5-HYDROXYINDOLEACETIC ACID (5-HIAA) URINE
General Information
HLAB/HOL Code: 5HIAA
UPHSM LIS Test #: 7030
Schedule:
Testing Time:
Testing Lab: Labcorp
UPHSM LIS Test #: 7030
Schedule:
Testing Time:
Testing Lab: Labcorp
Specimen Info
Only 1 specimen type required, unless otherwise specified
Volume: 5.0mL (1.0) mL Urine
Temperature: Ambient
Tube Type: 24 hour Urine
Collection Info:
Container: Plastic urine container, no preservative (Note: 1 g/L boric acid may be added as a preservative for other tests without harm to 5-HIAA.)
Special Instructions: Measure and record total 24-hour urine volume on the request form.
Collection: Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Screw the lid on securely. Label container with patient's name,
date, and time. Measure and record total urine volume. Mix well; send aliquot.
Patient Preparation: Avoid bananas, avocados, plums, eggplant, tomatoes, plantain, pineapples, walnuts, and interfering drugs for a 72-hour period prior to and during the collection.
Temperature: Ambient
Tube Type: 24 hour Urine
Collection Info:
Container: Plastic urine container, no preservative (Note: 1 g/L boric acid may be added as a preservative for other tests without harm to 5-HIAA.)
Special Instructions: Measure and record total 24-hour urine volume on the request form.
Collection: Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Screw the lid on securely. Label container with patient's name,
date, and time. Measure and record total urine volume. Mix well; send aliquot.
Patient Preparation: Avoid bananas, avocados, plums, eggplant, tomatoes, plantain, pineapples, walnuts, and interfering drugs for a 72-hour period prior to and during the collection.
Methods
Liquid chromatography/tandem mass spectrometry (LC/MS-MS)
LC/MS/MS
LC/MS/MS
CPT Codes
83497
* The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding
is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
Reference Range
0.0-14.9 mg/24 hours
If a borderline elevation of 5-HIAA is found, sample should be recollected following withdrawal of dietary and medication sources that might elevate 5-HIAA (see Patient Preparation). Nontropical sprue may cause a slight increase in urinary 5-HIAA. 5-HIAA levels are lowered by renal insufficiency and after small bowel resection. When a patient strongly suspected for carcinoid syndrome shows normal or borderline increases of 5-HIAA, two possibilities should be considered: one, that large amounts of serotonin produced are not being metabolized, in which case blood levels of serotonin are required to document the diagnosis; and two, that secretion of 5-HIAA by the tumor is intermittent, in which case repeat timed specimen collections are needed to demonstrate the abnormality.
Levels of 5-HIAA may not be elevated in nonfunctional tumors. Because flushing is mediated by different hormones in foregut and midgut tumors, some patients with a neuroendocrine tumors will have symptoms of flushing with low or normal levels of 5-HIAA. A number of substances interfere with determination of urinary 5-HIAA.1
Causes of Elevated 5-HIAA:
• Foods: Avocado, bananas, eggplant, kiwi fruit, nuts (hickory nuts, pecans, walnuts), pineapple, plums, tomato products.
• Drugs: Acetaminophen (Tylenol®), antihistamines (nasal drops and spray), antihypertensives, antipsychotics, caffeine, cough suppressants, diazepam (Valium®), muscle relaxants, nicotine, warfarin (Coumadin®)
Causes of Diminished 5-HIAA:
• Alcohol, aspirin, antidepressants (imipramine, monoamine oxidase inhibitors), herbal products: Diadzin (active compound in kudzu, a Chinese herbal treatment for alcohol abuse), St John's wort
If a borderline elevation of 5-HIAA is found, sample should be recollected following withdrawal of dietary and medication sources that might elevate 5-HIAA (see Patient Preparation). Nontropical sprue may cause a slight increase in urinary 5-HIAA. 5-HIAA levels are lowered by renal insufficiency and after small bowel resection. When a patient strongly suspected for carcinoid syndrome shows normal or borderline increases of 5-HIAA, two possibilities should be considered: one, that large amounts of serotonin produced are not being metabolized, in which case blood levels of serotonin are required to document the diagnosis; and two, that secretion of 5-HIAA by the tumor is intermittent, in which case repeat timed specimen collections are needed to demonstrate the abnormality.
Levels of 5-HIAA may not be elevated in nonfunctional tumors. Because flushing is mediated by different hormones in foregut and midgut tumors, some patients with a neuroendocrine tumors will have symptoms of flushing with low or normal levels of 5-HIAA. A number of substances interfere with determination of urinary 5-HIAA.1
Causes of Elevated 5-HIAA:
• Foods: Avocado, bananas, eggplant, kiwi fruit, nuts (hickory nuts, pecans, walnuts), pineapple, plums, tomato products.
• Drugs: Acetaminophen (Tylenol®), antihistamines (nasal drops and spray), antihypertensives, antipsychotics, caffeine, cough suppressants, diazepam (Valium®), muscle relaxants, nicotine, warfarin (Coumadin®)
Causes of Diminished 5-HIAA:
• Alcohol, aspirin, antidepressants (imipramine, monoamine oxidase inhibitors), herbal products: Diadzin (active compound in kudzu, a Chinese herbal treatment for alcohol abuse), St John's wort
