Why the ACTH Value is So Important
The ACTH value plays a central role in the diagnosis of Equine Cushing's Syndrome (ECS). If you want to know what measuring this hormone says about your horse's health, you've come to the right place. An elevated ACTH level can indicate an unhealthy hormonal balance and result in various symptoms, such as laminitis or poor muscle development. In this article, you will learn how to gain important information about your horse's health by interpreting the ACTH value.

The Role of ACTH in Horses
Understanding the Pituitary Gland
The pituitary gland is a small but crucial organ in your horse that produces hormones like ACTH. These hormones play an essential role in regulating metabolism and stress response, ensuring your horse can react optimally in various situations.
Regulation of Cortisol Release
The pituitary gland ensures that cortisol release in your horse's body remains balanced. In a healthy horse, high cortisol levels lead to a decrease in ACTH production. Dopamine from the hypothalamus also regulates these processes by inhibiting ACTH release.
In diseases such as Equine Cushing's Syndrome (ECS), these regulatory mechanisms fail. Dopamine deficiency and a lack of response to elevated cortisol levels lead to consistently high ACTH values, resulting in a chronic overproduction of cortisol. This dysregulation can cause serious health problems, making it crucial to regularly check ACTH levels and take appropriate action if abnormalities are found.
Equine Cushing's Syndrome (ECS)
Mechanisms of the Disease
Equine Cushing's Syndrome arises from an imbalance in the pituitary gland, which is crucial for regulating ACTH and cortisol. In a healthy horse, elevated cortisol levels inhibit ACTH production. In contrast, ECS horses show a permanent increase in ACTH levels due to a dopamine deficiency and the insensitivity of tumorous cells to cortisol. This dysregulation leads to the chronic overproduction of cortisol.
Symptoms of ECS
The symptoms of ECS are varied, ranging from long, curly hair to laminitis and poor performance. These signs can not only affect your horse's well-being but also significantly reduce its quality of life.
Common symptoms include delayed or incomplete coat shedding, laminitis, and poor muscling, which leads to the formation of typical fat deposits, such as the cresty neck. You might also notice your horse sweating more and exhibiting unusually high urine production. In advanced cases, CNS symptoms like ataxia and blindness may occur, indicating increased pressure in the brain. Early detection of these symptoms is crucial to maintain your horse's well-being and initiate treatment promptly.
Symptoms of Equine Cushing's Syndrome (ECS)
Changes in Coat and Hair
In horses with ECS, changes in the coat and hair are often observed. This typically manifests as long, dense, and often curly hair. In the early stages, changes may initially only be visible in a few areas, such as the jaw or legs.
Delayed or Incomplete Coat Shedding
Another striking feature of ECS is delayed or incomplete coat shedding. Healthy horses undergo seasonal coat changes, but in ECS horses, this often happens irregularly.
These delayed processes are due to persistently high ACTH levels, which disrupt the normal regulation of coat shedding processes. This can lead to lifelong dense and long hair structures that can impair your horse's well-being.
Hoof Problems
Laminitis is a common complication of ECS, caused by an unfavorable redistribution of nutrients in the body. This can lead to significant pain and discomfort for your horse.
Hoof problems pose a serious health threat, as they can not only restrict your horse's movement but also severely impact its overall quality of life. Early diagnosis and treatment are crucial to prevent permanent damage.
Excessive Sweating
Another symptom is increased sweating, even in cooler temperatures or with little exertion. This results from hormonal dysregulation that burdens your horse's body.
Excessive sweating can not only be uncomfortable for your horse but also lead to dehydration if not treated promptly. Therefore, pay attention to your horse's sweating reactions to minimize potential health risks.
Muscle Loss
A common symptom is poor muscle development, which can manifest as a swayback or potbelly. Muscle mass can decrease due to hormonal changes, affecting overall mobility.
Muscle loss occurs because increased cortisol production disrupts muscle metabolism. This is not just an aesthetic problem but can also significantly impair your horse's performance and general well-being.
Fat Redistribution
In ECS, there is often a redistribution of body fat, noticeable, for example, by a cresty neck or fat pads above the eyes. These changes are a visible sign of the disease.
Inappropriate fat accumulation is a consequence of hormonal imbalances and can affect both your horse's health and charisma. These changes should be carefully monitored to allow for timely intervention.
Performance Issues
Horses with ECS often show poor performance, which affects both leisure activities and training. These symptoms can cause your horse to lose endurance and vitality.
Performance problems can be attributed to a combination of muscle loss, poor muscle development, and lack of motivation. It is important to regularly monitor your horse's performance to plan appropriate support measures.
Increased Urine Production and Water Intake
Another sign is high urine production and increased drinking behavior. Your horse may have difficulty regulating its fluid balance due to hormonal disturbances.
These symptoms can lead to dehydration if not enough water is available. It is important to monitor your horse's fluid intake and ensure it always has access to fresh water to avoid health risks.

Delayed Wound Healing
One of the numerous challenges of Equine Cushing's Syndrome (ECS) is delayed wound healing. This occurs due to chronically elevated cortisol levels, which severely impair the body's healing process. Cortisol has an immunosuppressive effect that reduces your horse's ability to heal wounds effectively. For this reason, it is essential to pay close attention to wounds and injuries and seek veterinary advice if necessary.
Sinusitis and Dental Diseases
Horses with ECS often suffer from sinusitis and dental diseases. These problems can be caused by a weakened immune system and hormonal changes. Regular veterinary check-ups are therefore essential to detect and treat complications in time.
Infectious Skin Diseases
Horses with ECS are also more susceptible to infectious skin diseases. Therefore, you should watch out for signs of infection such as redness or swelling and consult a veterinarian immediately if such symptoms occur.
Infectious skin diseases can manifest as skin sores or abscesses and are often a direct consequence of a weakened immune system due to ECS. The presence of high cortisol levels not only impedes wound healing but also promotes the colonization of bacteria and fungi on the skin surface. Therefore, it is important to ensure high-quality care and hygiene to minimize the risk of these diseases.
CNS Symptoms (rare)
In very rare cases, CNS symptoms can also occur with Equine Cushing's Syndrome. These are often the result of a very advanced adenoma pressing on other parts of the brain.
CNS symptoms like ataxia and blindness are alarming signs and should be taken very seriously. If your horse suddenly shows a change in its movement pattern or vision, quick action is required. A thorough veterinary examination is indispensable in such cases to determine the cause and initiate appropriate treatment. Early detection can be crucial to improve your horse's quality of life.
Diagnosis of ECS
Measuring ACTH Concentration in Blood
To diagnose Equine Cushing's Syndrome (ECS), the ACTH concentration in your horse's blood is measured. For this, blood is taken from the horse once in the morning; it should be fasted and only have access to hay. Normal values are between 10-50 pg/ml, although seasonal differences must be considered, as healthy horses can have higher ACTH values in autumn.
Dexamethasone Suppression Test
If the result of the ACTH measurement is unclear, the dexamethasone suppression test can be used. This requires two blood samples taken 20 hours apart to determine how your horse reacts to dexamethasone administration.
This test is significant because it is based on the principle that healthy horses should experience a downregulation of their cortisol production with dexamethasone. In contrast, a horse suffering from ECS is unable to show this reaction. This crucially underpins the diagnosis of ECS. Note that a positive result in your horse can indicate a persistent increase in ACTH production, highlighting the need for further medical intervention.

Treatment of ECS
Pergolide (Prascend) Therapy
Treatment for ECS primarily involves administering pergolide (Prascend). This medication is given once daily at a dose of 2μg/kg body weight and acts as a dopamine agonist, inhibiting ACTH secretion from the pituitary gland. Typically, an improvement in symptoms can be observed within 6-12 weeks.
Managing Symptoms and Comorbidities
When treating ECS, it is essential to also consider comorbidities such as laminitis. Regular veterinary check-ups and specific treatments are necessary to ensure your horse's long-term well-being.
The treatment of comorbidities plays a crucial role in managing ECS. Many horses require targeted therapies for conditions such as laminitis or dental diseases. Regular laminitis shoeing and sensible deworming and vaccination protocols are also important. Shearing can also help many horses suffering from delayed coat shedding. These measures contribute to improving your horse's quality of life.
Dietary Recommendations
A high-quality diet is crucial for the well-being of your ECS horse. Make sure to avoid carbohydrate-rich feeds with high glucose and insulin responses, such as oats and corn.
The diet should be based on good hay, supplemented with vegetable oils, alfalfa products, and pectin-containing feeds. These foods help to alleviate ECS symptoms and support your horse's overall health. For emaciated animals, soy or brewer's yeast can be added to help them gain weight and strengthen muscles.
Supplementary Feed for Cushing's Horses
An unbalanced diet, high performance demands, and environmental stressors can lead to deficiencies and metabolic problems in horses, particularly those with Cushing's Syndrome. The Metabolism Booster for Horses, developed by Sandra Fencl in collaboration with the Katharinen Pharmacy in Unterhaching, is the ideal solution for these challenges.
This supplementary feed provides your horse with essential vitamins, minerals, and trace elements often lacking in their daily diet. Many customers report increased vitality and performance in their horses. The Metabolism Booster significantly supports metabolism and improves the well-being of horses with Cushing's Syndrome.
Supportive Supplements
In addition to the main therapy, supportive supplements can be helpful to increase the dopamine sensitivity of the pituitary pars intermedia. Chasteberry has proven effective in this regard.
Supportive supplements like chasteberry can help to increase dopamine sensitivity and thus the effectiveness of the therapy. These additional measures complement the main treatment with pergolide and should be integrated into the feeding plan in consultation with your veterinarian. A holistic view of nutrition and supplements can significantly improve your horse's quality of life and well-being.
Supportive Care for ECS Horses
Regular Health Check-ups
To optimally support the health of your ECS horse, regular veterinary check-ups are essential. These check-ups allow for early detection of changes in health and prompt reaction, which is crucial, especially for concomitant diseases such as laminitis.
Hoof Care and Shoeing
Proper hoof care is fundamental for ECS horses, as these animals have a higher risk of laminitis due to their condition. Regular shoeing and monitoring of hoof health are therefore indispensable.
For hoof care, you should ensure even wear of the hooves to avoid pressure points and injuries. A professional should check and trim the hooves at least every 4-6 weeks to ensure optimal conditions for your hoof health. Pay attention to changes and regularly seek professional support to prevent serious problems.
Parasite Control and Vaccinations
Parasite control and regular vaccinations are crucial for the well-being of your ECS horse. These supportive measures help stabilize general health and prevent potential complications.
Through regular deworming, you minimize the risk of parasitic infections, which can have devastating consequences in already weakened animals. Vaccinations should be administered as recommended by the veterinarian to ensure your horse is optimally protected. Regular check-ups are essential to maintain protection.
Dental Care
Dental care plays an important role in supporting ECS horses. Regular dental check-ups help detect problems early and promote general food intake.
Dental health is particularly important for ECS horses, as chronic overproduction of cortisol can promote the development of dental diseases. Regular dental check-ups by a veterinarian or specialized equine dentist are crucial to prevent diseases such as tooth fractures or inflammation. Good dental care also supports food intake and the general quality of life of your horse.
Conclusion
The ACTH value is a crucial indicator of your horse's health, especially when Equine Cushing's Syndrome (ECS) is suspected. A high ACTH level indicates a disorder in the regulation of cortisol production, which can lead to various health problems. Therefore, it is important to regularly check the ACTH concentration to intervene early. This enables targeted therapy and improves your horse's quality of life, while you also monitor the development of concomitant diseases.
These questions about the ACTH value in horses are frequently asked:
1. What should the ACTH level in horses be?
The normal ACTH level in horses is usually below 35 pg/mL (picograms per milliliter) during the non-stressful season. However, in autumn (August to October), the normal value can be higher due to seasonal fluctuations. It is important to compare the results with seasonal reference values and the horse's general condition.
2. What blood values are indicative of Cushing's Syndrome in horses?
In a horse with Cushing's Syndrome (PPID), various blood values may be abnormal. Frequently elevated values include ACTH (adrenocorticotropic hormone) and insulin. In addition, elevated glucose levels, an altered leukocyte count, and abnormal liver enzyme values may be observed.
3. What causes high ACTH values in horses?
High ACTH values in horses are caused by a dysfunction of the pituitary gland, leading to excessive production of this hormone. This is typical for Cushing's Syndrome (PPID). Other factors such as stress, illness, and seasonal changes can also cause temporary increases in ACTH levels.
4. When is the best time for an ACTH test in horses?
The best time for an ACTH test in horses is in the morning, as hormone levels are most stable then. It is also ideal to perform the test outside of the autumn months to avoid seasonal fluctuations. If the test is performed in autumn, seasonally adjusted reference values should be used.
5. When should a horse be tested for Cushing's Syndrome?
A horse should be tested for Cushing's Syndrome if it shows clinical symptoms such as a long, curly coat, excessive sweating, laminitis, recurrent infections, muscle wasting, and increased drinking and urination. PPID should also be considered in older horses (from about 15 years of age) with unclear symptoms. Early testing helps manage the disease better.
6. How does Cushing's start in horses?
Cushing's often begins insidiously with non-specific symptoms. Early signs may include a longer, denser, or curly coat that is not fully shed in summer. Other early symptoms include increased drinking and urination, recurrent laminitis, and a general deterioration of health.
7. How old can a horse with Cushing's live to be?
With proper care and treatment, horses with Cushing's Syndrome can reach a normal age. Many horses live for many years despite the diagnosis, often into their 20s. The key is consistent treatment and regular veterinary care to minimize complications.
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