Early diagnosis gains ground in equine laminitis care

Laminitis management is increasingly becoming a story about timing. New clinical commentary from the University of Pennsylvania’s Andrew van Eps, alongside fresh reporting on an adiponectin assay validated for equids, reinforces a central message for equine practice: the best chance to improve outcomes may come before a horse looks overtly laminitic. In van Eps’ recent review, endocrinopathic laminitis is framed as a consequence of persistent hyperinsulinemia, with insulin control described as the key to both prevention and effective treatment. (pubmed.ncbi.nlm.nih.gov)

That framing reflects a broader shift in the field over the past two decades. Equine clinicians once focused heavily on inflammatory and mechanical pathways, but current endocrine guidance places insulin dysregulation at the center of most endocrinopathic cases. University of Kentucky guidance says insulin dysregulation is the key driver of hyperinsulinemia-associated laminitis and stresses that timely diagnostic testing is essential for management planning. Penn’s van Eps laboratory similarly describes endocrine dysfunction as the most common cause of laminitis in horses and ponies, and has built its research program around diagnostics, imaging, and prevention. (equine.mgcafe.uky.edu)

What’s changing now is the push toward more usable early-warning tools. In an October 21, 2026 report from The Horse, van Eps said his team validated a rapid turbidimetric immunoassay for adiponectin, a hormone produced by fat cells that has been linked in prior studies to insulin dysregulation and increased laminitis risk. He said the assay was precise and reliable in horses, ponies, and donkeys, and could support same-day laboratory turnaround. The potential appeal for practitioners is straightforward: unlike insulin, adiponectin appears to be less influenced by feeding, transport stress, or pain, which may make it a steadier adjunct marker when interpreting a single sample. (thehorse.com)

Penn has already operationalized that idea in its clinical endocrinology service. The van Eps lab offers adiponectin as an individual assay and as part of insulin-adiponectin and broader insulin dysregulation panels. Its clinician guidance states that low adiponectin is strongly associated with insulin dysregulation and laminitis risk, is relatively unaffected by stress or recent feed intake, and can help identify high-risk horses and ponies, including some with normal resting insulin. The same guidance recommends measuring both insulin and adiponectin when possible, while noting that management-driven improvement in adiponectin can take months. (vet.upenn.edu)

The clinical rationale for earlier screening is strengthened by the nature of the disease itself. Van Eps’ 2026 review notes that endocrinopathic laminitis is commonly subclinical, meaning horses may be accumulating lamellar injury before they show unmistakable signs. He argues that early diagnosis should include metabolic screening to establish risk and radiographic screening to detect early changes that may not yet be clinically apparent. Penn’s research program is also evaluating digital radiographic measurements for acute laminitis diagnosis, while its broader laminitis work includes advanced imaging, sensor-based assessment, and prevention strategies such as therapeutic regional hypothermia for sepsis-related cases. (pubmed.ncbi.nlm.nih.gov)

Industry reaction, while not framed as controversy, points to growing interest in how these tools fit into real-world workflows. The Horse presented adiponectin testing as a promising addition, not a replacement, for current metabolic assessment, and quoted van Eps saying it could be used for both screening and monitoring response to diet, exercise, and drug therapy. University of Kentucky’s extension guidance lands in a similar place: resting insulin is practical but can miss mildly affected animals, so dynamic testing such as the oral sugar test remains important when suspicion stays high despite a normal resting result. Taken together, the message is less about a single breakthrough test and more about a layered diagnostic strategy. (thehorse.com)

Why it matters: For equine veterinarians, this is a meaningful refinement of case finding and case management. Earlier identification of insulin dysregulation or elevated laminitis risk can change nutrition counseling, exercise recommendations, medication decisions, and monitoring frequency before a horse reaches the point of catastrophic hoof failure. It also supports more informed conversations with pet parents about why a horse that seems only overweight, cresty, or intermittently footsore may warrant endocrine workups and baseline imaging. In practice, the emerging role of adiponectin may be especially useful in borderline or noisy cases, where pain, stress, or feeding status complicate insulin interpretation. (pubmed.ncbi.nlm.nih.gov)

What to watch: The next step is validation in broader field use, especially whether combined insulin-adiponectin testing improves sensitivity, monitoring, or decision-making enough to change routine wellness screening and laminitis protocols. Clinicians should also watch for further publication from Penn’s group on radiographic thresholds, biomarker panels, and how these tools perform across ponies, light-breed horses, donkeys, and horses with concurrent PPID or corticosteroid exposure. (thehorse.com)