To help diagnose and monitor treatment for a carcinoid tumor that produces serotonin
When you have symptoms suggestive of a carcinoid tumor, such as flushing, abdominal pain, diarrhea, and/or wheezing; at intervals following treatment
A 24-hour urine sample; rarely, a random urine sample or a blood sample drawn from a vein
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?
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.
This test is primarily ordered when you have signs and symptoms suggestive of a carcinoid tumor.
Some examples include:
This test may also be ordered at intervals when monitoring the effectiveness of treatment for a carcinoid tumor.
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.
There are a variety of drugs that can affect the 5-HIAA test:
You should talk to your healthcare provider before decreasing or discontinuing any medications.
The level of 5-HIAA in the urine varies throughout the day. By collecting all urine for 24 hours, the amount of 5-HIAA in the urine can be averaged over the entire day and increases of 5-HIAA will be detected more easily than in a single random urine sample.
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.
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.
Sources Used in Current Review
2019 review performed by Hui Li, PhD, DABCC, FACB, FCACB, Clinical Chemist, Laboratory/Medical Director, Dynacare.
Tsoli, Marina & Kaltsas, Gregory (© 2019). Encyclopedia of Endocrine Diseases (Second Edition), Volume 2, 2019, Pages 13-20.
Ito T. et. al. Carcinoid-syndrome: recent advances, current status and controversies. Curr Opin Endocrinol Diabetes Obes. 2018 Feb;25(1):22-35. Accessed online through https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747542/pdf/nihms919791.pdf.
Kaltsas G. et. al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pre- and Perioperative Therapy in Patients with Neuroendocrine Tumors. Neuroendocrinology. 2017 Sep; 105(3): 245–254. Accessed online through https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637287/?report=reader#. Accessed 4/5/2019.
Adaway, J. et. al. Serum and plasma 5-hydroxyindoleacetic acid as an alternative to 24-h urine 5-hydroxyindoleacetic acid measurement. Ann Clin Biochem. 2016;53:554–560. Accessed online through https://journals.sagepub.com/doi/full/10.1177/0004563215613109?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed. Accessed 4/5/2019.
(© 1995–2019) 5-Hydroxyindoleacetic Acid (5-HIAA), 24 Hour, Urine. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at https://www.mayocliniclabs.com/test-catalog/2011/Clinical+and+Interpretive/9248. Accessed on 4/5/2019.
(© 2019) 5‐HIAA, Plasma. Laboratory Corporation of America [On-line information]. Available online at https://www.labcorp.com/test-menu/39026/5%E2%80%90hiaa-plasma. Accessed on 4/5/2019.
(© 2019) 5-Hydroxyindoleacetic acid (5-HIAA), Plasma. ARUP Laboratories [On-line information]. Available online at http://ltd.aruplab.com/Tests/Pub/3000202. Accessed on 4/5/2019.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO. Pp 497-498.
(2005). Gastrointestinal Carcinoid Tumors, A Detailed Guide. American Cancer Society [On-line information]. Available online at http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=14.
Nanda, R. (2005 April 15, Updated). 5-HIAA. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003612.htm.
Brose, M. (2004 August 3, Updated). Carcinoid Syndrome. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000347.htm.
Zuetenhorst, J. et. al. (2004 July 9). Daily Cyclic Changes in the Urinary Excretion of 5-Hydroxyindoleacetic Acid in Patients with Carcinoid Tumors. Clinical Chemistry [On-line journal]. Available online at http://www.clinchem.org/cgi/content/full/50/9/1634.
(© 2006). 5-Hydroxyindoleacetic Acid (HIAA), Urine. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_a349.jsp#1152320.
Datta, V. (2005 May 17, Updated). Serum serotonin level. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003562.htm.
Sweeney, J. and Rosemurgy, A. (1997 January/February). Carcinoid Tumors of the Gut. Cancer Control Journal v4 (1) [On-line journal]. Available online at https://www.moffitt.usf.edu/pubs/ccj/v4n1/article2.htm.
Strosberg, J. et. al. (2006 January). Selective Hepatic Artery Embolization for Treatment of Patients With Metastatic Carcinoid and Pancreatic Endocrine Tumors. Cancer Control Journal v13 (1) [On-line journal]. Available online at https://www.moffitt.usf.edu/pubs/ccj/.
Johnson, R. et. al. (2003 November). Ethanol Origin in Postmortem Urine: A LC/MS Determination of Serotonin Metabolites. Federal Aviation Administration [On-line Medicine Technical Report]. Available online through http://www.faa.gov.
Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 555-556.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 584-587.
Dugdale, D. (2008 November 10). 5-HIAA. MedLinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003612.htm. Accessed July 2010.
(Revised 2009 June 06). Detailed Guide: Gastrointestinal Carcinoid Tumors. American Cancer Society [On-line information]. Available online at http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=14. Accessed July 2010.
(Revised 2010 March 18). Detailed Guide: Lung Carcinoid Tumor. American Cancer Society [On-line information]. Available online at http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=56. Accessed July 2010.
(2010 February). Carcinoid Tumor. Cancer.Net, American Society of Clinical Oncology [On-line information]. Available online at http://www.cancer.net/patient/Cancer+Types/Carcinoid+Tumor. Accessed July 2010.
(Modified 2008 May 16) Gastrointestinal Carcinoid Tumors Treatment (PDQ®), Health Professional Version [On-line information]. Available online at http://www.cancer.gov/cancertopics/pdq/treatment/gastrointestinalcarcinoid/HealthProfessional. Accessed July 2010.
Santacroce, L. and Diomede, L. (Updated 2009 November 19). Malignant Carcinoid Syndrome. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/282515-overview. Accessed July 2010.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds (2005). Harrison's Principles of Internal Medicine, 16th Edition, McGraw Hill, Pp 2224-2225.
Garg, S. (Updated 2014 February 6). 5-Hydroxyindoleacetic Acid (5-HIAA). Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2089202-overview. Accessed February 2014.
Tebbi, C. (Updated 2014 January 27). Carcinoid Tumor. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/986050-overview. Accessed February 2014.
(© 1995–2014). 5-Hydroxyindoleacetic Acid (5-HIAA), Urine. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/9248. Accessed February 2014.
Frank, E. et. al. (Updated 2013 September). Carcinoid Tumors. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/CarcinoidTumors.html?client_ID=LTD. Accessed February 2014.
Dugdale, D. (Updated 2012 September 9) 5-HIAA. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003612.htm. Accessed February 2014.
(Updated 2012 July 10). Carcinoid Syndrome. Mayo Clinic [On-line information]. Available online at http://www.mayoclinic.org/diseases-conditions/carcinoid-syndrome/basics/definition/CON-20027127. Accessed February 2014.
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 573-574.
McPherson, R. and Pincus, M. (© 2011). Henry's Clinical Diagnosis and Management by Laboratory Methods 22nd Edition: Elsevier Saunders, Philadelphia, PA. Pp 461.