5-HIAA

This test measures the amount of 5-hydroxyindoleacetic acid (5-HIAA) in the urine. 5-HIAA is a muscle stimulant and the primary metabolite of serotonin, a hormone derived from the amino acid tryptophan. Serotonin is produced as needed by the nervous system, mainly the brain, but also special cells in the bronchial tubes (lungs) and gastrointestinal tract. It helps transmit nerve impulses and constrict blood vessels, participates in the wake-sleep cycle, and affects mood. After it is used by the body, serotonin is broken down in the liver, and its metabolites, including 5-HIAA, are excreted in the urine.

Ordinarily, only small varying amounts of 5-HIAA are present in the urine. Large quantities of serotonin and 5-HIAA may be produced, however, by some carcinoid tumors. Carcinoid tumors are slow-growing masses that can form in the gastrointestinal tract, on the appendix, and in the lungs. According to the American Cancer Society, there are about 5,000 carcinoid tumors diagnosed each year in United States. Many more of these tumors may exist, but most remain small and do not cause any symptoms. When carcinoid tumors are discovered in asymptomatic patients during surgical procedures performed for other reasons, they are called "incidental" tumors. A small percentage of these tumors may eventually grow large enough to cause obstructions in the intestines or bronchial tubes of the lungs.

About 10% of carcinoid tumors, primarily those found in the gastrointestinal tract, will produce enough serotonin to cause symptoms such as flushing of the face, diarrhea, a rapid heart rate, and wheezing, usually only after the tumor has spread to the liver. These symptoms are referred to as carcinoid syndrome. The serotonin that causes carcinoid syndrome may be released continuously or intermittently and can lead to significantly increased quantities of 5-HIAA in the urine.

For the 24-hour urine collection, all of the urine should be saved for a 24-hour period. It is best to keep the sample in cool, dark place, such as a refrigerator.

Pre-sample preparation is important for accurate 5-HIAA test results. Foods such as avocados, bananas, pineapples, plums, walnuts, tomatoes, kiwi fruit, and eggplant can interfere with 5-HIAA measurement and should be avoided for 3 days prior to and during urine collection. There are also a variety of drugs that can affect the 5-HIAA test, but you should talk to your doctor before decreasing or discontinuing any medications.