituitary–adrenal system (HPA) and the sympatho‐adrenomedullary system (SAM), aim to maintain or restore homeostasis by mutual interaction. SAM is quickly‐reacting as it primarily works through the nervous system—the sympathetic nervous system. In response to stress, signals are sent to activate the adrenal medulla which releases catecholamines (primarily adrenaline and norepinephrine). The catecholamines have a momentary effect on the body's organs that are prepared for a fight situation. At the same time, the stressor activates the HPA axis by signals from the brain causing secretion of the pituitary hormone adrenocorticotropic hormone (ACTH). ACTH acts on the adrenal cortex, which secretes glucocorticoids, including cortisol. Since HPA primarily works through hormones, the system is slightly slower than SAM and gives rise to a metabolic effect. While short‐term stress response is an adaptive and beneficial process, chronic or excessive stress can lead to a range of negative health outcomes including reproductive disorders and infertility. Several mechanisms have been proposed to explain the link between stress and reproduction. This includes in particular kisspeptin, which is closely related to reproduction, as it is a powerful stimulator of the Hypothalamic–pituitary–gonadal (HPG) system. The present review, through current knowledge in various male and female species, deals with the role of the SAM and the HPA, including the major action of kisspeptin and glucocorticoids that trigger the consequences of psychological or physiological stress on reproductive function.

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Relationship between endogenous plasma adrenocorticotropic hormone concentration and reproductive performance in Thoroughbred broodmares

Cited by 3 publications

References 32 publications

BEVA primary care clinical guidelines: Diagnosis and management of equine pituitary pars intermedia dysfunction

BEVA primary care clinical guidelines: Diagnosis and management of equine pituitary pars intermedia dysfunction

Outcomes of Ovulation Induction Aimed to Pregnancy in Eight Hypopituitarism Patients

Pathogenesis of the crosstalk between reproductive function and stress in animals—part 1: Hypothalamo–pituitary–adrenal axis, sympatho‐adrenomedullary system and kisspeptin

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