MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

5-hydroxyindoloctová kyselina - 5-OH-indolacetát - 5 HIAA

Charakteristika

Serotonin sérový

  • Stimulant hladké svaloviny
  • Red blood cells, or possibly the white cells, are factors in the conversion of serotonin to 5-HIAA. [8]

Význam

  • Can vary depending on...
    • Tumors
    • Renal malfunction
    • Small bowel resection etc. [2]

Low levels of 5-HIAA

Cerebrospinal fluid

  • Associated with aggressive behavior [2]
  • Ass. suicide by violent means [2]

Interakcemi nižší 5-HIAA v moči

  • Aspirin
  • Ethyl alcohol
  • Imipramine
  • Levodopa
  • MAO inhibitors
  • Heparin
  • Isoniazid
  • Methyldopa
  • Tricyclic antidepressants [3]

Stravou

Elevated serotonin (hyperserotonemia)

Autismus

  • One of the most common biological findings in autism [2]
  • In patients with autistic spectrum disorders [2]

Carcinoid

  • Serotonin, and consequently 5-HIAA, are produced in excess by most carcinoid tumors
  • Carcinoid syndrome:
    • Flushing
    • Hepatomegaly (enlarged liver)
    • Diarrhea
    • Bronchospasm, wheezing
    • Heart disease [2]
    • Abdominal cramping [4]
    • Peripheral edema (the swelling of tissue usually in the lower limbs) [4]
    • Right heart valve disease [6]
    • Fibrosis of endocardium, blood vessels, and skin [6]
      • Usually by midgut tumors - more serotonine
      • Drain into the portal circulation
        • Symptoms do not usually occur until the tumor metastasizes to the liver
          • Releases humoral factors directly into the systemic circulation [6]
    • First pass through the liver 30 - 80% of 5-HT is metabolized [6]
    • 90% of the remainder is metabolized in the lungs (to 5-HIAA) [6]
    • Remaining 10%, almost all is taken up by platelets
      • Remains until it is released during clotting, promoting further platelet aggregation [6]
    • Serotonin production by disseminated carcinoid tumors can sometimes be so substantial that body tryptophan stores become depleted
      • Clinical tryptophan deficiency, resembling pellagra
        • Diarrhea, dementia, and dermatitis [6]
  • Carcinoid tumors of the enterochromaffin (Kultschitzsky) cells of the small intestine
    • Release large amounts of serotonin [2]
      • Greater than 25 mg / 24 hours (higher if the patient has malabsorption)
        • Strong evidence for carcinoid [2]
  • Carcinoid tumors may cause increased excretion of
    • 75% had above normal urinary 5-HIAA excretion
    • 64% had above normal serotonin excretion

5-HIAA may be normal !!!

  • Even with the carcinoid syndrome [2]
    • In subjects without diarrhea [2]
    • some patients excrete nonhydroxylated indolic acids [2]
  • Midgut carcinoids
    • Most apt to 5-HIAA elevation
    • renal disease may have falsely low 5-HIAA levels in the urine [2]

Poor correlation between 5-HIAA level and the clinical severity of the carcinoid syndrome [2]

  • 5-HIAA is increased in untreated patients with malabsorption
    • Increased urinary tryptophan metabolites
      • Celiac disease
      • Tropical sprue
      • Whipple disease
      • Stasis syndrome
      • Cystic fibrosis [2]
      • Chronic intestinal obstruction.
  • Midgut tumors - ileal carcinoid
    • Usually contain and release large quantities of serotonin
    • Amounts may not be fully reflected in the amount of 5-HIAA in urine
      • Little is metabolized
  • Foregut tumors
    • Lack the decarboxylase enzyme necessary to convert 5-hydroxytryptophan to serotonin
      • Minimal to no elevation in urinary 5-HIAA levels
  • Hindgut tumors - rectal carcinoid

Chemoterapie

  • Vzestup v séru jako odpověď na podání chemoterapie
    • Spolu se substancí P koreluje s fází emeze [1]
    • serotonin and SP are involved primarily, though not exclusively, in acute and delayed vomiting [1]

Anxieta - úzkost

  • Urinary levels of 5-HIAA and VMA [7]
    • In 46 patients with generalized anxiety disorder [7]
    • Significant association [7]

Lékovými interakcemi vyšší 5-HIAA v moči

  • Acetaminophen
  • Caffeine
  • Ephedrine
  • Diazepam (Valium)
  • Nicotine
  • Glyceryl guaiacolate (an ingredient found in some cough medicines)
  • Phenobarbital [3]
  • 5-hydroxytryptophan [4]
Pravděpodobně i (vytěsnění tryptofanu z vazby na albumin + i stim. vyšší produkce 5-HIAA):

Lékovými interakcemi vyšší sérový serotonin

Observed levels are usually <400 ng/mL [6]

  • lithium [6]
  • MAO-inhibitors
  • Methyldopa
  • Morphine
  • Reserpine [6]
  • Selective serotonin reuptake inhibitors (e.g., fluoxetine)
    • Can lead to depletion of platelet serotonin [6]

Potravinami s obsahem serotoninu vyšší 5-HIAA v moči

  • Do not contribute significantly to blood 5-HT measurements [6]
  • no change in platelet serotonin concentration. [5]
  • Can elevate urinary 5-HT and urinary 5-HIAA levels up to 10-fold [6]
  • Should be avoided for 48 hours prior to the start of the collection [6]
  • Pineapples [2]
  • Eggplant [2]
  • Avocadoes [2]
  • Plantain 30.3 +/- 7.5 mg/g weight; [5]
  • Pineapple 17.0 +/- 5.1 mg/g weight; ; [5]
  • Banana 15.0 +/- 2.4 mg/g weight; ; [5]
  • Kiwi fruit 5.8 +/- 0.9 mg/g weight; ; [5]
  • Plums 4.7 +/- 0.8 mg/g weight; ; [5]
  • Tomatoes 3.2 +/- 0.6 mg/g weight; [5]
  • Walnut mg/g weight; [5]
  • Hickory family mg/g weight; [5]
  • Butternuts 398 +/- 90 mg/g weight; [5]
  • Black walnuts 304 +/- 46 mg/g weight; [5]
  • English walnuts 87 +/- 20 mg/g weight;[5]
  • Shagbark hickory nuts 143 +/- 23 mg/g weight; [5]
  • Mockernut hickory nuts 67 +/- 13 mg/g weight; [5]
  • Pecans 29 +/- 4 mg/g weight; [5]
  • Sweet pignuts 25 +/- 8 mg/g weight; [5]
  • Dates [6]
  • Grapefruit [6]
  • Cantaloupe [6]
  • Honeydew melon [6]

Stanovení

Moč

  • 24-hour urine samples combined with an acidic additive to maintain pH below 3 [2]
  • 24-hour urine 5-HIAA[1] - 2-7 mg/24 h or 10.5-36.6 µmol/24 h [4]
  • Urine spot 5-HIAA[2] - 0-14 mg/g creatinine [4]

Sérum

  • Serum serotonin assay may detect some carcinoids missed by 5-HIAA assay.[2]
  • Excess 5-HIAA is released intermittently [3]
  • Plasma 5-HIAA: 0-22 np/mL [4]
  • In a symptomatic patient, a serum serotonin value of >400 ng/mL is suggestive of a carcinoid tumor [6]
  • Metastatic carcinoid tumors show very high levels of serum serotonin, usually exceeding 1000 ng/mL. [6]

Literatura:

[1] 5-Hydroxyindoleacetic acid and substance P profiles in patients receiving emetogenic chemotherapy [Internet]. [citován 30. duben 2013]. Získáno od: opp.sagepub.com/content/12/4/201.short
[2] 5-Hydroxyindoleacetic acid - Wikipedia, the free encyclopedia [Internet]. [citován 4. červen 2013]. Dostupné od: en.wikipedia.org/wiki/5-Hydroxyindoleacetic_acid
[3] 5-HIAA: The Test | 5-hydroxyindoleacetic acid [Internet]. [citován 5. červen 2013]. Dostupné od: labtestsonline.org/understanding/analytes/5hiaa/tab/test
[4] Carcinoid Syndrome and the Benefits of the 5-Hydroxyindoleacetic Acid Test - Yahoo! Voices - voices.yahoo.com [Internet]. [citován 5. červen 2013]. Dostupné od: voices.yahoo.com/carcinoid-syndrome-benefits-5-hydroxyindoleacetic-859069.html?cat=68
[5] Serotonin content of foods: effect on urinary... [Am J Clin Nutr. 1985] - PubMed - NCBI [Internet]. [citován 5. červen 2013]. Dostupné od: www.ncbi.nlm.nih.gov/pubmed/2413754
[6] Carcinoid Syndrome, Neuroendocrine carcinoma [Internet]. [citován 5. červen 2013]. Dostupné od: www.clinlabnavigator.com/carcinoid-syndrome.html
[7] Neuropsychobiology 1995, Vol. 31, No. 1 - The Association of Urinary 5-Hydroxyindoleacetic Acid and Vanillylmandelic Acid in Patients with Generalized Anxiety - Abstract - Karger Publishers [Internet]. [citován 11. červen 2013]. Dostupné od: www.karger.com/Article/Abstract/119165syndrome.html==
[8] 1. Conversion of Serotonin (5-Hydroxytryptamine) to 5-Hydroxyindoleacetic Acid by Rabbit Blood [Internet]. [citován 11. červen 2013]. Dostupné od: ebm.sagepub.com/content/99/3/742.abstract



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Poslední aktualizace: 12. 6. 2013 0:35:55