Effect of thyrotropin‐releasing hormone stimulation testing on the oral sugar test in horses when performed as a combined protocol

Background The use of parallel dynamic tests to identify insulin dysregulation (ID) and pituitary pars intermedia dysfunction (PPID) in horses could have better diagnostic utility than measuring baseline hormone concentrations, if the tests do not alter diagnostic interpretation of one another. Hypothesis Performing a thyrotropin‐releasing hormone (TRH) stimulation test before an oral sugar test (OST) would not affect results of OST. Animals Twenty‐six healthy university‐owned horses. Methods A prospective randomized placebo‐controlled, crossover design was used to evaluate 3 OST protocols: OST alone, TRH followed by OST (TRH + OST), and placebo followed by OST (placebo + OST). Agreement for plasma insulin concentrations and diagnostic interpretation were assessed with Bland‐Altman and logistic regression analyses, respectively. Results Bland‐Altman analysis of TRH + OST versus OST alone showed good agreement between testing protocols, with bias ± SD for insulin concentrations at baseline 0.4 ± 4.7 μIU/mL (95% limits of agreement [LOA], −8.8 to 9.7), 60 minute −0.5 ± 22.6 μIU/mL (95% LOA, −44.7 to 43.8), and 90 minute 1.9 ± 20.6 μIU/mL (95% LOA, −38.5 to 42.4) after OST, similar to placebo + OST versus OST alone. Diagnostic interpretation (positive/negative) was not different between protocols (TRH + OST versus OST alone [P = .78], placebo + OST versus OST alone [P = .77], or TRH + OST versus placebo + OST [P = .57]). Conclusions and Clinical Importance Concurrent testing for PPID and ID with a TRH stimulation test before an OST is an acceptable diagnostic tool for investigation of endocrinopathies in horses and allows accurate testing to be performed efficiently in 1 visit.