Modelling of oscillatory cortisol response in horses using a Bayesian population approach for evaluation of dexamethasone suppression test protocols
Artikel i vetenskaplig tidskrift, 2019

Cortisol is a steroid hormone relevant to immune function in horses and other species and shows a circadian rhythm. The glucocorticoid dexamethasone suppresses cortisol in horses. Pituitary pars intermedia dysfunction (PPID) is a disease in which the cortisol suppression mechanism through dexamethasone is challenged. Overnight dexamethasone suppression test (DST) protocols are used to test the functioning of this mechanism and to establish a diagnosis for PPID. However, existing DST protocols have been recognized to perform poorly in previous experimental studies, often indicating presence of PPID in healthy horses. This study uses a pharmacokinetic/pharmacodynamic (PK/PD) modelling approach to analyse the oscillatory cortisol response and its interaction with dexamethasone. Two existing DST protocols were then scrutinized using model simulations with particular focus on their ability to avoid false positive outcomes. Using a Bayesian population approach allowed for quantification of uncertainty and enabled predictions for a broader population of horses than the underlying sample. Dose selection and sampling time point were both determined to have large influence on the number of false positives. Advice on pitfalls in test protocols and directions for possible improvement of DST protocols were given. The presented methodology is also easily extended to other clinical test protocols.

Oscillating Baseline

Dexamethasone Suppression Test



Bayesian Inference

Inter-Individual Variability

Turnover Model


Felix Held

Stiftelsen Fraunhofer-Chalmers Centrum för Industrimatematik

Chalmers, Matematiska vetenskaper, Tillämpad matematik och statistik

Carl Ekstrand

Sveriges lantbruksuniversitet (SLU)

Marija Cvijovic

Chalmers, Matematiska vetenskaper, Tillämpad matematik och statistik

Johan Gabrielsson

Sveriges lantbruksuniversitet (SLU)

Mats Jirstrand

Stiftelsen Fraunhofer-Chalmers Centrum för Industrimatematik

Journal of Pharmacokinetics and Pharmacodynamics

1567-567X (ISSN) 1573-8744 (eISSN)

Vol. 46 1 75-87


Farmaceutisk vetenskap

Bioinformatik (beräkningsbiologi)

Sannolikhetsteori och statistik


C3SE (Chalmers Centre for Computational Science and Engineering)





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