Urinary cortisol:creatinine ratios in healthy horses and horses with hyperadrenocorticism and non-adrenal disease

Dysregulation of Cortisol Metabolism in Equine Pituitary Pars Intermedia Dysfunction

Equine Cushing disease [pituitary pars intermedia dysfunction (PPID)] is a common condition of older horses, but its pathophysiology is complex and poorly understood. In contrast to pituitary-dependent hyperadrenocorticism in other species, PPID is characterized by elevated plasma ACTH but not elevated plasma cortisol. In this study, we address this paradox and the hypothesis that PPID is a syndrome of ACTH excess in which there is dysregulation of peripheral glucocorticoid metabolism and binding. In 14 horses with PPID compared with 15 healthy controls, we show that in plasma, cortisol levels and cortisol binding to corticosteroid binding globulin were not different; in urine, glucocorticoid and androgen metabolites were increased up to fourfold; in liver, 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) expression was reduced; in perirenal adipose tissue, 11β-HSD1 and carbonyl reductase 1 expression was increased; and tissue cortisol levels were not measurably different. The combination of normal plasma cortisol with markedly enhanced urinary cortisol metabolite excretion and dysregulated tissue-specific steroid-metabolizing enzymes suggests that cortisol clearance is increased in horses with PPID. We infer that the ACTH excess may be compensatory and pituitary pathology and autonomous secretion may be a secondary rather than primary pathology. It is possible that successful therapy in PPID may be targeted either at lowering ACTH or, paradoxically, at reducing cortisol clearance.

Review: Minimally invasive sampling media and the measurement of corticosteroids as biomarkers of stress in animals

Cook, N. J. 2012. Review: Minimally invasive sampling media and the measurement of corticosteroids as biomarkers of stress in animals. Can. J. Anim. Sci. 92: 227–259. The measurement of corticosteroid hormones is commonly used as a biomarker of an animal's response to stress. The difficulties in obtaining blood samples and the recognition of the stressor effect of blood sampling are primary drivers for the use of minimally invasive sample media. In mammals these include saliva, feces, urine, hair, and milk. In birds, samples include excreta, feathers, egg yolk and albumin. In fish, corticosteroids have been measured in excreta and swim-water. Each of these sample media incorporate corticosteroids in accordance with the processes by which they are formed, and this in turn dictates the periods of adrenocortical activity that each sample type represents. Cortisol in saliva represents a time-frame of minutes, whereas the production of feces may be hours to days depending on the species. The longest time-integrations are for hair and feathers which could be over a period of many weeks. The sample media also determines the structural changes that may occur via processes of conjugation to glucuronides and sulfides, metabolic conversion via enzymatic action, and bacterial breakdown. Structural changes determine the optimum methodologies used to measure corticosteroid hormones. In most sample media, measurement of a specific corticosteroid is a requirement depending on the species, e.g., cortisol in most mammals, or corticosterone in birds. However, in samples involving products of excretion, methodologies that measure a broad range of structurally related compounds are probably optimal. The utility of minimally invasive sample media as biomarkers of stress responses depends on the degree to which the corticosteroid content of the sample represents adrenocortical activity. Commonly, this involves comparisons between corticosteroid concentrations in blood plasma with concentrations in the alternative sample media. This review focuses on the methodological and biological validation of corticosteroid measurements in minimally invasive samples as biomarkers of adrenocortical responses to stress.

Equine pituitary pars intermedia dysfunction

Equine pituitary pars intermedia dysfunction (PPID), also known as equine Cushing's syndrome, is a widely recognized disease of aged horses. Over the past two decades, the aged horse population has expanded significantly and in addition, client awareness of PPID has increased. As a result, there has been an increase in both diagnostic testing and treatment of the disease. This review focuses on the pathophysiology and clinical syndrome, as well as advances in diagnostic testing and treatment of PPID, with an emphasis on those findings that are new since the excellent comprehensive review by Schott in 2002.

Tailored reference limits for urine corticoid:creatinine ratio in dogs to answer distinct clinical questions

To establish reference intervals for the urinary corticoid:creatinine ratio (UCCR) determined by chemiluminometric immunoassay, UCCR was measured by this method in 50 healthy dogs. To assess the diagnostic performance of different cut-off levels, the UCCR of 66 dogs with hyperadrenocorticism and 87 dogs with diseases mimicking hyperadrenocorticism were used to construct a receiver operating characteristic (ROC) curve. The upper reference limit derived from morning samples in healthy dogs was 30.81 × 10(-6). The area under the ROC curve was 0.94. The diagnostic cut-off with the highest negative likelihood ratio was 26.5 × 10(-6) (sensitivity 1, specificity 0.54), whereas the cut-off with the highest positive likelihood ratio was 161.2 × 10(-6) (specificity 0.988, sensitivity 0.515). The application of these two different diagnostic cut-offs eliminated the necessity to perform additional tests in 53 per cent of the patient population.

Pituitary pars intermedia dysfunction (Equine Cushing's disease) in an onager (Equus hemionus onager)

Pituitary pars intermedia dysfunction (PPID), also known as Equine Cushing's disease, is most often diagnosed in older horses and ponies. To the authors' knowledge, there have been no reports of its diagnosis in captive nondomestic equids. A 13-yr old onager (Equus hemionus onager) at the Zoological Society of London (ZSL) Whipsnade Zoo showed clinical signs suggestive of PPID, including hirsutism, fat redistribution, weight loss, laminitis, and chronic infections. A dexamethasone suppression test was performed to confirm PPID. Subsequently, adenomatous hyperplasia and microadenoma of the pars intermedia were identified postmortem. Four months later, this onager's dam died suddenly, and adenomatous hyperplasia of the pars intermedia was diagnosed following necropsy. The dam had shown no clinical signs of PPID. Examination of archives identified eight other adult onagers that died or were euthanized between 1993 and 2007. The brain was not examined in four of these, but pituitary glands were described as enlarged during necropsy in three animals based on the subjective assessment of an experienced zoo and wildlife pathologist, making an overall prevalence of enlargement of 83.3%. Hyperplastic pituitary changes are positively correlated with age in domestic equids, and this may also be the case in onagers. Alternative etiologies are also discussed.

The urinary corticoid:creatinine ratio (UCCR) in healthy cats undergoing hospitalisation

Thirty-one healthy pet cats had voided urine samples collected prior to, during and after a brief period of hospitalisation. Urinary corticoids were measured, both prior to and following an extraction technique, and the urinary corticoid:creatinine ratio (UCCR) was calculated. Associations between the UCCR and age, sex, breed and time of urine collection were investigated. There was no significant relationship established between age, sex and breed and the UCCR. A significant increase in the UCCR, however, did occur between the first home collected and first hospitalised urine sample, but only when comparing extracted corticoid results. A normal range for feline UCCR is established for the chemiluminescent immunoassay used in this study.