When you have symptoms suggestive of a carcinoid tumor, such as flushing, abdominal pain, diarrhea, and/or wheezing; at intervals following treatment
You may be instructed to avoid certain foods and medications prior to this test. (For more details, see the "What is being tested?" section below.)
5-hydroxyindoleacetic acid (5-HIAA) is the primary breakdown product (metabolite) of serotonin, a chemical substance (neurotransmitter) that transmits messages between nerve cells. This test measures the amount of 5-HIAA in the urine or blood.
Serotonin is produced as needed by the nervous system, mainly the brain, but also special cells in the bronchial tubes (lungs) and gastrointestinal (GI) 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 eliminated 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 noncancerous or cancerous neuroendocrine masses that can form in the GI tract, especially in the appendix, and in the lungs. About 2 out of every 3 carcinoid tumors are found in the GI tract with most of the rest occurring in the lungs, although they may affect other organs as well.
According to the American Cancer Society, there are about 8,000 neuroendocrine tumors or cancers that start in the GI tract and 2,000 to 4,000 that start in the lungs diagnosed each year in the 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 GI tract affecting the liver, will produce enough serotonin to cause symptoms, such as flushing of the face, diarrhea, a rapid heart rate, and wheezing, which 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 blood and urine.
How is the sample collected for testing?
- A 24-hour urine sample is preferred for the 5-HIAA test because the level of the metabolite can vary during the day. For a 24-hour urine collection, all of the urine produced should be saved for a 24-hour period. It is best to keep the sample in a cool, dark place, such as a refrigerator.
- A random urine sample is sometimes tested, usually along with a urine creatinine level, when a 24-hour sample is not feasible. The random sample is not as accurate, however, and if excess 5-HIAA is released intermittently, then it may be missed.
- Sometimes a blood sample is drawn from a vein in the arm.
Is any test preparation needed to ensure the quality of the sample?
Test preparation is important for accurate 5-HIAA test results. Foods rich in serotonin such as avocados, bananas, pineapples, plums, cantaloupes, grapefruits, plantains, melons, kiwi fruits, walnuts, hickory nuts, butternuts, pecans, tomatoes, and eggplants can interfere with 5-HIAA measurement and should be avoided for 3 days prior to and during sample collection. There are also a variety of drugs that can affect metabolism of serotonin and thus the 5-HIAA test. It is important that you talk to your healthcare provider before decreasing or discontinuing any medications.
Some laboratories request for overnight fasting prior to collection of blood samples.
How is the test used?
When is it ordered?
Some examples include:
- Flushing of the face and neck (appearance of deep red color, usually with sudden onset)
- Diarrhea, abdominal pain, nausea, vomiting
- Rapid heart rate
- Wheezing, coughing, difficulty breathing
This test may also be ordered at intervals when monitoring the effectiveness of treatment for a carcinoid tumor.
What does the test result mean?
A significantly increased level of 5-HIAA when you have carcinoid syndrome symptoms is suggestive but not diagnostic of a carcinoid tumor. In order to diagnose the condition, the tumor itself must be located, biopsied, and examined by a pathologist. Your healthcare practitioner will frequently follow an abnormal test result with an order for an imaging scan to help locate any tumor(s) that may be present.
You may still have a carcinoid tumor even if your 5-HIAA level is normal. Some carcinoid tumors do not produce serotonin or only produce it intermittently.
If you have no symptoms and normal levels of 5-HIAA, it is unlikely you have a carcinoid tumor that produces serotonin.
If you are being monitored following treatment for carcinoid tumor, decreasing levels of 5-HIAA indicate a response to treatment, while increased or rising levels indicate that treatment has not been successful.
Is there anything else I should know?
There are a variety of drugs that can affect the 5-HIAA test:
- Medications that can increase 5-HIAA include acetaminophen, caffeine, ephedrine, diazepam (Valium®), fluorouracil, glyceryl guaiacolate (an ingredient found in some cough medicines), melphalan (Alkeran®), mephenesin, methamphetamine (Desoxyn), methocarbamol (Robaxin®), naproxen, nicotine, phenacetin, phenmetrazine, phenobarbital, phentolamine, rauwolfia, and reserpine.
- Medications that can decrease 5-HIAA include aspirin, chlorpromazine (Thorazine), corticotropin, dihydroxyphenylacetic acid, ethyl alcohol, gentisic acid, homogentisic acid, hydrazine derivatives, imipramine(Tofranil®), isocarboxazid (Marplan), levodopa, MAO inhibitors, heparin, isoniazid, methenamine, methyldopa(Aldomet®), perchlorperazine, phenothiazines (Compazine®), promazine, promethazine (Mepergan®) and tricyclic antidepressants.
You should talk to your healthcare provider before decreasing or discontinuing any medications.
Why do I have to collect my urine for 24 hours?
Will my results be accurate if I must continue to take my medication?
If the drug is one that can increase or decrease the amount of serotonin and 5-HIAA, then your results may be affected. However, it is up to your healthcare provider and you to decide whether or not your medication can be safely stopped prior to and during the test collection. If your drugs must be taken, then your healthcare practitioner will interpret the test results with this in mind.
Are some people at a higher risk for developing a carcinoid tumor?
Anyone at any age can develop a carcinoid tumor but, according to the American Cancer Society, the average age at diagnosis is usually in the early 60s. People with a family history of multiple endocrine neoplasia (MEN1), a genetic condition that increases a person's risk of developing tumors in the endocrine system glands, may be at higher risk for developing a carcinoid tumor.