Efficacy of trilostane for the treatment of equine Cushing's syndrome

Abstract

Reasons for performing study: Trilostane, a competitive 3-beta hydroxysteroid dehydrogenase inhibitor, has been used successfully to control clinical signs and cortisol excess in canine pituitary dependent hyperadrenocorticism.

Objectives: Trilostane was evaluated for its efficacy in resolving clinical and clinicopathological abnormalities of equine Cushing's syndrome (ECS) and to assess its safety.

Methods: Twenty horses (mean age 21 years) diagnosed with ECS were followed for 1 or 2 years. Affected horses received 0.4-1 mg/kg (mean 0.5 mg/kg) trilostane once daily.

Results: Clinical signs assessed over 1 or 2 years, showed a reduction in lethargy in all horses post treatment. Polyuria and/or polydipsia, present in 11 horses, was reduced in all after treatment. Recurrent or chronic laminitis, present in 16 horses, improved in 13/16 (81%) of cases. There were no side effects reported. Combined dexamethasone suppression and thyrotropin releasing hormone (TRH) stimulation tests were significantly different before and 30 days following therapy. There was a significant reduction (P = 0.01) of cortisol following TRH administration before (160 +/- 53.0 nmol/l) and after (130 +/- 46.1 nmol/l) trilostane.

Conclusions: Trilostane caused improvement in clinical signs in horses, without side effects, and a corresponding decrease in cortisol response to TRH administration.

Potential relevance: Trilostane may be a useful therapy for the treatment of ECS. Further work comparing the effects of trilostane and pergolide is warranted.